Factors Influencing Completion of Multidose Vaccine Schedules in Adolescents

A Systematic Review

K. E. Gallagher; E. Kadokura; L. O. Eckert; S. Miyake; S. Mounier-Jack; M. Aldea; D. A. Ross; D. Watson-Jones


BMC Public Health. 2016;16(172) 

In This Article


The factors which affect rates of vaccine completion are context and time specific. Providers and programme planners should be aware that obtaining good consent and initiation rates is not enough; sub-groups within the population may need more help than others to complete the series. Efforts need to continue past the first dose to reduce inequality in completion. Adolescents captured for the first dose remain only partially protected from vaccine related disease until receipt of the final dose of the schedule.

Opportunistic vaccination at the delivery point of other services should be utilized as a strategy to increase vaccine completion. There is no evidence that concomitant service delivery is associated with lower completion. Among 11–18 year olds in Seattle, 71 % of visits to a primary health practitioner in 2006–11 were found to be lost opportunities for dose 3 of HPV vaccine.[72] Especially utilizing visits which were not originally for preventative health care services could rapidly improve completion rates and access those adolescents with low healthcare utilization.[71,72]

A Cochrane review in 2005 found 47 articles detailing the effect of patient reminder/recall on vaccine uptake, all were conducted in developed countries, only one study was conducted in adolescents.[73] In pooled results across all age groups, all reminder/recall systems appeared to improve coverage compared to the control groups. Personal telephone reminders were the most effective intervention (OR 1.92; 95 % CI 1.2–3.07). Letter reminders were close to the effectiveness of phone reminders (OR 1.79; 1.5–2.15), a postcard alone was less effective (OR 1.44; 1.09–1.89), and automated phone calls were least effective (OR 1.29; 1.09–1.53). Interventions to improve completion of vaccine series need to be assessed and the use of novel technologies needs to be explored where electronic records and recall systems are not available.