Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, and Child Health Evaluative Sciences, The Hospital for Sick Children (SickKids), Toronto, Canada.
Department of Psychology, University of Guelph, Guelph, Canada.
Vaccine. 2022 Dec 12;40(52):7526-7537. doi: 10.1016/j.vaccine.2022.10.026. Epub 2022 Oct 22.
Injection-related pain and fear are common adverse reactions in children undergoing vaccination and influence vaccine acceptance. Despite the large body of literature on sources of vaccine non-compliance, there is no estimate of the prevalence of pain and fear as contributing factors. The objective was to estimate the prevalence of injection pain or fear of needles as barriers to childhood (i.e., 0-18 years) vaccination.
Four databases were searched from inception for relevant English and French articles until August 2021. In addition, the references of recent systematic reviews and all articles included in the review were hand searched. Article screening and data extractions were performed in duplicate. Studies were included if they reported on injection-related pain or fear of needles in children (0-18 years) using a checklist/closed-ended question(s). Results were stratified by respondent (parents or children), type of pediatric population (general or under-vaccinated), and relative importance of barrier (pain or needle fear as primary reason or any reason for under-vaccination). Prevalence rates of pain or needle fear were combined using a random effects model. Quality of included studies was assessed using the Joanna Briggs Institute critical appraisal checklist for prevalence data. Quality across studies was assessed using GRADE.
There were 26 studies with 45 prevalence estimates published between 1995 and 2021. For parent reports (of children) and children self-reported reasons for non-compliance, prevalence rates of pain or needle fear ranged from 5 to 13% in a general population and 8 to 28% in an under-vaccinated population, with a substantial variation in the prevalence estimates. There was no difference between category of respondent or relative importance on pain or needle fear prevalence rate. A regression model demonstrated an overall prevalence rate of pain or needle fear as an obstacle to vaccination of 8% in the general population and 18.3% in the under-vaccinated population. All evidence was very low in quality.
This is the first review to systematically quantify the prevalence and therefore, importance, of pain and needle fear as obstacles to vaccination in children around the world. Pain from injection or fear of needles were demonstrated to be sufficiently prevalent as barriers to vaccination in children to warrant attention. Addressing pain and fear has the potential to significantly improve vaccination acceptance.
在儿童接种疫苗过程中，与注射相关的疼痛和恐惧是常见的不良反应，这会影响疫苗的接种率。尽管有大量关于疫苗接种不依从的文献，但目前尚无关于疼痛和恐惧作为影响因素的发生率的评估。本研究旨在评估注射疼痛或对针头的恐惧作为儿童（0-18 岁）疫苗接种障碍的发生率。
从数据库建立之初到 2021 年 8 月，我们检索了四个数据库以获取相关的英文和法文文章。此外，我们还对最近的系统评价的参考文献和纳入综述的所有文章进行了手工检索。文章筛选和数据提取均由两人独立进行。如果研究报告使用检查表/封闭式问题报告了儿童（0-18 岁）与注射相关的疼痛或对针头的恐惧，则将其纳入研究。研究结果按照应答者（父母或儿童）、儿科人群类型（一般人群或未充分接种疫苗人群）以及障碍的相对重要性（疼痛或针头恐惧作为主要原因或未充分接种疫苗的任何原因）进行分层。使用随机效应模型对疼痛或针头恐惧的发生率进行合并。使用 Joanna Briggs 研究所流行数据评估清单评估纳入研究的质量。使用 GRADE 评估研究间的质量。
本研究共纳入 26 项研究，其中包含 45 项发生率评估，这些研究发表于 1995 年至 2021 年期间。对于父母（报告子女）和儿童自我报告的疫苗接种不合规原因，一般人群中疼痛或针头恐惧的发生率为 5%至 13%，未充分接种疫苗人群中的发生率为 8%至 28%，发生率评估存在较大差异。应答者类别或疼痛或针头恐惧发生率的相对重要性无差异。回归模型显示，一般人群中，疼痛或针头恐惧作为疫苗接种障碍的总体发生率为 8%，未充分接种疫苗人群中的发生率为 18.3%。所有证据的质量均为极低。
这是第一项系统评估全球范围内注射疼痛或针头恐惧作为儿童疫苗接种障碍发生率及其重要性的综述。结果表明，注射疼痛或针头恐惧作为儿童疫苗接种障碍是相当普遍的，值得关注。解决疼痛和恐惧问题有可能显著提高疫苗接种率。
