Vaccination coverage and influencing factors of four non‑National Immunization Program vaccines: A cross‑sectional survey among children aged 1‒6 years in Beijing, China

Abstract

ABSTRACT The pneumococcal conjugate vaccine (PCV), Haemophilus influenzae type b (Hib) vaccine, rotavirus vaccine (RV), and varicella vaccine (VarV) have been recommended by WHO for inclusion in National Immunization Program (NIP). However, their vaccination rate is low in China as self-funded vaccines. This study aimed to investigate the coverage of these four vaccines and to identify their influencing factors. Selected via multi-stage stratified sampling, 4,182 guardians participated in a February–March 2025 study. Guardians completed an online questionnaire capturing sociodemographic characteristics, attitudes toward vaccination, and indicators of immunization service accessibility. Individual-level vaccination histories for children were extracted from the Beijing Immunization Information System and linked to survey responses. The vaccination coverage of PCV, Hib vaccine, RV and VarV were 48.5%, 47.4%, 43.5% and 89.3%, respectively. Older age, residence outside urban areas (suburban, outer suburban), and greater number of children in the household were associated with lower coverage of PCV, Hib vaccine, and RV, with adjusted ORs ranging from 0.160 to 0.929 (all p values < .05). Conversely, higher household income (200,000–499,999 CNY and ≥500,000 CNY), guardians’ perceived vaccination necessity, and receipt of vaccination notifications were associated with higher coverage of PCV, Hib vaccine, and RV, with adjusted ORs ranging from 1.018 to 6.521 (all p values < .05). The results indicated the vaccination coverage of PCV, Hib vaccine, and RV remains suboptimal in Beijing, with evident regional disparities. Free vaccination policies for PCV, Hib vaccine, RV, and VarV, together with strengthened reminder systems and targeted health education interventions, may help improve vaccine coverage among children.