Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
Vaccine. 2018 May 17;36(21):2921-2927. doi: 10.1016/j.vaccine.2018.04.028. Epub 2018 Apr 19.
Missed opportunities for vaccination (MOVs) occur when persons eligible for vaccination visit a health facility and do not get the vaccines they need. We conducted a systematic review to assess effects of interventions for reducing MOVs.
We searched PubMed, Scopus, and the Cochrane Central Register of Controlled Trials in April 2017. Three authors independently screened search outputs, reviewed potentially eligible papers, assessed risk of bias, and extracted data; resolving disagreements by consensus. We expressed study results as risk ratios (RR) with 95% confidence intervals (CI) and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool.
Six studies (five trials and one cohort study) met our inclusion criteria, all conducted in the United States of America. All six studies had various limitations and were classified as having a high risk of bias. We found moderate certainty evidence that the following interventions probably improve vaccination coverage: patient education (RR 1.92, 95% CI 1.38-2.68), patient tracking using community health workers (RR 1.18, 95% CI 1.11-1.25), and patient tracking and provider prompts (RR 1.24, 95% CI 1.18-1.31). In addition, we found low certainty evidence that concurrent interventions targeting health-facility (education, prompts, and audit and feedback) and family settings (phone calls) may increase vaccination coverage (RR 1.25, 95% CI 1.08-1.46).
The currently available evidence suggests that patient education, patient tracking, outreach sessions, and provider prompts reduce missed opportunities for vaccination and improve vaccination coverage. Rigorous studies are required to confirm these findings and increase the certainty of the current evidence base. WHO is currently coordinating efforts to generate such evidence, especially from low-income and middle-income countries, and it is likely that the data will be available in the next few years.
当符合接种条件的人前往医疗机构就诊但未能接种所需疫苗时，就会出现疫苗接种错失（MOV）。我们进行了一项系统评价，以评估减少 MOV 的干预措施的效果。
我们于 2017 年 4 月在 PubMed、Scopus 和 Cochrane 对照试验中心注册库中进行了检索。三位作者独立筛选检索结果、审查潜在合格的论文、评估偏倚风险并提取数据；通过协商解决分歧。我们用风险比（RR）及其 95%置信区间（CI）来表示研究结果，并使用推荐评估、制定与评价（GRADE）工具评估证据的确定性。
六项研究（五项试验和一项队列研究）符合我们的纳入标准，均在美国进行。所有六项研究都存在各种局限性，被归类为具有高偏倚风险。我们发现有中等确定性证据表明，以下干预措施可能会提高疫苗接种覆盖率：患者教育（RR 1.92，95%CI 1.38-2.68）、使用社区卫生工作者进行患者跟踪（RR 1.18，95%CI 1.11-1.25）以及患者跟踪和提供者提示（RR 1.24，95%CI 1.18-1.31）。此外，我们发现低确定性证据表明，同时针对卫生机构（教育、提示以及审核和反馈）和家庭环境（电话）的干预措施可能会增加疫苗接种覆盖率（RR 1.25，95%CI 1.08-1.46）。
目前的证据表明，患者教育、患者跟踪、外展服务和提供者提示可减少疫苗接种错失机会并提高疫苗接种覆盖率。需要进行严格的研究来证实这些发现并提高当前证据基础的确定性。世卫组织目前正在协调努力以生成此类证据，特别是来自低收入和中等收入国家的数据，并且在未来几年内可能会获得这些数据。
