针对患有慢性疾病的青少年进行疫苗接种的短信提醒：一项随机临床试验。

Text message reminders for vaccination of adolescents with chronic medical conditions: A randomized clinical trial.

作者信息

Hofstetter Annika M, Barrett Angela, Camargo Stewin, Rosenthal Susan L, Stockwell Melissa S

机构信息

Department of Pediatrics, University of Washington, Seattle, WA, United States; Seattle Children's Research Institute, Seattle, WA, United States; Department of Pediatrics, Columbia University, New York, NY, United States.

Department of Pediatrics, Columbia University, New York, NY, United States.

出版信息

Vaccine. 2017 Aug 16;35(35 Pt B):4554-4560. doi: 10.1016/j.vaccine.2017.07.022. Epub 2017 Jul 21.

DOI:10.1016/j.vaccine.2017.07.022

PMID:28736201

Abstract

BACKGROUND

Many adolescents with chronic medical conditions (CMCs) are at risk of vaccine-preventable infection, yet are frequently under-vaccinated. Text message reminders, particularly those with embedded educational information, have been shown to increase general pediatric vaccination. Their use has not been studied specifically among adolescents with CMCs.

METHODS

Eligible parents of adolescents with CMCs receiving care at one of 4 academically-affiliated pediatric clinics and requiring human papillomavirus (first dose), influenza, and/or pneumococcal polysaccharide vaccines were randomized in 4 consecutive cohorts to receive text message vaccine reminders with or without embedded educational information ("educational" vs. "plain" arm, respectively). Educational reminders, including one interactive message, addressed infection risk, vaccine safety/efficacy, and physician recommendations. Up to 5 weekly and 2 booster reminders were sent (October 2014-January 2015). Receipt of any needed vaccine and missed vaccination opportunities by 4, 12, and 24weeks after the initial reminder were compared between arms.

RESULTS

Of randomized parents (n=295), 175 (59.3%) were Spanish-speaking; most had adolescents with CMCs who were 13-17years (n=229; 77.6%) and publically insured (n=272; 92.5%). Baseline demographics and parental vaccine beliefs were similar between arms. More adolescents in the plain vs. educational reminder arm received any needed vaccine by 4weeks (31.9% vs. 22.7%, adjusted relative risk [aRR] 1.47, 95% CI 1.01-2.14), but not by 12 or 24weeks. Plain reminders were noted in post hoc analyses to have a greater effect than educational reminders in certain sub-populations, including 11-12year-olds and those sent the initial reminder in early fall. Fewer adolescents in the plain vs. educational reminder arm had a missed vaccination opportunity by 4weeks (10.9% vs. 41.3%; aRR 0.21, 95% CI 0.07-0.60), but not by 12 or 24weeks.

CONCLUSION

Plain text message vaccine reminders appear to have a positive effect compared to educational ones in the short-term and for certain families.

TRIAL REGISTRATION

NCT02231957 (www.clinicaltrials.gov).

摘要

背景

许多患有慢性疾病（CMC）的青少年面临疫苗可预防感染的风险，但他们往往接种疫苗不足。短信提醒，尤其是那些包含教育信息的提醒，已被证明可以提高儿童的总体疫苗接种率。尚未专门研究它们在患有CMC的青少年中的使用情况。

方法

在4家学术附属儿科诊所之一接受治疗且需要接种人乳头瘤病毒（首剂）、流感和/或肺炎球菌多糖疫苗的患有CMC的青少年的合格父母，在4个连续队列中被随机分组，分别接受带有或不带有嵌入式教育信息的短信疫苗提醒（分别为“教育组”与“普通组”）。教育提醒包括一条互动信息，涉及感染风险、疫苗安全性/有效性和医生建议。最多发送5条每周提醒和2条强化提醒（2014年10月至2015年1月）。比较两组在初次提醒后4周、12周和24周时所需疫苗的接种情况以及错过的疫苗接种机会。

结果

在随机分组的父母中（n = 295），175名（59.3%）讲西班牙语；大多数人的患有CMC的青少年年龄在13 - 17岁（n = 229；77.6%）且有公共保险（n = 272；92.5%）。两组的基线人口统计学特征和父母的疫苗观念相似。在4周时，普通提醒组比教育提醒组有更多青少年接种了任何所需疫苗（31.9%对22.7%，调整后相对风险[aRR] 1.47，95%置信区间1.01 - 2.14），但在12周或24周时并非如此。事后分析表明，普通提醒在某些亚组中，包括11 - 12岁的青少年以及初秋收到初次提醒的青少年中，比教育提醒的效果更大。在4周时，普通提醒组比教育提醒组错过疫苗接种机会的青少年更少（10.9%对41.3%；aRR 0.21，95%置信区间0.07 - 0.60），但在12周或24周时并非如此。