背景:为了应对疫苗犹豫的全球挑战,免疫战略咨询专家组大力推广疫苗接种提醒和召回干预措施。再加上科学进步带来的新机遇,这些措施对于成功免疫目标人群至关重要。
目的:本系统综述和荟萃分析旨在评估与标准或常规护理相比,各种干预措施在增加疫苗接种覆盖率方面的有效性。该审查将涵盖针对不同年龄段推荐的所有疫苗接种。
方法:2022年2月,咨询了2个数据库,检索1850项研究。遵循PRISMA(系统审查和荟萃分析的首选报告项目)指南,评估阶段后,共纳入79份手稿。这些包括46项试验/随机对照试验(RCTs)和33项前后研究。使用STATA软件(14.1.2版)使用随机效应模型进行荟萃分析。选择的结果是疫苗接种覆盖率改善有效性的风险比(RR)。此外,对纳入的手稿进行了荟萃回归分析。
结果:分析显示,当考虑所有干预措施时,RCT的总体疗效为RR1.22(95%CI1.19-1.26),前后研究的RR1.70(95%CI1.54-1.87)。亚组分析确定多组分干预(RR1.58,95%CI1.36-1.85)和回忆临床干预(RR1.24,95%CI1.17-1.32)是增加随机对照试验疫苗接种覆盖率最有效的方法。相比之下,教育干预措施(RR2.13,95%CI1.60-2.83)和多组分干预措施(RR1.61,95%CI1.43-1.82)在前后研究中的增幅最高.Meta回归分析显示,中年人与疫苗接种率的增加有关(RCT:系数0.54,95%CI0.12-0.95;前后:系数1.27,95%CI0.70-1.84)。
结论:社区,家庭,和基于医疗保健的多维干预措施,以及以教育为基础的追赶战略,有效提高疫苗接种覆盖率。因此,它们的系统实施与针对未接种疫苗的人群高度相关。这种方法符合国家疫苗接种时间表,旨在消除或根除疫苗可预防的疾病。
BACKGROUND: To address the global challenge of vaccine hesitancy, the Strategic Advisory Group of Experts on Immunization strongly promotes vaccination reminder and recall interventions. Coupled with the new opportunities presented by scientific advancements, these measures are crucial for successfully immunizing target population groups.
OBJECTIVE: This systematic review and meta-analysis aims to assess the effectiveness of various interventions in increasing vaccination coverage compared with standard or usual care. The review will cover all vaccinations recommended for different age groups.
METHODS: In February 2022, 2 databases were consulted, retrieving 1850 studies. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 79 manuscripts were included after the assessment phase. These comprised 46 trials/randomized controlled trials (RCTs) and 33 before-after studies. A meta-analysis using a random-effects model was performed with STATA software (version 14.1.2). The selected outcome was the risk ratio (RR) of vaccination coverage improvement effectiveness. Additionally, meta-regression analyses were conducted for the included manuscripts.
RESULTS: The analyses showed an overall efficacy of RR 1.22 (95% CI 1.19-1.26) for RCTs and RR 1.70 (95% CI 1.54-1.87) for before-after studies when considering all interventions cumulatively. Subgroup analyses identified
multicomponent interventions (RR 1.58, 95% CI 1.36-1.85) and recall clinical interventions (RR 1.24, 95% CI 1.17-1.32) as the most effective in increasing vaccination coverage for RCTs. By contrast, educational interventions (RR 2.13, 95% CI 1.60-2.83) and
multicomponent interventions (RR 1.61, 95% CI 1.43-1.82) achieved the highest increases for before-after studies. Meta-regression analyses indicated that the middle-aged adult population was associated with a higher increase in vaccination coverage (RCT: coefficient 0.54, 95% CI 0.12-0.95; before-after: coefficient 1.27, 95% CI 0.70-1.84).
CONCLUSIONS: Community, family, and health care-based multidimensional interventions, as well as education-based catch-up strategies, effectively improve vaccination coverage. Therefore, their systematic implementation is highly relevant for targeting undervaccinated population groups. This approach aligns with national vaccination schedules and aims to eliminate or eradicate vaccine-preventable diseases.