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Interventions to reduce inequalities in vaccine uptake in children and adolescents aged <19 years: a systematic review
  1. Tim Crocker-Buque1,
  2. Michael Edelstein2,
  3. Sandra Mounier-Jack1
  1. 1Health Protection Research Unit in Immunisation, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
  1. Correspondence to Dr Tim Crocker-Buque, Health Protection Research Unit in Immunisation, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; timothy.crocker-buque{at}lshtm.ac.uk

Abstract

Background In high-income countries, substantial differences exist in vaccine uptake relating to socioeconomic status, gender, ethnic group, geographic location and religious belief. This paper updates a 2009 systematic review on effective interventions to decrease vaccine uptake inequalities in light of new technologies applied to vaccination and new vaccine programmes (eg, human papillomavirus in adolescents).

Methods We searched MEDLINE, Embase, ASSIA, The Campbell Collaboration, CINAHL, The Cochrane Database of Systematic Reviews, Eppi Centre, Eric and PsychINFO for intervention, cohort or ecological studies conducted at primary/community care level in children and young people from birth to 19 years in OECD countries, with vaccine uptake or coverage as outcomes, published between 2008 and 2015.

Results The 41 included studies evaluated complex multicomponent interventions (n=16), reminder/recall systems (n=18), outreach programmes (n=3) or computer-based interventions (n=2). Complex, locally designed interventions demonstrated the best evidence for effectiveness in reducing inequalities in deprived, urban, ethnically diverse communities. There is some evidence that postal and telephone reminders are effective, however, evidence remains mixed for text-message reminders, although these may be more effective in adolescents. Interventions that escalated in intensity appeared particularly effective. Computer-based interventions were not effective. Few studies targeted an inequality specifically, although several reported differential effects by the ethnic group.

Conclusions Locally designed, multicomponent interventions should be used in urban, ethnically diverse, deprived populations. Some evidence is emerging for text-message reminders, particularly in adolescents. Further research should be conducted in the UK and Europe with a focus on reducing specific inequalities.

  • VACCINATION
  • IMMUNIZATION
  • INEQUALITIES
  • PRIMARY CARE
  • COMMUNICABLE DISEASES

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Twitter Follow Tim Crocker-Buque at @drtimcb

  • Contributors SM-J conceived the study with ME. TC-B undertook the literature search. TC-B and SM-J reviewed the abstracts and agreed inclusions. TC-B extracted the relevant data and produced an initial draft of the paper, which was reviewed and edited by SM-J and ME.

  • Funding The research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Immunisation at the London School of Hygiene and Tropical Medicine in partnership with Public Health England (PHE).

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health or PHE.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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