Stollery Children's Hospital and University of Alberta, Canada.
J Infect. 2016 Jun;72(6):659-666. doi: 10.1016/j.jinf.2016.04.002. Epub 2016 Apr 8.
The efficacy of immunization mandates for childcare or school entry is a long-standing controversy. The United States (US) adopted school entry immunization mandates in the 1800s, while most countries still do not have mandates. The objective of this systematic review was to analyze the evidence that immunization uptake increases with mandates.
A search was conducted for studies that compared immunization uptake in a population prior to and after mandates, or in similar populations with one group having and the other not having mandates. Data were extracted and synthesized qualitatively due to the heterogeneity of study design.
Eleven before-and-after studies and ten studies comparing uptake in similar populations with and without mandates were included. Studies were from the US (n = 18), France (n = 1) and Canada (n = 2). Eleven of the 21 studies looked at middle school mandates. All but two studies showed at least a trend towards increased uptake with mandates. Higher uptake was associated with a more long-standing mandate.
Immunization mandates have generally led to increased short-term and long-term uptake in the group to whom the mandate applies. Many studies have centered around middle school mandates in the US and there is a paucity of studies of childcare mandates or of studies of mandates in other countries or in settings with relatively high baseline immunization uptake.
儿童保健或入学免疫接种规定的疗效一直存在争议。美国（US）在 19 世纪就采用了入学免疫接种规定，而大多数国家仍然没有规定。本系统评价的目的是分析证据，证明免疫接种率随着规定的增加而增加。
对比较人群在规定前后或在具有和不具有规定的类似人群中免疫接种率的研究进行了搜索。由于研究设计的异质性，数据采用定性方法提取和综合。
共纳入 11 项前后对照研究和 10 项具有和不具有规定的类似人群比较研究。这些研究来自美国（n=18）、法国（n=1）和加拿大（n=2）。11 项研究着眼于中学规定。除两项研究外，其余研究均显示出规定后接种率至少有增加的趋势。长期存在的规定与更高的接种率相关。
免疫接种规定通常会导致规定适用人群的短期和长期接种率增加。许多研究都集中在美国的中学规定上，而关于儿童保健规定或其他国家或基线免疫接种率相对较高的环境中的规定的研究则很少。
