Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia;
School of Medicine, University of Western Australia, Western Australia, Australia.
Pediatrics. 2021 Mar;147(3). doi: 10.1542/peds.2020-1433. Epub 2021 Feb 8.
Children with medical comorbidities are at greater risk for severe influenza and poorer clinical outcomes. Despite recommendations and funding, influenza vaccine coverage remains inadequate in these children.
We aimed to systematically review literature assessing interventions targeting influenza vaccine coverage in children with comorbidities and assess the impact on influenza vaccine coverage.
PubMed, Scopus, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, and Web of Science databases were searched.
Interventions targeting influenza vaccine coverage in children with medical comorbidities.
Two reviewers independently screened articles, extracting studies' methods, interventions, settings, populations, and results. Four reviewers independently assessed risk of bias.
From 961 screened articles, 35 met inclusion criteria. Published studies revealed that influenza vaccine coverage was significantly improved through vaccination reminders and education directed at either patients' parents or providers, as well as by vaccination-related clinic process changes. Interventions improved influenza vaccine coverage by an average 60%, but no significant differences between intervention types were detected. Significant bias and study heterogeneity were also identified, limiting confidence in this effect estimate.
A high risk of bias and overall low quality of evidence limited our capacity to assess intervention types and methods.
Interventions were shown to consistently improve influenza vaccine coverage; however, no significant differences in coverage between different intervention types were observed. Future well-designed studies evaluating the effectiveness of different intervention are required to inform future optimal interventions.
患有合并症的儿童患严重流感和临床结局较差的风险更高。尽管有建议和资金支持，但这些儿童的流感疫苗接种率仍然不足。
我们旨在系统地回顾评估针对合并症儿童流感疫苗接种率的干预措施的文献，并评估其对流感疫苗接种率的影响。
我们检索了 PubMed、Scopus、Embase、护理学和联合健康文献累积索引、Cochrane 对照试验中心注册库、联合和补充医学数据库以及 Web of Science 数据库。
针对患有医学合并症的儿童的流感疫苗接种率的干预措施。
两名评审员独立筛选文章，提取研究方法、干预措施、设置、人群和结果。四名评审员独立评估偏倚风险。
从 961 篇筛选出的文章中，有 35 篇符合纳入标准。已发表的研究表明，通过向患儿家长或医务人员提供疫苗接种提醒和教育，以及通过与疫苗接种相关的临床流程改变，可显著提高流感疫苗接种率。干预措施平均使流感疫苗接种率提高了 60%，但未发现不同干预类型之间存在显著差异。还发现了显著的偏倚和研究异质性，这限制了对该效应估计的信心。
高偏倚风险和整体低质量证据限制了我们评估干预类型和方法的能力。
干预措施显示可一致提高流感疫苗接种率；然而，不同干预类型之间的接种率没有显著差异。需要未来设计良好的研究来评估不同干预措施的有效性，以为未来的最佳干预措施提供信息。
