Elsevier

Preventive Medicine

Volume 38, Issue 4, April 2004, Pages 503-509
Preventive Medicine

The role of mobile phones in improving vaccination rates in travelers

https://doi.org/10.1016/j.ypmed.2003.12.005Get rights and content

Abstract

Rationale. Noncompliance with vaccination schedules undermines the potential benefits of immunization. The purpose of this study was to evaluate whether a reminder of the next vaccine dose sent by the Short Messaging Service (SMS) to the vaccinee's mobile phone increases compliance with hepatitis A + B and hepatitis A vaccination schedule.

Subjects and methods. In this experimental, controlled study, the study group comprised travelers who went to the Internacional-Clı́nic Vaccination Centre between the 1st June and 30th September of 2001 for the standard immunization schedule against hepatitis A + B and against hepatitis A. Trained health-care workers entered the data into a computer to generate text messages reminding vaccinees of their scheduled doses. Two control groups, one from the same period of the same year including travelers from the third office (Control 2001) and the second, all travelers seen in the same period of the previous year (Control 2000), were used.

Results. For the second hepatitis A + B dose, compliance in the study group (Message Groups) was 88.4% (83.3–92.2); in the Control 2001, 80.7% (76.3–84.4, relative risk [RR] 1.10 [1.02–1.17]); and in the Control 2000, 77.2% (73.3–80.5, RR 1.15 [1.07–1.22]). For the third hepatitis A + B vaccine dose, results were 47.1% (40.5–53.8); 26.9% (22.8–31.7, RR 1.75 [1.41–2.17]); and 23.6% (20.1–27.4, RR 2.00 [1.63–2.45]), respectively. As for the hepatitis A vaccine, compliance rates for the second dose were 27.7% (23.9–31.9); 16.4% (14.4–18.6, RR 1.69 [1.40–2.04]); and 13.2% (11.6–14.9, RR 2.10 [1.75–2.54]); respectively.

Conclusions. SMS seems to be an effective tool for increasing compliance with vaccination schedules.

Introduction

Studies carried out with the hepatitis A vaccine have shown that a single dose is sufficient to achieve a seroconversion rate of at least 97%, while the rate increases to 99–100% after the second dose [1]. The commercially available combined hepatitis A + B vaccine requires three doses (at 0, 1, and 6 months) to confer a protection close to 100% [2]. Noncompliance with the recommended schedule limits the potential benefits of immunization.

It has been reported that noncompliance with therapeutic prescriptions in routine medical practice is around 50% [3]. The WHO's annual report for 2002 stated that global vaccination coverage in 2001 for the three doses of hepatitis B vaccine was only 30%, and around 75% for three doses of polio (Pol3) and for three doses of DTP (DTP3) [4].

Several factors contribute to the lack of compliance with the medical treatments, including the length of the treatment [5], [6], the occurrence of adverse events [6], [7], the healthcare providers' difficulties in transmitting information, costs, and the complexity of the administration schedule [8], [9], [10]. Other factors include those inherent in patients [11] and the long periods of time required between doses, as is the case for the hepatitis B vaccination schedule [12].

The use of new technologies (Internet, mobile phones) may help to reduce the impact of some of the factors mentioned because they improve the degree of compliance with the therapeutic or preventive actions. Areas where they can be used include the improved transmission of information, as they can be used as an easily accessible tool in monitoring treatments and facilitating access to medication. The new technologies are also of use simply to remind vaccinees when their next injections are due.

International travelers are a group that often requires several vaccination courses comprising more than a dose. Furthermore, some doses have to be administered some time after the traveler has returned home. It has been observed that compliance with therapeutic measures declines over time and that noncompliance is more frequent in preventive treatments due to their very nature; because of the circumstances surrounding their vaccination, travelers are a group of people in whom compliance with vaccination schedules is particularly low [13].

Access to new technologies by those who, for business or pleasure, travel abroad is high, mainly because of the age and cultural level of this group. For these reasons, it was hypothesized that new technologies, including text messaging by mobile phone, could be used as an intervention measure to improve compliance with the vaccination schedule.

The purpose of this study was to assess whether text messaging by mobile phone with computer-generated reminders of the date of administration of the next vaccine dose would lead to increased compliance levels with the hepatitis A + B and hepatitis A vaccination schedules.

Section snippets

Subjects and methods

An experimental, controlled study in which the effectiveness of an intervention measure was evaluated, namely, text messaging to the mobile phone, with a view to obtaining stricter compliance with a medical prescription: the vaccination schedule.

The target population of the study comprised travelers who went to the International-Clı́nic Vaccination Centre during the period from 1st June 2001 to 30th September 2001, to start a vaccination course with the hepatitis A + B vaccine (Twinrix®

Results

During the study period (1st June 2001 to 30th September 2001), 2348 travelers started vaccination courses against hepatitis A + B and the hepatitis A. Messages were sent by mobile phone to a total of 738 travelers. Only one traveler to whom the study was proposed did not want to be reminded. The Control 2001 group comprised 1610 travelers who received the same vaccines during the same period, but not the computer-generated reminders. The Control 2000 group comprised 2247 travelers who had

Discussion

The results of this study suggest that text messages sent to a mobile phone can be an effective intervention measure for adherence to vaccination schedules because compliance greatly improved for the third dose of hepatitis A + B and for the second dose of hepatitis A. The results confirm that these new technologies can be used to increase compliance with vaccination schedules and, very probably, with other preventive or therapeutic measures.

Compliance with medical prescriptions is particularly

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