Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada.
Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada.
Vaccine. 2021 Jun 29;39(29):3825-3833. doi: 10.1016/j.vaccine.2021.05.054. Epub 2021 Jun 3.
The National Advisory Committee on Immunization (NACI) makes recommendations for vaccines in Canada. To inform considerations for equity when making recommendations, the NACI Secretariat developed a matrix of factors that may influence vaccine equity. To inform the matrix we mapped the evidence for PROGRESS And Other factors potentially associated with unequal levels of illness or death from vaccine-preventable diseases (VPDs) and systematically reviewed the evidence for interventions aimed at reducing inequities.
In October 2019 we searched Medline, Embase, and CINAHL. Two reviewers agreed on the included studies. Our primary outcomes were VPD-related hospitalizations and deaths. Secondary outcomes were differential vaccine access, and exposure, susceptibility, severity, and consequences of VPDs. Two reviewers appraised the certainty of evidence. We mapped the evidence for PROGRESS And Other factors and summarized the findings descriptively. We summarized the interventions narratively.
We identified 413 studies reporting on PROGRESS And Other factors. The most commonly investigated factors included age (n = 374, 89%), pre-existing conditions (n = 179, 42%), and gender identity or sex (n = 144, 34%). We identified 2 trials investigating the effects of interventions. One (n = 1249) provided very low certainty evidence that staff vaccination policies may reduce hospitalizations and deaths from influenza among private care home residents. The other (n not reported) provided very low certainty evidence that universal vaccination by nurses in clinics may reduce hospitalizations for rotavirus gastroenteritis compared with vaccination by physicians or no intervention.
There is a large body of studies reporting on hospitalizations and deaths from VPDs stratified by PROGRESS And Other factors. We found only two trials examining the effects of interventions on hospitalization for or mortality from VPDs. This review has been helpful to NACI and will be helpful to similar organizations aiming to systematically identify and target health inequities through the development of vaccine program recommendations.
国家免疫咨询委员会（NACI）为加拿大的疫苗接种提出建议。为了在提出建议时考虑公平因素，NACI 秘书处在一个可能影响疫苗公平性的因素矩阵中进行了开发。为了丰富这个矩阵，我们对与疫苗可预防疾病（VPD）相关的不平等疾病或死亡水平相关的证据进行了映射，并系统地回顾了旨在减少不平等的干预措施的证据。
2019 年 10 月，我们在 Medline、Embase 和 CINAHL 上进行了搜索。两名审查员对纳入的研究达成一致意见。我们的主要结局是与 VPD 相关的住院和死亡。次要结局是疫苗的获得情况，以及 VPD 的暴露、易感性、严重程度和后果。两名审查员对证据的确定性进行了评估。我们对 PROGRESS 及其他因素的证据进行了映射，并进行了描述性总结。我们对干预措施进行了叙述性总结。
我们确定了 413 项报告 PROGRESS 及其他因素的研究。最常调查的因素包括年龄（n=374，89%）、现有疾病（n=179，42%）和性别认同或性别（n=144，34%）。我们确定了 2 项研究干预措施的影响。其中一项（n=1249）提供了非常低确定性的证据，表明工作人员接种疫苗政策可能会减少私人护理院居民中流感的住院和死亡。另一项（n 未报告）提供了非常低确定性的证据，表明诊所护士普遍接种疫苗可能比医生接种或不干预减少轮状病毒肠胃炎的住院治疗。
有大量的研究报告了按 PROGRESS 及其他因素分层的 VPD 住院和死亡情况。我们只发现了两项研究检查了干预措施对 VPD 住院或死亡的影响。本综述对 NACI 很有帮助，也将对类似的旨在通过制定疫苗计划建议系统地识别和针对健康不平等的组织有帮助。
