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Roncaglia S, Amendola A, Baldassarre P, Barilli F, Bianchi S, Biuso A, Chillemi C, Fappani C, Gasparini C, Gori M, Guida G, Ripoli F, Sgambetterra L, Tanzi E, Zuccotti GV. Quadrivalent Live-Attenuated Influenza Vaccine in Milan preschools: an Italian experience of school-located flu vaccination within the 2022-2023 season. Ital J Pediatr 2024; 50:97. [PMID: 38741102 DOI: 10.1186/s13052-024-01649-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/07/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND In Italy, since the 2020-2021 flu season, the flu vaccine recommendation was extended to all children aged 6 months to 6 years and quadrivalent Live-Attenuated Influenza Vaccine (qLAIV) was introduced. Since school-aged children are important carriers of annual influenza epidemics, a school-based influenza vaccination program may potentially increase vaccine uptake. Recent studies, conducted in the UK and the US, show that school-based vaccination can reach higher percentage of paediatric vaccination coverage compared to children vaccinated in other settings. METHODS During 2022-2023 flu season in 9 preschools located in Milan healthcare personnel vaccinated children with qLAIV at the end of a school day. A Google Form questionnaire was administered to preschoolers' parents of all preschools within the Municipality of Milan. RESULTS In the preschools engaged in the vaccination program, 233 out of 1939 children were vaccinated (12%). Among these, 61 (26.2%) had never been vaccinated for influenza before. Vaccination coverage was 11.5% for Italian children and 14.3% for children coming from an immigrant background. We collected 3659 questionnaire responses, divided according to study participation status (371 from preschools that participated in the vaccination program and 3288 from other preschools in Milan). 57% of the families who answered to the questionnaire vaccinated their children for flu. qLAIV accounted for 85.6% of vaccinations. We observed a statistically significant difference in the percentage of vaccinated children between those attending a school participating in the project (67.9%) and children attending other schools (56%) (p < 0.001). Vaccination was administered by family pediatricians (48.9%), in vaccination centers (34.8%), in vaccine hubs (11.3%), in schools (2.6%), by private pediatricians (1.6%) and in other settings (0.7%). Focusing on the responses from families whose children attend schools participating in the vaccination program, 21.8% stated that the vaccination was provided in school. CONCLUSION According to our experience, in Italy, at the moment, only the cooperation between health providers and alternative settings, including schools, may expand flu vaccination coverage. In particular, schools are to be considered a place to inform and reach out to families, useful to increase vaccination coverage.
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Affiliation(s)
| | - Antonella Amendola
- Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
- EpiSoMI CRC -Coordinated Research Center, Università Degli Studi Di Milano, Milan, Italy
| | | | | | - Silvia Bianchi
- Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Andrea Biuso
- Department of Paediatrics, Buzzi Children's Hospital, Milan, Italy
| | - Claudia Chillemi
- Department of Paediatrics, Buzzi Children's Hospital, Milan, Italy
| | - Clara Fappani
- Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Chiara Gasparini
- Department of Paediatrics, Buzzi Children's Hospital, Milan, Italy
| | - Maria Gori
- Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Gabriella Guida
- Department of Paediatrics, Buzzi Children's Hospital, Milan, Italy
| | - Francesca Ripoli
- Department of Paediatrics, Buzzi Children's Hospital, Milan, Italy
| | | | - Elisabetta Tanzi
- Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
- EpiSoMI CRC -Coordinated Research Center, Università Degli Studi Di Milano, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Paediatrics, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinic Sciences, Università Degli Studi Di Milano, Milan, Italy
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Miao C, Lu Q, Wu Y, He J. Evaluating the impact of school-based influenza vaccination programme on absenteeism and outbreaks at schools in Hong Kong: a retrospective cohort study protocol. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:62. [PMID: 38730508 PMCID: PMC11088163 DOI: 10.1186/s41043-024-00561-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Seasonal influenza causes annual school breaks and student absenteeism in Hong Kong schools and kindergartens. This proposal aims to conduct a retrospective cohort study to evaluate the impact of a school-based influenza vaccination (SIV) programme on absenteeism and outbreaks at schools in Hong Kong. METHODS The study will compare schools that implemented the SIV programme with schools that did not. The data will be sourced from school records, encompassing absenteeism records, outbreak reports, and vaccination rates. We will recruit 1000 students from 381 schools and kindergartens in 18 districts of Hong Kong starting June 2024. The primary outcome measures will include absenteeism rates due to influenza and school influenza outbreaks. Secondary outcomes will consist of vaccination coverage rates and the impact of the SIV programme on hospitalisations due to influenza-like illness. A t-test will be conducted to compare the outcomes between schools with and without the SIV programme. ETHICS AND DISSEMINATION The school completed signing the participants' informed consent form before reporting the data to us. Our study has been approved by the Hospital Authority Hong Kong West Cluster IRB Committee (IRB No: UW 17-111) and was a subtopic of the research "The estimated age-group specific influenza vaccine coverage rates in Hong Kong and the impact of the school outreach vaccination program". TRIAL REGISTRATION This study will be retrospectively registered.
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Affiliation(s)
- Chuhan Miao
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, No.5 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Qingyang Lu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, No.5 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Yuqian Wu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, No.5 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Jianxun He
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, No.5 Sassoon Road, Pokfulam, Hong Kong SAR, China.
- Department of Neurosurgery, Gansu Provincial Maternity and Child Care Hospital, No.999 Mogao Avenue, Lanzhou, Gansu, China.
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Hu Y, Yan R, Yin X, Gong E, Xin X, Gao A, Shi X, Wang J, Xue H, Feng L, Zhang J. Effectiveness of Multifaceted Strategies to Increase Influenza Vaccination Uptake: A Cluster Randomized Trial. JAMA Netw Open 2024; 7:e243098. [PMID: 38526493 PMCID: PMC10964116 DOI: 10.1001/jamanetworkopen.2024.3098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/26/2024] [Indexed: 03/26/2024] Open
Abstract
Importance Influenza vaccination rates remain low among primary school students and vary by school in Beijing, China. Theory-informed, multifaceted strategies are needed to improve influenza vaccination uptake. Objective To evaluate the effectiveness of multifaceted strategies in improving influenza vaccination uptake among primary school students. Design, Setting, and Participants This cluster randomized trial was conducted from September 2022 to May 2023 across primary schools in Beijing, China. Schools were allocated randomly in a 1:1 ratio to multifaceted strategies or usual practice. Schools were deemed eligible if the vaccination rates in the 2019 to 2020 season fell at or below the district-wide average for primary schools. Eligible participants included students in grades 2 and 3 with no medical contraindications for influenza vaccination. Intervention The multifaceted strategies intervention involved system-level planning and coordination (eg, developing an implementation blueprint, building social norms, and enhancing supervision), school-level training and educating school implementers (eg, conducting a 1-hour training and developing educational materials), and individual-level educating and reminding students and parents (eg, conducting educational activities and sending 4 reminders about vaccination). Main Outcomes and Measures The primary outcomes were influenza vaccination uptake at school reported by school clinicians as well as overall vaccine uptake either at school or outside of school as reported by parents at 3 months. Generalized linear mixed models were used for analysis. Results A total of 20 schools were randomized. One intervention school and 2 control schools did not administer vaccination on school grounds due to COVID-19, resulting in a total of 17 schools (9 intervention and 8 control). There was a total of 1691 students aged 7 to 8 years (890 male [52.6%]; 801 female [47.4%]) including 915 in the intervention group and 776 in the control group. Of all participants, 848 (50.1%) were in grade 2, and 1209 (71.5%) were vaccinated in the 2021 to 2022 season. Participants in the intervention and control groups shared similar characteristics. At follow-up, of the 915 students in the intervention group, 679 (74.5%) received a vaccination at school, and of the 776 students in the control group, 556 (71.7%) received a vaccination at school. The overall vaccination rates were 76.0% (695 of 915 students) for the intervention group and 71.3% (553 of 776 students) for the control group. Compared with the control group, there was significant improvement of vaccination uptake at school (odds ratio, 1.40; 95% CI, 1.06-1.85; P = .02) and overall uptake (odds ratio, 1.49; 95% CI, 1.12-1.99; P = .01) for the intervention group. Conclusions and Relevance In this study, multifaceted strategies showed modest effectiveness in improving influenza vaccination uptake among primary school students, which provides a basis for the implementation of school-located vaccination programs of other vaccines in China, and in other countries with comparable programs. Trial registration Chinese Clinical Trial Registry: ChiCTR2200062449.
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Affiliation(s)
- Yiluan Hu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruijie Yan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xuejun Yin
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Enying Gong
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin Xin
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Aiyu Gao
- Dongcheng Primary and Secondary School Health Care Center, Beijing, China
| | - Xiaoyan Shi
- Dongcheng Primary and Secondary School Health Care Center, Beijing, China
| | - Jing Wang
- Department of Infectious Disease, Dongcheng Center for Disease Control and Prevention, Beijing, China
| | - Hao Xue
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, California
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Juan Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
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Boyce TG, Christianson B, Hanson KE, Dunn D, Polter E, VanWormer JJ, Williams CL, Belongia EA, McLean HQ. Factors associated with human papillomavirus and meningococcal vaccination among adolescents living in rural and urban areas. Vaccine X 2022; 11:100180. [PMID: 35755142 PMCID: PMC9218554 DOI: 10.1016/j.jvacx.2022.100180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/01/2022] Open
Abstract
Background Studies have shown that adolescent vaccination rates with human papillomavirus (HPV) and quadrivalent meningococcal conjugate (MenACWY) vaccines are lower in rural areas of the U.S. than in urban areas. We sought to determine factors associated with vaccine acceptance in these two settings. Methods We conducted a cross-sectional survey of 536 parents or guardians of teens age 13 through 15 years in select rural and urban counties of Minnesota and Wisconsin. We collected information on demographic variables, receipt of adolescent vaccines, and attitudes toward HPV vaccine in particular. Multivariable logistic regression models were used to assess associations between covariates and outcomes of interest (HPV vaccine receipt and MenACWY receipt). Results Of the 536 respondents, 267 (50%) resided in a rural county. Most respondents were female (78%) and non-Hispanic White (88%). About half (52%) of teens of the surveyed parents received the three vaccines recommended specifically for adolescents: 90% received tetanus-diphtheria-acellular pertussis (Tdap), 84% received MenACWY, and 60% received one or more doses of HPV vaccine. Rural and urban parents surveyed differed on several covariates relating to teen's health services, parent's demographics, and household characteristics. Parent's perception of the importance that their healthcare providers placed on vaccination with HPV and MenACWY were independently associated with receipt of each of those vaccines (odds ratio [OR] 6.37, 95% confidence interval [CI] 2.90-13.96 and OR 2.15, 95% CI 1.07-4.31, respectively). Parents of vaccinated teens were less likely to report concerns about potential harm from the HPV vaccine or having heard stories about health problems caused by the HPV vaccine. Conclusion Teen receipt of HPV vaccine and MenACWY appears to be influenced by parents' perception of vaccine importance, provider recommendations, and concerns regarding potential harm from the HPV vaccine. Continued education of providers and parents of the importance of adolescent vaccinations is warranted.
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Key Words
- Adolescent
- CDC, Centers for Disease Control and Prevention
- CHIAS, Carolina HPV Immunization Attitudes and Beliefs Scale
- HPV, human papillomavirus
- Human papillomavirus
- IIS, immunization information system
- IRB, Institutional Review Board
- MCRI, Marshfield Clinic Research Institute
- MDH, Minnesota Department of Health
- MIIC, Minnesota Immunization Information Connection
- MenACWY, quadrivalent meningococcal conjugate vaccine
- Rural population
- Tdap, tetanus-diphtheria-acellular pertussis vaccine
- UIC, Urban Influence Codes
- Vaccinations
- WIR, Wisconsin Immunization Registry
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Affiliation(s)
- Thomas G Boyce
- Marshfield Clinic Research Institute, Marshfield, WI, USA
| | | | - Kayla E Hanson
- Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Denise Dunn
- Minnesota Department of Health, St. Paul, MN, USA
| | | | | | - Charnetta L Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Huong Q McLean
- Marshfield Clinic Research Institute, Marshfield, WI, USA
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Zhou F, Lindley MC. Variability in influenza vaccination opportunities and coverage among privately insured children. Vaccine 2020; 38:6464-6471. [PMID: 32826105 PMCID: PMC11326137 DOI: 10.1016/j.vaccine.2020.07.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 05/26/2020] [Accepted: 07/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Universal influenza vaccination has been recommended since 2010, yet influenza vaccination rates among children aged 6 months to 17 years remain low compared with other routinely recommended childhood vaccines. OBJECTIVE Assess in-plan vaccination coverage, opportunities, and missed opportunities during the 2016-2017 influenza season. STUDY DESIGN Retrospective analyses using 2016-2017 MarketScan® data for 2,768,799 privately insured children aged 1-17 years by the end of 2016 who were continuously enrolled in the same insurance plan during the 2016-2017 influenza season (defined as August 1, 2016 through May 31, 2017). We assessed in-plan vaccination coverage (percentage receiving ≥ 1 dose of influenza vaccine from August 2016-May 2017) and vaccination opportunities (percentage with ≥ 1 provider visit between September 2016 - May 2017). Among children who remained unvaccinated at the end of the season, those with ≥ 1 influenza vaccination opportunity between September 2016-May 2017 were determined to have a missed opportunity. RESULTS In-plan vaccination coverage during the 2016-17 season was 67.7% in infants (born 2015), 49.5% in toddlers (born 2012-2014), 35.0% in school-aged children (born 2004-2011), and 22.3% in teenagers (born 1999-2003). Like vaccination coverage, vaccination opportunities decreased with age (infants: 97.7%, toddlers: 91.9%, school-aged children: 82.6%, teenagers: 79.3%). Among unvaccinated children, 93.1%, 84.1%, 73.6% and 73.6% of each age group had a missed opportunity for influenza vaccination. CONCLUSION Opportunities for and coverage with influenza vaccination vary even among privately insured children. Along with continued efforts to reduce missed opportunities, effective strategies to bring children to their doctor for annual influenza vaccination are needed, particularly for older children.
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Affiliation(s)
- Fangjun Zhou
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, 30329, United States.
| | - Megan C Lindley
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, 30329, United States
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Benjamin-Chung J, Arnold BF, Kennedy CJ, Mishra K, Pokpongkiat N, Nguyen A, Jilek W, Holbrook K, Pan E, Kirley PD, Libby T, Hubbard AE, Reingold A, Colford JM. Evaluation of a city-wide school-located influenza vaccination program in Oakland, California, with respect to vaccination coverage, school absences, and laboratory-confirmed influenza: A matched cohort study. PLoS Med 2020; 17:e1003238. [PMID: 32810149 PMCID: PMC7433855 DOI: 10.1371/journal.pmed.1003238] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 07/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is estimated that vaccinating 50%-70% of school-aged children for influenza can produce population-wide indirect effects. We evaluated a city-wide school-located influenza vaccination (SLIV) intervention that aimed to increase influenza vaccination coverage. The intervention was implemented in ≥95 preschools and elementary schools in northern California from 2014 to 2018. Using a matched cohort design, we estimated intervention impacts on student influenza vaccination coverage, school absenteeism, and community-wide indirect effects on laboratory-confirmed influenza hospitalizations. METHODS AND FINDINGS We used a multivariate matching algorithm to identify a nearby comparison school district with pre-intervention characteristics similar to those of the intervention school district and matched schools in each district. To measure student influenza vaccination, we conducted cross-sectional surveys of student caregivers in 22 school pairs (2017 survey, N = 6,070; 2018 survey, N = 6,507). We estimated the incidence of laboratory-confirmed influenza hospitalization from 2011 to 2018 using surveillance data from school district zip codes. We analyzed student absenteeism data from 2011 to 2018 from each district (N = 42,487,816 student-days). To account for pre-intervention differences between districts, we estimated difference-in-differences (DID) in influenza hospitalization incidence and absenteeism rates using generalized linear and log-linear models with a population offset for incidence outcomes. Prior to the SLIV intervention, the median household income was $51,849 in the intervention site and $61,596 in the comparison site. The population in each site was predominately white (41% in the intervention site, 48% in the comparison site) and/or of Hispanic or Latino ethnicity (26% in the intervention site, 33% in the comparison site). The number of students vaccinated by the SLIV intervention ranged from 7,502 to 10,106 (22%-28% of eligible students) each year. During the intervention, influenza vaccination coverage among elementary students was 53%-66% in the comparison district. Coverage was similar between the intervention and comparison districts in influenza seasons 2014-2015 and 2015-2016 and was significantly higher in the intervention site in seasons 2016-2017 (7%; 95% CI 4, 11; p < 0.001) and 2017-2018 (11%; 95% CI 7, 15; p < 0.001). During seasons when vaccination coverage was higher among intervention schools and the vaccine was moderately effective, there was evidence of statistically significant indirect effects: The DID in the incidence of influenza hospitalization per 100,000 in the intervention versus comparison site was -17 (95% CI -30, -4; p = 0.008) in 2016-2017 and -37 (95% CI -54, -19; p < 0.001) in 2017-2018 among non-elementary-school-aged individuals and -73 (95% CI -147, 1; p = 0.054) in 2016-2017 and -160 (95% CI -267, -53; p = 0.004) in 2017-2018 among adults 65 years or older. The DID in illness-related school absences per 100 school days during the influenza season was -0.63 (95% CI -1.14, -0.13; p = 0.014) in 2016-2017 and -0.80 (95% CI -1.28, -0.31; p = 0.001) in 2017-2018. Limitations of this study include the use of an observational design, which may be subject to unmeasured confounding, and caregiver-reported vaccination status, which is subject to poor recall and low response rates. CONCLUSIONS A city-wide SLIV intervention in a large, diverse urban population was associated with a decrease in the incidence of laboratory-confirmed influenza hospitalization in all age groups and a decrease in illness-specific school absence rate among students in 2016-2017 and 2017-2018, seasons when the vaccine was moderately effective, suggesting that the intervention produced indirect effects. Our findings suggest that in populations with moderately high background levels of influenza vaccination coverage, SLIV programs are associated with further increases in coverage and reduced influenza across the community.
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Affiliation(s)
- Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Benjamin F. Arnold
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
| | - Chris J. Kennedy
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Kunal Mishra
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Nolan Pokpongkiat
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Anna Nguyen
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Wendy Jilek
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Kate Holbrook
- Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, Oakland, California, United States of America
| | - Erica Pan
- Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, Oakland, California, United States of America
- Department of Pediatrics, Division of Infectious Diseases, University of California, San Francisco, San Francisco, California, United States of America
| | - Pam D. Kirley
- California Emerging Infections Program, Oakland, California, United States of America
| | - Tanya Libby
- California Emerging Infections Program, Oakland, California, United States of America
| | - Alan E. Hubbard
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Arthur Reingold
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - John M. Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
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Kempe A, Saville AW, Albertin C, Helmkamp L, Zhou X, Vangela S, Dickinson LM, Tseng CH, Campbell JD, Whittington M, Gurfinkel D, Roth H, Hoefer D, Szilagyi P. Centralized Reminder/Recall to Increase Influenza Vaccination Rates: A Two-State Pragmatic Randomized Trial. Acad Pediatr 2020; 20:374-383. [PMID: 31698085 PMCID: PMC7477488 DOI: 10.1016/j.acap.2019.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Centralized reminder/recall (C-R/R) by health departments using immunization information systems is more effective and cost effective than practice-based approaches for increasing childhood vaccines but has not been studied for influenza vaccination. We assessed effectiveness and cost of C-R/R for increasing childhood influenza vaccination compared with usual care. METHODS Within Colorado (CO) and New York (NY), random samples of primary care practices (pediatric, family medicine, and health center) were selected proportionate to where children are served-65 practices (N = 54,353 children) in CO; 101 practices (N = 65,777) in NY. We conducted 4-arm RCTs per state (1, 2, or 3 autodial reminders vs usual care), with randomization at the patient level within practices from 10/2016 to 1/2017. RESULTS In CO, the maximum absolute difference in receipt of ≥1 influenza vaccine was 1.7% between the 2 R/R group and control (adjusted risk ratio [ARR] of 1.06 [1.01, 1.10]); other R/R arms did not differ significantly. In NY, ARRs for the study arms versus control varied from 1.05 (1.01, 1.10) for 3 R/R to 1.06 (1.01, 1.11) for 1-2 R/R groups and maximum absolute increase in vaccination was 0.6%. In time-to-event analyses, study arm was a significant predictor of vaccination in CO (P = .001) but not in NY. Costs/child randomized to one message were $.17 in CO and $.23 in NY. CONCLUSIONS C-R/R for influenza vaccine using autodial had low-level effects on increasing influenza rates in 2 states. Given the feasibility and low cost of C-R/R in previous trials, its utility for influenza should be re-examined using different modalities.
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Affiliation(s)
- Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine (A Kempe), Aurora, Colo.
| | - Alison W Saville
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo
| | - Christina Albertin
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles (C Albertin and P Szilagyi), Los Angeles, Calif
| | - Laura Helmkamp
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo
| | - Xinkai Zhou
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California (X Zhou, S Vangela, and C-H Tseng), Los Angeles, Calif
| | - Sitaram Vangela
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California (X Zhou, S Vangela, and C-H Tseng), Los Angeles, Calif
| | - L Miriam Dickinson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo; Department of Family Medicine, University of Colorado School of Medicine (LM Dickinson), Aurora, Colo
| | - Chi-Hong Tseng
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California (X Zhou, S Vangela, and C-H Tseng), Los Angeles, Calif
| | - Jonathan D Campbell
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus (JD Campbell and M Whittington), Aurora, Colo
| | - Melanie Whittington
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus (JD Campbell and M Whittington), Aurora, Colo
| | - Dennis Gurfinkel
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo
| | - Heather Roth
- Colorado Immunization Information System, Colorado Department of Public Health and Environment (H Roth), Denver, Colo
| | - Dina Hoefer
- New York State Immunization Information System, New York State Department of Health (D Hoefer), Albany, NY
| | - Peter Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles (C Albertin and P Szilagyi), Los Angeles, Calif
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Weinberg GA. Nontraditional Uses of Live Attenuated Influenza Vaccine: School-Located Influenza Vaccination. J Pediatric Infect Dis Soc 2020; 9:S19-S23. [PMID: 32191311 DOI: 10.1093/jpids/piaa007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Immunization against influenza continues to be the best method of preventing influenza infection in children, and additionally, indirectly helping to lower disease in adults, given the role of children as "spreaders" of influenza to the community at large. An increasing evidence base exists for the use of school-located influenza vaccination (SLIV) programs to increase the influenza vaccination rates among children. Live, attenuated influenza vaccine (LAIV) has unique characteristics that make it useful for SLIV programs, including ease of immunization without needles, faster delivery, and in many (but not all) years, good vaccine effectiveness. Reviewed herein are results of selected published trials as well as guidance on planning a successful SLIV program.
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Affiliation(s)
- Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, University of Rochester Golisano Children's Hospital, Rochester, New York, USA
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Frascella B, Oradini-Alacreu A, Balzarini F, Signorelli C, Lopalco PL, Odone A. Effectiveness of email-based reminders to increase vaccine uptake: a systematic review. Vaccine 2020; 38:433-443. [DOI: 10.1016/j.vaccine.2019.10.089] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/25/2019] [Accepted: 10/27/2019] [Indexed: 01/08/2023]
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Szilagyi PG, Schaffer S, Rand CM, Goldstein NP, Hightower AD, Younge M, Albertin CS, DiBitetto K, Yoo BK, Humiston SG. School-Located Influenza Vaccination: Do Vaccine Clinics at School Raise Vaccination Rates? THE JOURNAL OF SCHOOL HEALTH 2019; 89:1004-1012. [PMID: 31612491 DOI: 10.1111/josh.12840] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Only half of US schoolchildren receive influenza vaccine. School-located influenza vaccination (SLIV) might raise vaccination rates but conducting flu vaccine clinics at schools is challenging to implement. We compared 2 school-based programs designed to raise influenza vaccination rates: parent reminder/educational messages sent to parents from schools which is a low-intensity intervention vs the combination of reminder/educational messages plus SLIV clinics which is a high-intensity intervention. METHODS We assigned 36 schools (6 school districts, 2 per group) to 3 groups: (1) control, ie, no SLIV and no parent reminder/education, (2) parent reminder/education emailed by schools, and (3) parent reminder/education plus SLIV clinics. Some schools had SLIV clinics in prior years. Health department nurses conducted SLIV clinics. RESULTS Among 24,832 children at 36 schools, vaccination rates were control (51.3%), parent reminder/education-only (41.2%), and reminder/education + SLIV (58.7%). On multivariate analyses which controlled for vaccination in prior seasons, children in reminder/education + SLIV schools had higher vaccination rates (OR 1.27, 95% CI 1.10-1.47), but children in reminder/education-only schools had lower rates (OR 0.87, 95% CI 0.75-1.00) than children in control schools. CONCLUSIONS Parent reminder/education combined with SLIV clinics raise vaccination rates, but parent reminder/education alone does not.
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Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California Los Angeles (UCLA), Los Angeles, CA, 10833
| | - Stanley Schaffer
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642
| | - Cynthia M Rand
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642
| | - Nicolas Pn Goldstein
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642
| | - A Dirk Hightower
- Department of Clinical and Social Psychology, University of Rochester and Children's Institute, Rochester, NY, 14642
| | - Mary Younge
- Department of Public Health, Monroe County, NY, 14620
| | - Christina S Albertin
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California Los Angeles (UCLA), Los Angeles, CA, 14642
| | - Kristine DiBitetto
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642
| | - Byung-Kwang Yoo
- Department of Public Health Sciences, University of California at Davis, Davis, CA, 95616
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Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children. BMC Health Serv Res 2019; 19:407. [PMID: 31234842 PMCID: PMC6591987 DOI: 10.1186/s12913-019-4228-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 06/07/2019] [Indexed: 12/04/2022] Open
Abstract
Background Studies have noted variations in the cost-effectiveness of school-located influenza vaccination (SLIV), but little is known about how SLIV’s cost-effectiveness may vary by targeted age group (e.g., elementary or secondary school students), or vaccine consent process (paper-based or web-based). Further, SLIV’s cost-effectiveness may be impacted by its spillover effect on practice-based vaccination; prior studies have not addressed this issue. Methods We performed a cost-effectiveness analysis on two SLIV programs in upstate New York in 2015–2016: (a) elementary school SLIV using a stepped wedge design with schools as clusters (24 suburban and 18 urban schools) and (b) secondary school SLIV using a cluster randomized trial (16 suburban and 4 urban schools). The cost-per-additionally-vaccinated child (i.e., incremental cost-effectiveness ratio (ICER)) was estimated by dividing the incremental SLIV intervention cost by the incremental effectiveness (i.e., the additional number of vaccinated students in intervention schools compared to control schools). We performed deterministic analyses, one-way sensitivity analyses, and probabilistic analyses. Results The overall effectiveness measure (proportion of children vaccinated) was 5.7 and 5.5 percentage points higher, respectively, in intervention elementary (52.8%) and secondary schools (48.2%) than grade-matched control schools. SLIV programs vaccinated a small proportion of children in intervention elementary (5.2%) and secondary schools (2.5%). In elementary and secondary schools, the ICER excluding vaccine purchase was $85.71 and $86.51 per-additionally-vaccinated-child, respectively. When additionally accounting for observed spillover impact on practice-based vaccination, the ICER decreased to $80.53 in elementary schools -- decreasing substantially in secondary schools. (to $53.40). These estimates were higher than the published practice-based vaccination cost (median = $25.50, mean = $45.48). Also, these estimates were higher than our 2009–2011 urban SLIV program mean costs ($65) due to additional costs for use of a new web-based consent system ($12.97 per-additionally-vaccinated-child) and higher project coordination costs in 2015–2016. One-way sensitivity analyses showed that ICER estimates were most sensitive to the SLIV effectiveness. Conclusions SLIV raises vaccination rates and may increase practice-based vaccination in primary care practices. While these SLIV programs are effective, to be as cost-effective as practice-based vaccination our SLIV programs would need to vaccinate more students and/or lower the costs for consent systems and project coordination. Trial Registration ClinicalTrials.govNCT02227186 (August 25, 2014), updated NCT03137667 (May 2, 2017). Electronic supplementary material The online version of this article (10.1186/s12913-019-4228-5) contains supplementary material, which is available to authorized users.
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Szilagyi PG, Schaffer S, Rand CM, Goldstein NPN, Younge M, Mendoza M, Albertin CS, Concannon C, Graupman E, Hightower AD, Yoo BK, Humiston SG. Text Message Reminders for Child Influenza Vaccination in the Setting of School-Located Influenza Vaccination: A Randomized Clinical Trial. Clin Pediatr (Phila) 2019; 58:428-436. [PMID: 30600690 DOI: 10.1177/0009922818821878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Half of US school children receive influenza vaccine. In our previous trials, school-located influenza vaccination (SLIV) raised vaccination rates by 5 to 8 percentage points. We assessed whether text message reminders to parents could raise vaccination rates above those observed with SLIV. Within urban elementary schools we randomized families into text message + SLIV (intervention) versus SLIV alone (comparison). All parents were sent 2 backpack notifications plus 2 autodialer phone reminders about SLIV at a single SLIV clinic. Intervention group parents also were sent 3 text messages from the school nurse encouraging flu vaccination via either primary care or SLIV. Among 15 768 children at 32 schools, vaccination rates were text + SLIV (40%) and SLIV control (40%); 4% of students per group received influenza vaccination at SLIV. Text message reminders did not raise influenza vaccination rates above those observed with SLIV alone. More intensive interventions are needed to raise influenza vaccination rates.
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Affiliation(s)
- Peter G Szilagyi
- 1 University of California Los Angeles Mattel Children's Hospital, Los Angeles, CA, USA
| | - Stanley Schaffer
- 2 Golisano Children's Hospital, Rochester, NY, USA.,3 University of Rochester, Rochester, NY, USA
| | - Cynthia M Rand
- 2 Golisano Children's Hospital, Rochester, NY, USA.,3 University of Rochester, Rochester, NY, USA
| | - Nicolas P N Goldstein
- 2 Golisano Children's Hospital, Rochester, NY, USA.,3 University of Rochester, Rochester, NY, USA
| | - Mary Younge
- 3 University of Rochester, Rochester, NY, USA
| | - Michael Mendoza
- 3 University of Rochester, Rochester, NY, USA.,4 Department of Public Health, Monroe County, NY, Rochester, NY, USA
| | - Christina S Albertin
- 1 University of California Los Angeles Mattel Children's Hospital, Los Angeles, CA, USA
| | - Cathleen Concannon
- 2 Golisano Children's Hospital, Rochester, NY, USA.,3 University of Rochester, Rochester, NY, USA
| | - Erin Graupman
- 5 Rochester City School District, Rochester, New York, NY, USA
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Schaffer SJ, Rand CM, Humiston SG, Concannon C, Hightower AD, Albertin C, Szilagyi PG. Practical considerations in developing a successful school-located influenza vaccination (SLIV) program. Vaccine 2019; 37:2171-2173. [PMID: 30878250 DOI: 10.1016/j.vaccine.2019.01.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/27/2018] [Accepted: 01/03/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Stanley J Schaffer
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester, 601 Elmwood Ave., Box 777, Rochester, NY 14642, USA.
| | - Cynthia M Rand
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester, 601 Elmwood Ave., Box 777, Rochester, NY 14642, USA.
| | - Sharon G Humiston
- Department of Pediatrics, Children's Mercy Medical Center - Northland, University of Missouri - Kansas City (UMKC), 501 NW Barry Rd., Kansas City, MO 64155, USA.
| | - Cathleen Concannon
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester, 601 Elmwood Ave., Box 777, Rochester, NY 14642, USA.
| | - A Dirk Hightower
- Department of Clinical and Social Psychology, University of Rochester, and Children's Institute, 274 N. Goodman St., Rochester, NY 14607, USA.
| | | | - Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California Los Angeles (UCLA), 10833 LeConte Ave., MC 175217, Los Angeles, CA, USA.
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Bekkat-Berkani R, Romano-Mazzotti L. Understanding the unique characteristics of seasonal influenza illness to improve vaccine uptake in the US. Vaccine 2018; 36:7276-7285. [PMID: 30366802 DOI: 10.1016/j.vaccine.2018.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 12/31/2022]
Abstract
Seasonal influenza results in substantial morbidity, mortality and socio-economic burden. The US Advisory Committee on Immunization Practices recommends vaccination of everyone over 6 months of age, but coverage remains substantially below the Healthy People 2020 target of 70% in most age groups. Influenza is different from other vaccine-preventable diseases in several ways that influence vaccine uptake. Although the incidence of most vaccine-preventable diseases is low, there is a perception that these diseases result in significant illness or death. In contrast, seasonal influenza has a relatively high incidence, but there is an incorrect perception of a lower disease severity. The vaccine effectiveness of seasonal influenza vaccines is less than other routine vaccines, varies from season to season between northern and southern hemispheres, and can be low in some seasons. It is also not well recognized that vaccination can attenuate the severity of influenza illness. Finally, the need for annual vaccination is perceived as a burden to busy people. Understanding these differences from the perspective of caregivers and vaccinees might help to improve influenza vaccine uptake. Presenting vaccine effectiveness in terms of clinical outcomes that have the most impact might help to overcome the perceptions that influenza is a non-serious disease and that the vaccine is not effective. The benefits of disease attenuation need to be emphasized in terms of reduced mortality, hospitalization, absenteeism and disruption to daily life. Innovative communication strategies should be adopted, including stronger recommendations from and to healthcare providers, continuous patient education, and social media initiatives employing more emotional and narrative approaches than traditionally used. Finally, access to seasonal influenza vaccination needs to be improved, and barriers such as cost and inconvenience removed. Multiple initiatives have already been successful. The remaining challenge is to translate individual successes into public health policies with corresponding funding and implementation.
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