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School-located intervention program yielded modest increases in influenza vaccination rates
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DENVER — A school-located influenza vaccination intervention program in suburban and urban US schools was linked to a lower increase in vaccination rates than expected, according to findings presented at the Pediatric Academic Societies’ Annual Meeting 2011, held here.
Sharon G. Humiston, MD, MPH, of Children’s Mercy Hospitals & Clinics in Kansas City, Mo., and the University of Rochester Medical Center in Rochester, N.Y., said that the modest increases surprised the researchers.
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“We expected a much bigger bump, but we didn’t get it,” she said.
Another surprising finding, according to Humiston, was that the majority of parents preferred injectable over nasal spray vaccination.
The current randomized controlled trial involved school-based intervention programs in urban and suburban elementary schools in Monroe County, N.Y., during fall 2009. School districts — stratified by urban or suburban designation — were assigned school-located interventions or no school-located interventions.
Services offered included injected and nasal spray influenza vaccines delivered during school hours. Live attenuated and inactivated vaccines were offered.
Interventions were broken down into low- and high-intensity groups. Low-intensity intervention involved mailed notices and blank consent forms in September, and high-intensity intervention involved more frequent notices, blank consent forms in October and two autodialer reminders.
Results
Before intervention, influenza vaccination rates did not differ significantly by intervention group when stratified by suburban or urban schools, with the exception that the suburban high-intervention group had a 28% rate and the suburban low-intervention group had a 31% rate (P=.03).
Across groups, receipt of one or more doses of seasonal vaccine was greater in the high- and low-intervention groups than in the no-intervention groups from Aug. 1, 2009, to Jan. 15, 2010 (P<.01). In urban schools, high intervention was also linked to an increase in receipt of one more vaccine doses compared with low-intervention schools during the same time period (P=0.004).
In a multivariate analysis accounting for location and grade, overall influenza vaccination rates were higher in the high-intervention group compared with controls (OR=1.7, P<.001). In that same analysis, low intervention also was linked to greater overall vaccination rates than controls (OR=1.4, P<.001).
High intervention resulted in a greater impact than low intervention in urban schools (OR=1.3, P=.02). However, the same effect was not observed in suburban schools (OR=1.0, P=.76).
“As expected, vaccination rates were generally higher in suburban areas than urban areas,” Humiston said.
Challenges
“We needed to figure out how much communication with parents was enough,” Humiston said, adding that interventions included letters, postcards, backpack flyers and fact sheets. “We really tried to introduce parents to this concept.”
Some parents who wanted their child vaccinated in school returned incomplete consent forms.
“There were formidable challenges,” she said. “One school district that signed on backed out in the middle of program because they wanted after-school vaccinations rather than vaccinations during school hours.”
This last point raised the issue that if the vaccinations are being done after school, they can be done at a doctor’s office, according to Humiston.
She also noted that conducting the program in one day vs. two days is also a concern, particularly for the vendors who deliver the service.
“The vendor did not do well because getting to school was the main cost,” she said. “Low enrollment in the program may make it not worth the while of the vendor financially. We need to make it cheaper or vendors may not be able to participate.”
Humiston said that school-located influenza vaccination programs are increasing, but that data on the efficacy of such programs are scarce.
“The bottom line is this: how can we increase immunization rates without spending more money?” she said.
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