{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:31:29Z","timestamp":1790353889514,"version":"4.1.0"},"reference-count":13,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2016,6,3]],"date-time":"2016-06-03T00:00:00Z","timestamp":1464912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: In 2014 a 2-doses varicella vaccine (VarV) schedule was recommended by the Zhejiang Provincial Center for Disease Control and Prevention. We aimed to assess the coverage of the 1st dose of VarV (VarV1) and the 2nd dose of VarV (VarV2) among children aged 2\u20136 years through the Zhejiang Provincial Immunization Information System (ZJIIS) and to explore the determinants associated with the VarV coverage. Methods: Children aged 2\u20136 years (born from 1 January 2009 to 31 December 2013) registered in ZJIIS were enrolled. Anonymized individual records of target children were extracted from the ZJIIS database on 1 January 2016, including their VarV and (measles-containing vaccine) MCV vaccination information. The VarV1 and VarV2 coverage rates were evaluated for each birth cohorts. The coverage of VarV also was estimated among strata defined by cities, gender and immigration status. We also evaluated the difference in coverage between VarV and MCV. Results: A total of 3,028,222 children aged 2\u20136 years were enrolled. The coverage of VarV1 ranged from 84.8% to 87.9% in the 2009\u20132013 birth cohorts, while the coverage of VarV2 increased from 31.8% for the 2009 birth cohort to 48.7% for the 2011 birth cohort. Higher coverage rates for both VarV1 and VarV2 were observed among resident children in relevant birth cohorts. The coverage rates of VarV1 and VarV2 were lower than those for the 1st and 2nd dose of MCV, which were above 95%. The proportion of children who were vaccinated with VarV1 at the recommended age increased from 34.6% for the 2009 birth cohort to 75.2% for the 2013 birth cohort, while the proportion of children who were vaccinated with VarV2 at the recommended age increased from 19.7% for the 2009 birth cohort to 48.7% for the 2011 birth cohort. Conclusions: Our study showed a rapid increasing VarV2 coverage of children, indicating a growing acceptance of the 2-doses VarV schedule among children\u2019s caregivers and physicians after the new recommendation released. We highlighted the necessity for a 2-doses VarV vaccination school-entry requirement to achieve the high coverage of &gt;90% and to eliminate disparities in coverage among sub-populations. We also recommended continuous monitoring of the VarV coverage via ZJIIS over time.<\/jats:p>","DOI":"10.3390\/ijerph13060560","type":"journal-article","created":{"date-parts":[[2016,6,3]],"date-time":"2016-06-03T10:37:37Z","timestamp":1464950257000},"page":"560","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["An Evaluation of Voluntary Varicella Vaccination Coverage in Zhejiang Province, East China"],"prefix":"10.3390","volume":"13","author":[{"given":"Yu","family":"Hu","sequence":"first","affiliation":[{"name":"Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaping","family":"Chen","sequence":"additional","affiliation":[{"name":"Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Li","sequence":"additional","affiliation":[{"name":"Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2016,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S82","DOI":"10.1086\/522145","article-title":"Varicella vaccine effectiveness in the US vaccination program: A review","volume":"197","author":"Seward","year":"2008","journal-title":"J. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1097\/01.inf.0000109287.97518.67","article-title":"Ten year follow-up of healthy children who received one or two injections of varicella vaccine","volume":"23","author":"Kuter","year":"2004","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2713","DOI":"10.3390\/ijerph110302713","article-title":"Using the Immunization Information System to determine vaccination coverage rates among children aged 1\u20137 years: A report from Zhejiang Province, China","volume":"11","author":"Li","year":"2014","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_4","first-page":"174","article-title":"Two-dose varicella vaccination coverage among children aged 7 years\u2014Six sentinel sites, United States, 2006\u20132012","volume":"63","author":"Lopez","year":"2014","journal-title":"Morb. Mortal. Wkly Rep. (MMWR)"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1097\/INF.0000000000000821","article-title":"Impact of the US Two-dose Varicella Vaccination Program on the Epidemiology of Varicella Outbreaks: Data from Nine States, 2005\u20132012","volume":"34","author":"Leung","year":"2015","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1097\/INF.0000000000000444","article-title":"Two-dose varicella vaccine effectiveness and rash severity in outbreaks of varicella among public school students","volume":"33","author":"Thomas","year":"2014","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1056\/NEJMoa064040","article-title":"Loss of vaccine-induced immunity to varicella over time","volume":"356","author":"Chaves","year":"2007","journal-title":"N. Engl. J. 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Infect."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/13\/6\/560\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T19:24:59Z","timestamp":1760210699000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/13\/6\/560"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,6,3]]},"references-count":13,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2016,6]]}},"alternative-id":["ijerph13060560"],"URL":"https:\/\/doi.org\/10.3390\/ijerph13060560","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,6,3]]}}}