Impact of elementary school-located influenza vaccinations: A stepped wedge trial across a community |
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| Affiliation: | 1. Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California Los Angeles (UCLA), Los Angeles, CA, USA;2. Department of Pediatrics, Golisano Children’s Hospital, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA;3. Department of Clinical and Social Psychology, University of Rochester and Children’s Institute Rochester, NY, USA;4. Department of Public Health, Monroe County, NY, USA;5. Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, USA;6. Department of Public Health Sciences, University of California at Davis, Davis, CA, USA;7. Department of Pediatrics, Children’s Mercy, Kansas City, MO, USA;8. Pop Health/Analytics Group, NextGen Healthcare, Fairport, NY, USA;1. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States;2. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States;3. Emory Vaccine Center, Emory University, Atlanta, GA, United States;4. Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, United States;1. Emory University, Department of Epidemiology and Laney Graduate School, Atlanta, GA, United States;2. Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, and Division of Infectious Diseases, Department of Medicine, Atlanta, GA, United States;3. Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, United States;4. Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, United States;5. Emory University, School of Medicine, Department of Gynecology and Obstetrics, Atlanta, GA, United States;6. University of Kansas Medical Center, Department of Obstetrics and Gynecology, Kansas City, KS, United States;7. Emory University, Emory Vaccine Center and School of Medicine, Atlanta, GA, United States;8. Emory University, Department of Pediatrics, Atlanta, GA, United States;1. Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;2. Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan;3. Yoiko-no Shounika Sato, Niigata, Japan;4. Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;5. Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan;1. Department of Pediatrics, University of Washington, Seattle, WA, United States;2. Seattle Children’s Research Institute, Seattle, WA, United States;3. Department of Pediatrics, Columbia University, New York, NY, United States;4. NewYork-Presbyterian Hospital, New York, NY, United States;5. Department of Psychiatry, Columbia University, New York, NY, United States;6. Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States;1. Department of Obstetrics, Gynecology, & Reproductive Sciences, School of Medicine, Yale University, PO Box 208063, New Haven, CT 06520-8063, United States;2. Department of Pediatrics, School of Medicine, Yale University, P.O. Box 208064, New Haven, CT 06520-8064, United States;3. Department of Investigative Medicine, School of Medicine, Yale University, 2 Church Street South, Suite 114, New Haven, CT 06519, United States;4. Women’s Center Clinic, Yale New Haven Hospital, 789 Howard Ave., New Haven, CT 06519, United States;5. Yale School of Medicine, Yale University, 333 Cedar Street, New Haven, CT 06510, United States;1. Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia;2. Discipline of Paediatric and Child Health, University of Sydney, Sydney, Australia;3. The Children''s Hospital at Westmead, Cnr Hawksbury Rd & Hainsworth St, Locked Bag 4001, Westmead, NSW 2145, Australia;4. National Centre for Immunisation, Research and Surveillance, Sydney, Australia;5. Kids Research Institute at The Children''s Hospital at Westmead, Cnr Hawksbury Rd & Hainsworth St, Locked Bag 4001, Westmead, NSW 2145, Australia;6. Western Sydney Sexual Health Centre, University of Sydney, Jeffery House, Marsden St, Paramatta, NSW, Australia;7. Discipline of Obstetrics & Gynaecology and Neonatology, University of Sydney, Sydney, Australia;8. Northern Clinical School at Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia |
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| Abstract: | BackgroundInfluenza vaccination rates among children are low and novel strategies are needed to raise coverage. We measured the impact of school-located influenza vaccination (SLIV) on coverage, examined whether SLIV substitutes for practice-based influenza vaccination (“substitution”), and estimated whether a second year of experience with SLIV increases its impact.MethodsWe implemented a stepped wedge study design with schools as clusters. In Year 1, we randomly allocated schools to SLIV or control. In Year 2, all schools performed SLIV. We used emails (suburban schools) or backpack fliers (both urban and suburban schools) to notify parents, and offered web-based (suburban) or paper-based vaccination (urban) consent forms. Local health department nurses administered SLIV vaccinations and billed insurers. We analyzed state immunization registry data to measure influenza vaccination rates.Results42 schools (38,078 children) participated over 2 years. Overall vaccination rates were 5 and 7 percentage points higher among SLIV- school children versus control-school children in suburban (aOR 1.36, 95% CI 1.25–1.49 in Years 1–2 SLIV vs. Year 1 control schools) and urban schools (aOR 1.22, 95% CI 1.10–1.36), respectively, adjusting for prior year’s vaccination and other covariates. While no substitution occurred among children attending suburban schools, some substitution occurred among children attending urban schools, although overall vaccination rates were still higher in urban schools due to SLIV. Compared to an initial year of SLIV, more children were vaccinated in a second year of SLIV at urban (8.3% vs. 6.8%, aOR 1.24, 95% CI 1.04–1.47) but not suburban schools (3.5% vs. 2.7%, aOR 1.24, 95% CI 0.98–1.57).ConclusionsIn this stepped wedge trial, SLIV increased overall influenza vaccination rates in suburban and urban schools. Some substitution for primary care vaccination occurred in urban settings. A second year of SLIV expanded its reach slightly in urban schools. |
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