Wong Valerie W Y, Lok Kris Y W, Tarrant Marie
School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region.
School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region.
Vaccine. 2016 Jan 2;34(1):20-32. doi: 10.1016/j.vaccine.2015.11.020. Epub 2015 Nov 18.
Pregnant women and their infants under 6 months of age infected with influenza have a high risk of serious morbidity and mortality. Influenza vaccine during pregnancy offers 3-for-1 benefits to pregnant women, fetuses and newborn infants. Current vaccination uptake rates during pregnancy, however, are often lower than other high-risk groups and the general population.
We systematically reviewed evidence on the effectiveness of interventions to improve influenza vaccination coverage in pregnant women. Risk differences (RDs) were calculated from the included studies.
Eleven studies were included in the review, of which four were randomized controlled trials (RCTs). Three cohort studies assessed provider-focused interventions while four RCTs and one cohort study evaluated pregnant women-focused interventions. Two cohort studies and a prospective intervention study assessed the effectiveness of bundled interventions. No study solely assessed the effectiveness of interventions to enhance access to influenza vaccination. One moderate quality RCT showed that an influenza pamphlet, with or without a verbalized benefit statement, improved the vaccination rate (RD=0.26; RD=0.39). The other reviewed RCTs showed discordant results, with RDs ranging from -0.15 to 0.03. Although all observational studies significantly improved vaccination rates (RDs ranged from 0.03 to 0.44), the quality of the evidence varied.
There is a lack of effective interventions to increase the influenza vaccination rate in pregnant women. Based on the existing research, we recommend that clinicians provide influenza pamphlets to pregnant women with a verbalized statement about the benefits of influenza vaccine to newborns. Further high-quality RCTs are needed to develop successful maternal influenza vaccination programs. Increased clarity in reporting the content of interventions would help to improve the comparability and generalizability of the published studies.
感染流感的孕妇及其6个月以下婴儿发生严重发病和死亡的风险很高。孕期接种流感疫苗对孕妇、胎儿和新生儿有三重益处。然而，目前孕期的疫苗接种率往往低于其他高危人群和普通人群。
我们系统回顾了关于提高孕妇流感疫苗接种覆盖率干预措施有效性的证据。从纳入的研究中计算风险差异（RD）。
该综述纳入了11项研究，其中4项为随机对照试验（RCT）。3项队列研究评估了以医疗服务提供者为重点的干预措施，而4项RCT和1项队列研究评估了以孕妇为重点的干预措施。2项队列研究和1项前瞻性干预研究评估了综合干预措施的有效性。没有研究单独评估增强流感疫苗接种可及性干预措施的有效性。一项中等质量的RCT表明，有或没有口头说明益处的流感宣传册可提高接种率（RD = 0.26；RD = 0.39）。其他纳入综述的RCT结果不一致，RD范围为-0.15至0.03。尽管所有观察性研究均显著提高了接种率（RD范围为0.03至0.44），但证据质量各不相同。
缺乏提高孕妇流感疫苗接种率的有效干预措施。基于现有研究，我们建议临床医生向孕妇提供流感宣传册，并口头说明流感疫苗对新生儿的益处。需要进一步开展高质量的RCT来制定成功的孕妇流感疫苗接种计划。提高干预措施内容报告的清晰度将有助于提高已发表研究的可比性和可推广性。
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