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改善青少年免疫接种可及性和覆盖率干预措施的系统评价与Meta分析

Systematic Review and Meta-Analysis of Interventions to Improve Access and Coverage of Adolescent Immunizations.

作者信息

Das Jai K, Salam Rehana A, Arshad Ahmed, Lassi Zohra S, Bhutta Zulfiqar A

机构信息

Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.

Robinson Research Institute, University of Adelaide, Adelaide, Australia.

出版信息

J Adolesc Health. 2016 Oct;59(4S):S40-S48. doi: 10.1016/j.jadohealth.2016.07.005.


DOI:10.1016/j.jadohealth.2016.07.005
PMID:27664595
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5026683/
Abstract

Vaccination strategies are among the most successful and cost-effective public health strategies for preventing disease and death. Until recently, most of the existing immunization programs targeted infants and children younger than 5 years which have successfully resulted in reducing global infant and child mortality. Adolescent immunization has been relatively neglected, leaving a quarter of world's population underimmunized and hence vulnerable to a number of preventable diseases. In recent years, a large number of programs have been launched to increase the uptake of different vaccines in adolescents; however, the recommended vaccination coverage among the adolescent population overall remains very low, especially in low- and middle-income countries. Adolescent vaccination has received significantly more attention since the advent of the human papillomavirus (HPV) vaccine in 2006. However, only half of the adolescent girls in the United States received a single dose of HPV vaccine while merely 43% and 33% received two and three doses, respectively. We systematically reviewed literature published up to December 2014 and included 23 studies on the effectiveness of interventions to improve immunization coverage among adolescents. Moderate-quality evidence suggested an overall increase in vaccination coverage by 78% (relative risk: 1.78; 95% confidence interval: 1.41-2.23). Review findings suggest that interventions including implementing vaccination requirement in school, sending reminders, and national permissive recommendation for adolescent vaccination have the potential to improve immunization uptake. Strategies to improve coverage for HPV vaccines resulted in a significant decrease in the prevalence of HPV by 44% and genital warts by 33%; however, the quality of evidence was low. Analysis from single studies with low- or very low-quality evidence suggested significant decrease in varicella deaths, measles incidence, rubella susceptibility, and incidence of pertussis while the impact was nonsignificant for incidence of mumps with their respective vaccines. Further rigorous evidence is needed to evaluate the effectiveness of strategies to improve immunization uptake among adolescents from low- and middle-income countries.

摘要

疫苗接种策略是预防疾病和死亡最成功且最具成本效益的公共卫生策略之一。直到最近,现有的大多数免疫规划都针对5岁以下的婴幼儿,这已成功降低了全球婴幼儿死亡率。青少年免疫接种相对受到忽视,导致全球四分之一的人口免疫接种不足,因此易患多种可预防疾病。近年来,已启动了大量项目以提高青少年对不同疫苗的接种率;然而,青少年总体推荐疫苗接种覆盖率仍然很低,尤其是在低收入和中等收入国家。自2006年人乳头瘤病毒(HPV)疫苗问世以来,青少年接种疫苗受到了更多关注。然而,在美国,只有一半的青少年女孩接种了一剂HPV疫苗,而分别只有43%和33%的人接种了两剂和三剂。我们系统回顾了截至2014年12月发表的文献,纳入了23项关于提高青少年免疫接种覆盖率干预措施有效性的研究。中等质量的证据表明疫苗接种覆盖率总体提高了78%(相对风险:1.78;95%置信区间:1.41 - 2.23)。综述结果表明,包括在学校实施疫苗接种要求、发送提醒以及国家对青少年疫苗接种的许可性建议等干预措施有可能提高免疫接种率。提高HPV疫苗接种覆盖率的策略使HPV患病率显著降低了44%,尖锐湿疣患病率显著降低了33%;然而,证据质量较低。来自低质量或极低质量证据的单项研究分析表明,水痘死亡、麻疹发病率、风疹易感性和百日咳发病率显著下降,而腮腺炎发病率及其相应疫苗的影响不显著。需要进一步严格的证据来评估提高低收入和中等收入国家青少年免疫接种率策略的有效性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce3a/5026683/6d18abaf0bad/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce3a/5026683/c5336452f72c/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce3a/5026683/e91ca7732c26/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce3a/5026683/f7eb77f05266/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce3a/5026683/6d18abaf0bad/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce3a/5026683/c5336452f72c/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce3a/5026683/e91ca7732c26/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce3a/5026683/f7eb77f05266/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce3a/5026683/6d18abaf0bad/gr4.jpg

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Systematic Review and Meta-Analysis of Interventions to Improve Access and Coverage of Adolescent Immunizations.

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[2]
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[8]
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[9]
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[10]
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[2]
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[3]
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BMJ Glob Health. 2025-4-9

[4]
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[5]
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Malar J. 2024-11-29

[6]
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[7]
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Glob Health Sci Pract. 2024-6-27

[8]
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[9]
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[10]
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本文引用的文献

[1]
Adolescent Health Interventions: Conclusions, Evidence Gaps, and Research Priorities.

J Adolesc Health. 2016-10

[2]
Interventions to Prevent Unintentional Injuries Among Adolescents: A Systematic Review and Meta-Analysis.

J Adolesc Health. 2016-10

[3]
Interventions for Adolescent Substance Abuse: An Overview of Systematic Reviews.

J Adolesc Health. 2016-10

[4]
Interventions for Adolescent Mental Health: An Overview of Systematic Reviews.

J Adolesc Health. 2016-10

[5]
Adolescent Health and Well-Being: Background and Methodology for Review of Potential Interventions.

J Adolesc Health. 2016-10

[6]
Interventions to Improve Adolescent Nutrition: A Systematic Review and Meta-Analysis.

J Adolesc Health. 2016-10

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J Adolesc Health. 2016-10

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JAMA Oncol. 2015-7

[9]
Cost-effectiveness of female human papillomavirus vaccination in 179 countries: a PRIME modelling study.

Lancet Glob Health. 2014-6-9

[10]
Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature.

JAMA Pediatr. 2014-1

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