Defining the determinants of vaccine uptake and undervaccination in migrant populations in Europe to improve routine and COVID-19 vaccine uptake: a systematic review.
Defining the determinants of vaccine uptake and undervaccination in migrant populations in Europe to improve routine and COVID-19 vaccine uptake: a systematic review.
复制标题
确定欧洲移民人口疫苗接种和疫苗接种不足的决定因素，以改善常规疫苗和 COVID-19 疫苗接种：系统评价。
DOI：
10.1016/s1473-3099(22)00066-4
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发表时间：
2022-09
影响因子：
56.3
通讯作者：
Hargreaves, Sally
中科院分区：
文献类型：
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作者：
Crawshaw, Alison F.;Farah, Yasmin;Deal, Anna;Rustage, Kieran;Hayward, Sally E.;Carter, Jessica;Knights, Felicity;Goldsmith, Lucy P.;Campos-Matos, Ines;Wurie, Fatima;Majeed, Azeem;Bedford, Helen;Forster, Alice S.;Hargreaves, Sally
如果我们要解决疫苗接种不平等问题并实现世卫组织新的《2030年免疫议程》的目标，了解为什么欧洲的一些移民面临免疫接种不足的风险，以及常规疫苗和COVID-19疫苗的接种率较低，至关重要。我们进行了一项系统性综述（PROSPERO：CRD 42020219214），探讨了欧盟和欧洲经济区、英国和瑞士移民中疫苗接种的障碍和促进因素（使用5A分类法进行分类：获得、意识、负担能力、接受、激活）以及疫苗接种不足的社会人口学决定因素。我们检索了MEDLINE、CINAHL和PsycINFO从2000年到2021年的主要研究，没有语言限制。筛选了5259个数据来源，包括来自16个国家的67项研究，代表了366529名移民。我们确定了多种获取障碍，包括语言、识字和沟通障碍，获取和提供疫苗接种服务的实际和法律的障碍，以及缺乏具体指南和卫生保健专业人员知识等服务障碍，包括麻疹-腮腺炎-风疹、白喉-百日咳-破伤风、人乳头瘤病毒、流感、脊髓灰质炎和COVID-19疫苗等关键疫苗。接受障碍主要是东欧和穆斯林移民报告的人乳头瘤病毒，麻疹和流感疫苗。我们确定了移民中疫苗接种不足的23个重要决定因素（p<0.05），包括非洲血统，最近的移民，以及难民或寻求庇护者。我们没有发现与性别或年龄有很强的整体关联。量身定制的疫苗接种信息、社区外展和行为推动促进了接种。移徙者在获得卫生保健方面的障碍已经得到充分记录，本审查确认了这些障碍在限制疫苗接种方面的作用。这些发现对加强高收入国家的疫苗接种计划（包括针对COVID-19的疫苗接种计划）具有直接相关性，并表明需要量身定制、文化敏感和循证的战略、明确的公共卫生信息和卫生系统的加强，以解决移民接种疫苗的获得和接受障碍，并为向移民提供追加疫苗接种创造机会和途径。
Understanding why some migrants in Europe are at risk of underimmunisation and show lower vaccination uptake for routine and COVID-19 vaccines is critical if we are to address vaccination inequities and meet the goals of WHO's new Immunisation Agenda 2030. We did a systematic review (PROSPERO: CRD42020219214) exploring barriers and facilitators of vaccine uptake (categorised using the 5As taxonomy: access, awareness, affordability, acceptance, activation) and sociodemographic determinants of undervaccination among migrants in the EU and European Economic Area, the UK, and Switzerland. We searched MEDLINE, CINAHL, and PsycINFO from 2000 to 2021 for primary research, with no restrictions on language. 5259 data sources were screened, with 67 studies included from 16 countries, representing 366 529 migrants. We identified multiple access barriers—including language, literacy, and communication barriers, practical and legal barriers to accessing and delivering vaccination services, and service barriers such as lack of specific guidelines and knowledge of health-care professionals—for key vaccines including measles-mumps-rubella, diphtheria-pertussis-tetanus, human papillomavirus, influenza, polio, and COVID-19 vaccines. Acceptance barriers were mostly reported in eastern European and Muslim migrants for human papillomavirus, measles, and influenza vaccines. We identified 23 significant determinants of undervaccination in migrants (p<0·05), including African origin, recent migration, and being a refugee or asylum seeker. We did not identify a strong overall association with gender or age. Tailored vaccination messaging, community outreach, and behavioural nudges facilitated uptake. Migrants' barriers to accessing health care are already well documented, and this Review confirms their role in limiting vaccine uptake. These findings hold immediate relevance to strengthening vaccination programmes in high-income countries, including for COVID-19, and suggest that tailored, culturally sensitive, and evidence-informed strategies, unambiguous public health messaging, and health system strengthening are needed to address access and acceptance barriers to vaccination in migrants and create opportunities and pathways for offering catch-up vaccinations to migrants.