Feasibility of a randomised controlled trial comparing opioid dose escalation with low-dose methadone addition for refractory cancer pain: JORTC-PAL23/NCCH2309 - protocol.

In China, routine childhood vaccination coverage among generally healthy children has reached levels exceeding 99%. In contrast, vaccination coverage among children with special health care needs (CSHCN), including those with chronic illnesses, preterm birth, immunodeficiency, or other medical complexities, remains strikingly low, with reported rates of approximately 6%. This disparity reflects the disproportionate challenges faced by CSHCN families in navigating immunization decisions and services, particularly when standard vaccination schedules require individualized risk assessment and cross-institutional coordination. Parental vaccine hesitancy among CSHCN families in China is shaped by factors that align broadly with the internationally recognized 3C model (confidence, complacency, and convenience), yet with distinct contextual characteristics. Unlike Western settings, where hesitancy often centers on confidence in vaccine safety or scientific evidence, hesitancy among Chinese parents of CSHCN more commonly arises from system-level gaps in the delivery of vaccine advisory information, including inconsistent clinical guidance, limited provider capacity, and fragmented referral pathways between specialty care and community vaccination services. These gaps generate uncertainty regarding whether, when, and where vaccination should occur, rather than outright rejection of vaccines. To address these challenges, several provinces and cities in China have established immunization advisory clinics (IACs), which provide individualized vaccination assessments for CSHCN. IACs typically offer services such as evaluation of vaccination contraindications, development of catch-up immunization plans, risk assessment and premanagement of potential adverse events following immunization, and postvaccination follow-up. Based on publicly available reports, IACs are most commonly located in tertiary hospitals, although some cities have integrated IAC services into community health centers. Models of service delivery vary across regions. For example, Qingdao has implemented an integrated model in which vaccination assessment and administration occur at the same site, whereas Shanghai adopts a separated model in which CSHCN are referred by community or specialist physicians to hospital-based IACs for assessment, followed by vaccination at community clinics according to specialist recommendations.