Chamberlain A T, Seib K, Ault K A, Rosenberg E S, Frew P M, Cortés M, Whitney E A S, Berkelman R L, Orenstein W A, Omer S B
Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR Room 3040Z, Atlanta, GA 30322, USA.
Division of Infectious Diseases, School of Medicine, Emory University, 1462 Clifton Rd. NE, Room 446, Atlanta, GA 30322, USA.
Vaccine. 2015 Jul 9;33(30):3571-9. doi: 10.1016/j.vaccine.2015.05.048. Epub 2015 Jun 1.
Evidence-based interventions to improve influenza vaccine coverage among pregnant women are needed, particularly among those who remain unvaccinated late into the influenza season. Improving rates of antenatal tetanus, diphtheria and acellular pertussis (Tdap) vaccination is also needed.
To test the effectiveness of a practice-, provider-, and patient-focused influenza and Tdap vaccine promotion package on improving antenatal influenza and Tdap vaccination in the obstetric setting.
A cluster-randomized trial among 11 obstetric practices in Georgia was conducted in 2012-2013. Intervention practices adopted the intervention package that included identification of a vaccine champion, provider-to-patient talking points, educational brochures, posters, lapel buttons, and iPads loaded with a patient-centered tutorial. Participants were recruited from December 2012-April 2013 and included 325 unvaccinated pregnant women in Georgia. Random effects regression models were used to evaluate primary and secondary outcomes.
Data on antenatal influenza and Tdap vaccine receipt were obtained for 300 (92.3%) and 291 (89.5%) women, respectively. Although antenatal influenza and Tdap vaccination rates were higher in the intervention group than the control group, improvements were not significant (For influenza: risk difference (RD)=3.6%, 95% confidence interval (CI): -4.0%, 11.2%; for Tdap: RD=1.3%, 95% CI: -10.7%, 13.2%). While the majority of intervention package components were positively associated with antenatal vaccine receipt, a provider's recommendation was the factor most strongly associated with actual receipt, regardless of study group or vaccine.
The intervention package did not significantly improve antenatal influenza or Tdap vaccine coverage. More research is needed to determine what motivates women remaining unvaccinated against influenza late into the influenza season to get vaccinated. Future research should quantify the extent to which clinical interventions can bolster a provider's recommendation for vaccination. This study is registered with clinicaltrials.gov, study ID NCT01761799.
需要基于证据的干预措施来提高孕妇的流感疫苗接种率，尤其是那些在流感季节后期仍未接种疫苗的孕妇。提高产前破伤风、白喉和无细胞百日咳（Tdap）疫苗接种率也很有必要。
测试一个以医疗机构、医护人员和患者为重点的流感和Tdap疫苗推广方案对提高产科环境中产前流感和Tdap疫苗接种率的有效性。
2012 - 2013年在佐治亚州的11家产科医疗机构中进行了一项整群随机试验。干预组的医疗机构采用了干预方案，该方案包括确定一名疫苗倡导者、医护人员与患者的谈话要点、教育手册、海报、翻领纽扣以及装有以患者为中心教程的iPad。参与者于2012年12月至2013年4月招募，包括佐治亚州325名未接种疫苗的孕妇。采用随机效应回归模型评估主要和次要结局。
分别获得了300名（92.3%）和291名（89.5%）女性的产前流感和Tdap疫苗接种数据。虽然干预组的产前流感和Tdap疫苗接种率高于对照组，但改善并不显著（流感：风险差异（RD）=3.6%，95%置信区间（CI）：-4.0%，11.2%；Tdap：RD =1.3%，95% CI：-10.7%，13.2%）。虽然大多数干预方案组成部分与产前疫苗接种呈正相关，但医护人员的建议是与实际接种最密切相关的因素，无论研究组或疫苗如何。
该干预方案并未显著提高产前流感或Tdap疫苗接种率。需要更多研究来确定是什么因素促使那些在流感季节后期仍未接种流感疫苗的女性接种疫苗。未来的研究应量化临床干预能在多大程度上增强医护人员对疫苗接种的建议。本研究已在clinicaltrials.gov注册，研究编号NCT01761799。
