Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.
Vaccinology and Immunology Research Trials Unit (VIRTU), Women's and Children's Hospital, North Adelaide, South Australia, Australia.
PLoS One. 2019 Mar 28;14(3):e0214538. doi: 10.1371/journal.pone.0214538. eCollection 2019.
Maternal pertussis vaccination has been introduced in several countries to prevent pertussis morbidity and mortality in infants too young to be vaccinated. Our review aimed to systematically collect and summarize the available evidence on the effectiveness of interventions used to improve pertussis vaccination uptake in pregnant women.
We conducted a systematic search of MEDLINE/PubMed, PMC and CINAHL. Before and after studies and those with a concurrent control group were considered for inclusion. Standardized effect sizes were described as the ratio of the odds to be vaccinated in the intervention group compared with the standard care group and absolute benefit increase (ABI) were calculated.
Six studies were included in the review, of which three were randomized controlled trials (RCTs). Strategies to improve uptake were focused on healthcare providers, pregnant women, or enhancing vaccine access. Healthcare provider interventions included provider reminder, education, feedback and standing orders. Interventions directed at pregnant women focused solely on education. Observational studies showed: (1) the provision of maternal pertussis vaccination by midwives at the place of antenatal care has improved uptake of pertussis vaccine during pregnancy from 20% to 90%; (2) introduction of an automated reminder within the electronic medical record was associated with an improvement in the pertussis immunization rate from 48% to 97%; (3) an increase in prenatal pertussis vaccine uptake from 36% to 61% after strategies to increase provider awareness of recommendations were introduced. In contrast to these findings, interventions in all three RCTs (2 involved education of pregnant women, 1 had multi-component interventions) did not demonstrate improved vaccination uptake.
Based on the existing research, we recommend incorporating midwife delivered maternal immunization programs at antenatal clinics, use of a provider reminder system to target unvaccinated pregnant women and include maternal pertussis immunization as part of standard antenatal care.
为预防婴儿因无法接种疫苗而罹患百日咳，一些国家已开始为产妇接种百日咳疫苗。本综述旨在系统性地收集和总结目前可获取的所有关于提高孕妇百日咳疫苗接种率的干预措施的有效性证据。
我们系统性地检索了 MEDLINE/PubMed、PMC 和 CINAHL。将前后对照研究和同期对照研究纳入考虑。以干预组与标准护理组接种疫苗的可能性之比来描述标准化效果量，并计算绝对获益增加（ABI）。
本综述共纳入 6 项研究，其中 3 项为随机对照试验（RCT）。提高接种率的策略主要集中在医疗保健提供者、孕妇或增加疫苗可及性上。医疗保健提供者干预措施包括提供提醒、教育、反馈和医嘱。针对孕妇的干预措施仅聚焦于教育。观察性研究表明：（1）在产前护理场所由助产士提供百日咳疫苗可将孕期百日咳疫苗接种率从 20%提高到 90%；（2）在电子病历中引入自动提醒后，百日咳免疫接种率从 48%提高到 97%；（3）在提高医疗服务提供者对建议认知的策略实施后，产前百日咳疫苗接种率从 36%提高到 61%。然而，与这些发现相反，所有 3 项 RCT 中的干预措施（2 项涉及对孕妇的教育，1 项为多组分干预）均未显示出接种率的提高。
基于现有研究，我们建议在产前门诊引入由助产士提供的产妇免疫接种计划，使用针对未接种孕妇的提供者提醒系统，并将母亲的百日咳免疫接种纳入标准产前护理的一部分。
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