Abstract
Keywords
National Foundation for Infectious Diseases: Adolescent vaccination bridging from a strong childhood foundation to a healthy adulthood: A report on strategies to increase adolescent immunization rates. Available at: http://www2.aap.org/immunization/pediatricians/pdf/ImmunizationofAdolescents_nfid.pdf. Accessed November 16, 2015.
National Foundation for Infectious Diseases: Adolescent vaccination bridging from a strong childhood foundation to a healthy adulthood: A report on strategies to increase adolescent immunization rates. Available at: http://www2.aap.org/immunization/pediatricians/pdf/ImmunizationofAdolescents_nfid.pdf. Accessed November 16, 2015.
Methods
Results

Study | Study design | Country | Setting | Intervention | Target population | Control | Outcomes assessed |
---|---|---|---|---|---|---|---|
Measles | |||||||
Zhuo et al. [21] | Before–after | China | Community | Supplementary immunization activities | All ages | No supplementary immunization activity | Incidence of measles |
MMR | |||||||
Ogbuanu et al. [22] | Before–after | United States | School | Selective school-based immunization | 9–14 years | No intervention | Incidence of mumps |
Varicella | |||||||
Nguyen et al. [23] | Before–after | United States | Nationwide vaccination | Universal childhood varicella vaccination program | All ages (outcome assessed for 10–19 years) | Before implementation of childhood varicella immunization | Number of deaths caused by varicella infection |
TDaP | |||||||
Quinn and McIntyre [24] | Before–after | Australia | School | School-based delivery of TDaP | 12–19 years | Nonavailability of school-based immunization | Incidence of pertussis |
Rubella | |||||||
Nelson et al. [25] | Before–after | United States | School | Vaccination requirement in school | Girls older than 10 years | Before the vaccination requirement | Rubella susceptibility |
HPV | |||||||
Baandrup et al. [26] | Before–after | Denmark | Countrywide provision | Licensing and mass provision of HPV as part of National HPV Program | 12–19 years | Absence of nationwide HPV availability | Incidence of genital warts |
Bauer et al. [27] | Before–after | United States | Countrywide provision | Introduction population-level administration of HPV vaccine | <21 years | Nonavailability of population-level vaccination | Incidence of genital warts |
Markowitz et al. [28] | Before–after | United States | Countrywide provision | Introduction of HPV vaccine into routine immunization schedule | 14- to 24-year-old females | HPV vaccine not included in routine immunization schedule | Prevalence of HPV |
Mesher et al. [29] | Before–after | England | Countrywide provision | Introduction of National HPV Immunization Program | 16- to 24-year-old females | Nonavailability of population-level vaccination | Prevalence of HPV |
Musto et al. [30] | Quasitrial | Canada | School and community | Within schools vaccination during Grades 1, 5, and 9 | 9- to 11- and 13- to 15-year-old females | Community-based vaccine availability at local community clinics by appointment | Vaccine uptake |
Read et al. [31] | Before–after | Australia | Clinic | Introduction of National HPV Vaccination Program | 12- to 18-year-old females | HPV vaccine not included in national immunization schedule | Incidence of genital warts |
Reiter et al. [32] | Before–after | United States | Nationwide recommendation | National permissive recommendation for HPV vaccine | 11- to 17-year-old males | No recommendation | Vaccine initiation |
Multivaccine | |||||||
Averhoff et al. [33] | Before–after | United States | School | Vaccination requirement in school | Fifth- through eighth-grade students | Students not subject to the requirement | Vaccine coverage |
Bugenske et al. [34] | Quasitrial | United States | School | Vaccination requirement in school | 13–17 years | Students not subject to the requirement | Vaccine coverage |
Carlson and Lewis [35] | Before–after | Canada | School | Vaccination requirement in school | Grades 7–13 | Students not subject to the requirement | Vaccine coverage |
Fogarty et al. [36] | Before–after | United States | School | Vaccination requirement in school | Seventh-grade students | No control | Vaccine coverage |
Harper and Murray [37] | Quasitrial | United States | Clinic | Clinic staff recommended vaccine on every visit | 11–18 years | No recommendation | Vaccine coverage |
Kempe et al. [38] | RCT | United States | School | Recall reminders for vaccination | Sixth-grade male students | No recommendation | Vaccine coverage |
Kharbanda et al. [39] | Before–after | United States | Hospital | Vaccination requirement in school | 11–14 years | Students not subject to the requirement | Vaccine coverage |
Moss et al. [40] | Before–after | United States | Clinic | Clinic staff were invited to attend 1-hour one-on-one webinar on adolescent vaccines and strategies to improve immunization rates such as reviewing and flagging charts, decreasing missed opportunities, recalls, and establishing center guidelines for immunizations. | 12–17 years | No staff training | Vaccine coverage |
Stockwell et al. [41] | RCT | United States | Community | Text message reminders for vaccination | 12–18 years | No reminder | Vaccine coverage |
Suh et al. [42] | RCT | United States | Clinic | Reminders letters and calls for vaccination | 11–18 years | No reminder | Vaccine coverage |
Szilagyi et al. [43] | RCT | United States | Clinic | Mail letters and telephone reminders for vaccination | 11–17 years | No reminder | Vaccine coverage |



Quality assessment | Summary of findings | |||||||
---|---|---|---|---|---|---|---|---|
Number of studies | Design | Limitations | Consistency | Directness | Number of events | RR (95% CI) | ||
Generalizability to population of interest | Generalizability to intervention of interest | Intervention | Control | |||||
Vaccine coverage: moderate outcome-specific quality of evidence | ||||||||
13 studies (14 data sets) | RCT, quasi, and observational studies | Study designs not robust | Twelve studies suggest benefit | All studies targeted adolescents aged 11–19 years in developed countries | Interventions included vaccination requirement in school, reminders, and national permissive recommendation | 5,092 | 4,303 | 1.78 (1.41–2.23) |
HPV prevalence: low outcome-specific quality of evidence | ||||||||
Two studies | Observational studies | Study designs not robust | Both studies suggest benefit | Studies targeted adolescents aged 14–24 years in developed countries | Intervention included introducing HPV vaccine into routine immunization | 499 | 554 | .56 (.38–.82) |
Incidence of genital warts: low outcome-specific quality of evidence | ||||||||
Three studies | Observational studies | Study designs not robust | All three studies suggest benefit | All studies from developed countries targeting adolescents from age 12 to 21 years | All studies focused on increased provision of HPV vaccine through national HPV programs | 3,875 | 5,409 | .66 (.52–.84) |
Varicella deaths: very low outcome-specific quality of evidence | ||||||||
One | Observational study | Study design not robust | Only one study | Intervention targeted all age groups in the United States, outcomes reported for 10- to 19-year age group | Universal childhood varicella vaccination program | 77 | 104 | .74 (.56–.98) |
Mumps incidence: low outcome-specific quality of evidence | ||||||||
One | Quasitrial | No randomization (quasitrial) | Only one study | Adolescents 9–14 years in the United States | School-based immunization | 28 | 7 | .96 (.42–2.21) |
Pertussis incidence: very low outcome-specific quality of evidence | ||||||||
One | Observational study | Study design not robust | Only one study | Interventions targeted adolescents 12–19 years in Australia | School-based delivery of TDaP vaccine | 31 | 128 | .24 (.16–.36) |
Rubella susceptibility: very low outcome specific quality of evidence | ||||||||
One | Observational study | Study design not robust | Only one study | Interventions targeted adolescent girls >10 years in the United States | Vaccination requirement in school | 15 | 49 | .27 (.15–.46) |
Measles incidence: very low outcome-specific quality of evidence | ||||||||
One | Observational study | Study design not robust | Only one study | Interventions targeted all ages in China | Supplementary immunization activities | 3 | 26 | .12 (.03–.38) |
Discussion
John D Piette a, KC Lun b, Lincoln A Moura c, Hamish SF Fraser d, Patricia N Mechael e, John Powell f & Shariq R Khoja g. Impacts of e-health on the outcomes of care in low- and middle-income countries: Where do we go from here? Bulletin of the World Health Organization. Available at: http://www.who.int/bulletin/volumes/90/5/11-099069/en/index.html. Accessed November 16, 2015.
Acknowledgments
Funding Sources
References
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Conflicts of Interest: The authors do not have any financial or nonfinancial competing interests for this review.
Disclaimer: Publication of this article was supported by the Bill and Melinda Gates Foundation. The opinions or views expressed in this supplement are those of the authors and do not necessarily represent the official position of the funder.
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- Evidence and Evidence Gaps in Adolescent HealthJournal of Adolescent HealthVol. 59Issue 4
- PreviewThe momentum to bring adolescents and young adults to center stage in global health and international development is palpable. Adolescents are increasingly seen as a crucial group for the success of the newly adopted Agenda for Sustainable Development [1]. Sitting within the Agenda for Sustainable Development framework, the 2030 Global Strategy for Women's, Children's and Adolescents' Health has extended the Every Woman, Every Child agenda to adolescence [2]. The strategy articulates the need for adolescent responsive health systems as well as social determinants, a focus that extends to legal and policy environments [3].
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