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Vaccination Programs: Community-Based Interventions Implemented in Combination

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What the Task Force Found

About The Systematic Review

This Task Force finding is based on evidence from a Community Guide systematic review completed in 2010 (17 studies; search period 1980 - 2010) combined with more recent evidence (1 study, search period 2010 - 2012). This review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to increasing appropriate vaccination. The finding updates and replaces the 2010 finding for Community Based Interventions Implemented in Combination [PDF - 181 kB].

Context

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Summary of Results

The systematic review included 18 studies with 21 study arms.

  • Overall vaccination rates: median increase of 14 percentage points (interquartile interval [IQI]: 7 to 24 percentage points; 18 studies)
    • Older adults (65 years and older): median increase of 30.8 percentage points (range of values: 16 to 53 percentage points; 4 studies)
    • Children (12 years and younger): median increase of 12 percentage points (IQI: 5 to 18 percentage points; 14 studies)
  • Studies that combined one or more interventions to increase client and community demand with one or more interventions to enhance access to vaccination services saw a median increase in vaccination rates of 16 percentage points (IQI: 12 to 26 percentage points; 14 studies)
  • Intervention combinations that included client reminders reported a median increase in vaccination rates of 13 percentage points (IQI: 8 to 18 percentage points; 15 study arms)

Summary of Economic Evidence

Twenty-two studies that qualified for the economic review evaluated combinations of community-based interventions such as client reminders, mass media, home visits, and client incentives. All monetary values provided are in 2012 U.S. dollars.

  • Estimates of cost and cost-effectiveness varied between studies.
    • The median intervention cost per person per year was $54 (IQI: $14 to $214; 19 studies).
    • The median cost per additional vaccinated person was $461 (IQI: $51 to $798; 19 studies)
    • Estimates were higher for combined interventions that included intensive outreach and home visits.
    • Estimates were lower for combined interventions that were substantially based on mail or telephone reminders.

Applicability

Based on the settings and populations from included studies, results are applicable to the following.

  • Populations with low vaccination rates:
    • Children ages 12 years and younger
    • Older adults ages 65 years and older
    • Groups with low socioeconomic status
    • Racial and ethnic minorities
  • For different vaccines, including:
    • Childhood recommended
    • Pneumococcal – adults
    • Influenza – adults
  • Urban areas

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

Future evaluations should aim to address the following questions:

  • How effective are these programs when applied to adolescents, or in rural settings?
  • What are the economic efficiencies of the more resource-intensive components—manual outreach and tracking and home visits?
  • How does program effectiveness differ based on included component interventions and strategic combinations?
  • What are the most efficient ways to sustain these programs, especially for existing community-based organizations?

Study Characteristics

  • Interventions were conducted in urban (21 study arms) and rural (1 study arm) settings.
  • Interventions targeted children (21 study arms), adolescents (1 study arm) and adults (4 study arms).
  • Studies evaluated the following vaccines:
    • Childhood recommended (15 study arms)
    • Influenza – adults (4 study arms)
    • Pneumococcal – adults (2 study arms)
    • Hepatitis B - child (1 study arm)
  • Majority of the studies evaluated interventions that targeted populations with low socioeconomic status (10 study arms).

Publications