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Effectiveness of hospital-based strategies for improving childhood immunization coverage: A systematic review
Laura Reifferscheid1, Marilou S Kiely2, Maggie Szu Ning Lin1
1Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
Insights
Hospital-based vaccination strategies can improve childhood immunization rates, particularly through opportunistic vaccination during visits. Strategies promoting vaccination after discharge showed less success, highlighting the need for tailored approaches.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Hospital settings offer a key opportunity to enhance childhood vaccination coverage.
- This systematic review evaluates the efficacy of hospital-based strategies in boosting vaccination rates among children.
Approach:
- A comprehensive systematic search identified 25 high-quality studies from high-income countries published up to September 20, 2021.
- Interventions included opportunistic vaccination, patient education, community connection, and reminder systems, with a focus on routine, outbreak, and influenza vaccines.
Key Points:
- Opportunistic vaccination during hospital visits proved effective, increasing coverage for routine vaccines up to 71% and influenza vaccines between 9-61%.
- Combined strategies involving opportunistic vaccination with education or reminders showed varied success.
- Interventions focused on post-discharge vaccination (education, reminders, community connection) yielded limited positive results.
Conclusions:
- Hospital-based vaccination interventions can improve coverage, but success is influenced by population baseline coverage and implementation methods.
- Tailoring post-discharge vaccination strategies to individual needs may enhance their effectiveness.
Background:
Hospital settings represent an opportunity to offer and/or promote childhood vaccination. The purpose of the systematic review was to assess the effectiveness of different hospital-based strategies for improving childhood vaccination coverage.
Methods:
A systematic search of multiple bibliographic databases, thesis databases, and relevant websites was conducted to identify peer-reviewed articles published up to September 20, 2021. Articles were included if they evaluated the impact of a hospital (inpatient or emergency department)-based intervention on childhood vaccination coverage, were published in English or French, and were conducted in high-income countries. High quality studies were included in a narrative synthesis.
Results:
We included 25 high quality studies out of 7,845 unique citations. Studies focused on routine, outbreak, and influenza vaccines, and interventions included opportunistic vaccination (i.e. vaccination during hospital visit) (n = 7), patient education (n = 2), community connection (n = 2), patient reminders (n = 2), and opportunistic vaccination combined with patient education and/or reminders (n = 12). Opportunistic vaccination interventions were generally successful at improving vaccine coverage, though results ranged from no impact to vaccinating 71 % of eligible children with routine vaccines and 9-61 % of eligible children with influenza vaccines. Interventions that aimed to increase vaccination after hospital discharge (community connection, patient education, reminders) were less successful.
Conclusions:
Some interventions that provide vaccination to children accessing hospitals improved vaccine coverage; however, the baseline coverage level of the population, as well as implementation strategies used impact success. There is limited evidence that interventions promoting vaccination after hospital discharge are more successful if they are tailored to the individual.
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