Jaca Anelisa, Mathebula Lindi, Malinga Thobile, Rampersadh Kimona, Zulu Masibulele, Hohlfeld Ameer Steven-Jorg, Wiysonge Charles Shey, Jacobson Vann Julie C, Ndwandwe Duduzile
Cochrane South Africa, South African Medical Research Council, Cape Town 7505, South Africa.
Vaccine Preventable Diseases Programme, World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo.
Vaccines (Basel). 2025 Jul 30;13(8):811. doi: 10.3390/vaccines13080811.
Immunization is a highly effective intervention for controlling over 20 life-threatening infectious diseases, significantly reducing both morbidity and mortality rates. One notable achievement in vaccination efforts was the global eradication of smallpox, which the World Health Assembly declared on 8 May 1980. Additionally, there has been a remarkable 99.9% reduction in wild poliovirus cases since 1988, decreasing from more than 350,000 cases that year to just 30 cases in 2022.
The objective of this review was to assess the effects of various interventions designed to increase vaccination uptake among adults.
A thorough search was conducted in the CENTRAL, Embase Ovid, Medline Ovid, PubMed, Web of Science, and Global Index Medicus databases for primary studies. This search was conducted in August 2021 and updated in November 2024.
Randomized trials were eligible for inclusion in this review, regardless of publication status or language.
Two authors independently screened the search outputs to select potentially eligible studies. Risk ratios (RR) with 95% confidence intervals (CI) were calculated for each randomized controlled trial (RCT). A meta-analysis was conducted using a random-effects model, and the quality of the evidence was assessed using the GRADE approach.
A total of 35 randomized controlled trials met the inclusion criteria and were included in this review, with the majority conducted in the United States. The interventions targeted adults aged 18 and older who were eligible for vaccination, involving a total of 403,709 participants. The overall pooled results for interventions aimed at increasing influenza vaccination showed a risk ratio of 1.41 (95% CI: 1.15, 1.73). Most studies focused on influenza vaccination (18 studies), while the remaining studies examined various other vaccines, including those for hepatitis A, COVID-19, hepatitis B, pneumococcal disease, tetanus, diphtheria, pertussis (Tdap), herpes zoster, and human papillomavirus (HPV). The results indicate that letter reminders were slightly effective in increasing influenza vaccination uptake compared to the control group (RR: 1.75, 95% CI: 0.97, 1.16; 6 studies; 161,495 participants; low-certainty evidence). Additionally, participants who received education interventions showed increased levels of influenza vaccination uptake compared to those in the control group (RR: 1.88, 95% CI: 0.61, 5.76; 3 studies; 1318 participants; low-certainty evidence). Furthermore, tracking and outreach interventions also led to an increase in influenza vaccination uptake (RR: 1.87, 95% CI: 0.78, 4.46; 2 studies; 33,752 participants; low-certainty evidence).
Letter reminders and educational interventions targeted at recipients are effective in increasing vaccination uptake compared to control groups.
免疫接种是控制20多种危及生命的传染病的高效干预措施，能显著降低发病率和死亡率。疫苗接种工作的一项显著成就是全球根除天花，世界卫生大会于1980年5月8日宣布了这一成果。此外，自1988年以来，野生脊髓灰质炎病毒病例显著减少了99.9%，从当年的超过35万例降至2022年的仅30例。
本综述的目的是评估旨在提高成人疫苗接种率的各种干预措施的效果。
在CENTRAL、Embase Ovid、Medline Ovid、PubMed、Web of Science和Global Index Medicus数据库中全面检索了原始研究。该检索于2021年8月进行，并于2024年11月更新。
随机试验符合本综述的纳入标准，无论其发表状态或语言如何。
两位作者独立筛选检索结果，以选择可能符合条件的研究。为每个随机对照试验（RCT）计算了具有95%置信区间（CI）的风险比（RR）。使用随机效应模型进行荟萃分析，并使用GRADE方法评估证据质量。
共有35项随机对照试验符合纳入标准并纳入本综述，其中大多数在美国进行。干预措施针对符合疫苗接种条件的18岁及以上成年人，共有403,709名参与者。旨在提高流感疫苗接种率的干预措施的总体汇总结果显示风险比为1.41（95%CI：1.15，1.73）。大多数研究聚焦于流感疫苗接种（18项研究），其余研究则考察了各种其他疫苗，包括甲型肝炎、新冠病毒病、乙型肝炎、肺炎球菌病、破伤风、白喉、百日咳（Tdap）、带状疱疹和人乳头瘤病毒（HPV）疫苗。结果表明，与对照组相比，信件提醒在提高流感疫苗接种率方面略有效果（RR：1.75，95%CI：0.97，1.16；6项研究；161,495名参与者；低确定性证据）。此外，与对照组相比，接受教育干预的参与者的流感疫苗接种率有所提高（RR：1.88，95%CI：0.61，5.76；3项研究；1318名参与者；低确定性证据）。此外，追踪和外展干预也导致流感疫苗接种率上升（RR：1.87，95%CI：0.78，4.46；2项研究；33,752名参与者；低确定性证据）。
与对照组相比，针对接种者的信件提醒和教育干预在提高疫苗接种率方面是有效的。
