Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK.
Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK.
Vaccine. 2019 May 31;37(25):3255-3266. doi: 10.1016/j.vaccine.2019.04.091. Epub 2019 May 6.
The effectiveness of vaccines is known to be altered by a range of psychological factors. We conducted a systematic review to evaluate the effects of psychological interventions on the ability of vaccines to protect against disease, as measured by antibody responses.
Electronic databases (EMBASE, Medline, PsychINFO, CINAHL) were searched from their inception to 6th February 2018.
The search yielded 9 eligible trials conducted with 1603 participants and four broad categories of intervention: meditation/mindfulness (n = 3), massage (n = 3), expressive writing (n = 2) and cognitive behavioural stress management (n = 1). Some evidence of benefit on the antibody response to vaccination was observed in 6/9 of all trials and in 4/7 of randomised controlled trials. However, effects on antibody levels were often mixed, with only 3 of 6 trials showing benefit demonstrating an improvement in all antibody outcomes and at all time points assessed. Trials demonstrating benefit also provided direct or indirect evidence of adequate adherence with the intervention; and in 50% of these trials, there was also evidence that the intervention was effective in changing the mediating psychological constructs targeted by the intervention.
This literature is characterised by considerable heterogeneity in terms of intervention type, vaccine type, age of participants and the temporal relationship between vaccination and intervention. We conclude that there is early evidence to suggest that psychological interventions may enhance the antibody response to vaccination. However, the effects are inconsistent, with the greatest likelihood of benefit seen in trials evidencing adequate adherence with the intervention. Future work would benefit from rigorous intervention development that focuses on achieving adequate adherence and large well-controlled randomised trials with a focus on an agreed set of outcomes.
已知疫苗的有效性会受到一系列心理因素的影响。我们进行了一项系统评价，以评估心理干预对疫苗预防疾病能力的影响，其效果通过抗体反应来衡量。
从建库开始到 2018 年 2 月 6 日，我们在电子数据库（EMBASE、Medline、PsychINFO、CINAHL）中进行了检索。
搜索结果得到了 9 项合格的试验，涉及 1603 名参与者，干预措施分为四大类：冥想/正念（n=3）、按摩（n=3）、表达性写作（n=2）和认知行为应激管理（n=1）。所有试验中有 6/9 项、随机对照试验中有 4/7 项观察到对疫苗接种抗体反应有一定益处。然而，抗体水平的影响往往是混合的，仅有 6 项试验中的 3 项显示益处，这 3 项试验表明所有抗体结果都得到了改善，且在所有评估的时间点都得到了改善。显示益处的试验也提供了直接或间接的证据，表明干预措施得到了充分的遵循；在这些试验中有 50%还表明，干预措施在改变干预措施针对的中介心理结构方面也是有效的。
本文献的特点是干预类型、疫苗类型、参与者年龄以及疫苗接种和干预之间的时间关系方面存在很大的异质性。我们的结论是，有早期证据表明心理干预可能增强疫苗接种的抗体反应。然而，效果不一致，在证据表明干预措施得到充分遵循的试验中，最有可能获益。未来的工作将受益于严格的干预措施开发，重点是实现充分的遵循，以及针对一套既定结果的大型、对照良好的随机试验。
