Marian Smith somehow missed getting a flu shot this year, which is unlike her — in the past, she always got one.The 58-year-old Washington D.C. resident says it was easier to remember to get it when the vaccine was provided at a clinic at work. But now the clinic is a bus ride away, and getting the shot wasn’t at the top of her mind.”Of course, I could get it right here at the grocery store,” Smith tells NPR, as she rushes to pick up her lunch. “But I just didn’t get it — I don’t know, I can’t tell you why.”Maybe a reminder from her doctor would have been the nudge she needed. A review study published by the Cochrane Library this month suggests that reminding people when their vaccinations are due or overdue increases the number of people who get immunized.The team of researchers reviewed 75 studies from 10 countries. Fifty-eight were performed in the U.S.; the remainder were conducted in Australasia, Europe and Africa.The research looked at reminders — via phone calls, texts, email, or post cards — for routine immunizations in infants and children, including MMR (measles, mumps, rubella) and polio. The scientists also reviewed 24 studies of influenza vaccination in adults, and several studies of vaccination rates for routine adult vaccines against other illnesses, such as tetanus and hepatitis B.Overall, the scientists say, about 8 percent more people got their vaccination after getting a reminder compared with those who got no reminder. Similar results were found among studies of children and adults.That may not sound like a lot, the researchers say, but when you consider the population of the U.S., it means many, many infants, children and adults might benefit from a reminder.”All types of patient reminders and recall are likely to be effective,” says Julie Jacobson Vann from the University of North Carolina at Chapel Hill School of Nursing, who led the Cochrane review.But the most effective reminder, she says, was the “old fashioned telephone call — where somebody personally calls someone and lets them know about the benefits of vaccinations, and invites them to come in and be vaccinated.”The next best reminder? Snail mail or a text message.Reminders might be particularly useful for flu shots. While about 90 percent of children are immunized against the most common childhood diseases, that rate sharply drops when it comes to annual vaccinations again influenza. And roughly a third of adults over 65 don’t get the annual shot; they can be at even greater risk of severe complications from the flu than kids.The vast majority of flu-related hospitalizations and deaths occur among people 65 and older, Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville, Tenn., points out.Fortunately, Schaffner says, there are now two vaccines specifically formulated for older adults.”They give more punch to the immune system,” he says, “stimulating it to work better and therefore you get more benefit from the vaccine.”Medicare also covers the cost of the flu vaccine. “All you have to do is roll up your sleeve,” Schaffner says. “Nobody reaches into your wallet — it doesn’t cost you a penny.”But you do have to remember to get the shot before you’re exposed to the flu.Schaffner suggests that the findings of this new analysis, along with the increasing use of electronic medical records, which can make it easy to keep track of vaccinations and send out reminders automatically, should encourage more doctors and healthcare providers to give their patients the helpful nudge many need. Copyright 2018 NPR. To see more, visit http://www.npr.org/.