Pennisi Flavia, Borlini Stefania, Cuciniello Rita, D'Amelio Anna Carole, Calabretta Rosaria, Pinto Antonio, Signorelli Carlo
Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milan, Italy.
PhD National Program in One Health Approaches to Infectious Diseases and Life Science Research, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy.
Healthcare (Basel). 2025 Jul 10;13(14):1667. doi: 10.3390/healthcare13141667.
Adult vaccination remains suboptimal, particularly among older adults and individuals with chronic conditions. Hospitals represent a strategic setting for improving vaccination coverage among these high-risk populations. This systematic review and meta-analysis evaluated hospital-based interventions aimed at enhancing vaccine uptake in adults aged ≥60 years or 18-64 years with at-risk medical conditions. We conducted a systematic review and meta-analysis following PRISMA and MOOSE guidelines. Searches in PubMed, EMBASE, and Scopus identified studies published in the last 10 years evaluating hospital-based interventions reporting vaccination uptake. The risk of bias was assessed using validated tools (NOS, RoB 2, ROBINS-I, QI-MQCS). A meta-analysis was conducted for categories with ≥3 eligible studies reporting pre- and post-intervention vaccination coverage in the same population. We included 44 studies. Multi-component strategies ( = 21) showed the most consistent results (e.g., pneumococcal uptake from 2.2% to 43.4%, < 0.001). Reminder-based interventions ( = 4) achieved influenza coverage increases from 31.0% to 68.0% and a COVID-19 booster uptake boost of +38% after SMS reminders. Educational strategies ( = 11) varied in effectiveness, with one study reporting influenza coverage rising from 1.6% to 12.2% (+662.5%, OR 8.86, < 0.01). Standing order protocols increased pneumococcal vaccination from 10% to 60% in high-risk adults. Hospital-based catch-up programs improved DTaP-IPV uptake from 56.2% to 80.8% ( < 0.001). For patient education, the pooled OR was 2.11 (95% CI: 1.96-2.27; < 0.001, I = 97.2%) under a fixed-effects model, and 2.47 (95% CI: 1.53-3.98; < 0.001) under a random-effects model. For multi-component strategies, the OR was 2.39 (95% CI: 2.33-2.44; < 0.001, I = 98.0%) with fixed effects, and 3.12 (95% CI: 2.49-3.92; < 0.001) with random effects. No publication bias was detected. Hospital-based interventions, particularly those using multi-component approaches, effectively improve vaccine coverage in older and high-risk adults. Embedding vaccination into routine hospital care offers a scalable opportunity to reduce disparities and enhance population-level protection. Future policies should prioritize the institutional integration of such strategies to support healthy aging and vaccine equity.
成人疫苗接种情况仍未达到最佳水平，在老年人和慢性病患者中尤为如此。医院是提高这些高危人群疫苗接种覆盖率的关键场所。本系统评价和荟萃分析评估了旨在提高60岁及以上或患有高危疾病的18 - 64岁成年人疫苗接种率的医院干预措施。我们按照PRISMA和MOOSE指南进行了系统评价和荟萃分析。在PubMed、EMBASE和Scopus数据库中进行检索，以确定过去10年发表的评估医院干预措施并报告疫苗接种率的研究。使用经过验证的工具（NOS、RoB 2、ROBINS - I、QI - MQCS）评估偏倚风险。对同一人群中≥3项符合条件的研究报告干预前后疫苗接种覆盖率的类别进行荟萃分析。我们纳入了44项研究。多成分策略（n = 21）显示出最一致的结果（例如，肺炎球菌疫苗接种率从2.2%提高到43.4%，P < 0.001）。基于提醒的干预措施（n = 4）使流感疫苗接种率从31.0%提高到68.0%，短信提醒后新冠病毒加强针接种率提高了38%。教育策略（n = 11）效果各异，一项研究报告流感疫苗接种率从1.6%提高到12.2%（+662.5%，OR 8.86，P < 0.01）。常备医嘱方案使高危成年人的肺炎球菌疫苗接种率从10%提高到60%。医院的补种计划使白百破 - 脊髓灰质炎灭活疫苗接种率从56.2%提高到80.8%（P < 0.001）。对于患者教育，在固定效应模型下，合并OR为2.11（95%CI：1.96 - 2.27；P < 0.001，I² = 97.2%），在随机效应模型下为2.47（95%CI：1.53 - 3.98；P < 0.001）。对于多成分策略，固定效应下的OR为2.39（95%CI：2.33 - 2.44；P < 0.001，I² = 98.0%），随机效应下为3.12（95%CI：2.49 - 3.92；P < 0.001）。未检测到发表偏倚。基于医院的干预措施，尤其是那些采用多成分方法的措施，能有效提高老年人和高危成年人的疫苗接种覆盖率。将疫苗接种纳入常规医院护理为减少差距和加强人群层面的保护提供了可扩展的机会。未来政策应优先考虑将此类策略进行机构整合，以支持健康老龄化和疫苗公平性。
