Researchers at Emory University School of Medicine and Rollins School of Public Health compared vaccination rates among adolescents in one county, where flu shot clinics were held in the schools, to another county where flu vaccine was made available through health care providers and a third county where no extra programs were implemented.
In both the “school-based” and “provider-based” counties, parents received educational materials and students watched their peers put on a skit about the benefits of vaccination at school. The difference was where vaccination was provided.
The results will be published in the November 2011 issue of the journal Pediatrics. All three counties are in the East Central Health District of Georgia.
“The effectiveness of school-based vaccination programs has been demonstrated in other states, but we wanted to take a closer look at participation among adolescents, and especially among a rural, primarily African-American population,” says first author Lisa Gargano, PhD, manager of research projects in the Division of Infectious Diseases at Emory University School of Medicine.
“One of the main reasons why school-based programs are recognized as being more effective is because of convenience,” she says. “But we wanted to know whether parents in this population would accept flu shots that are not being given by a doctor.”
The senior author is James M. Hughes, MD, professor of medicine and public health at Emory and president of the Infectious Diseases Society of America (IDSA).
This fall, 17 out of 18 health districts in Georgia are participating in a state public health program offering flu shots in school-based clinics, although not every school will hold a flu clinic. For example, the three counties that participated in the published study are not holding school-based clinics this year, Gargano says.
Holding a school clinic day puts a substantial burden on a health department in a small rural county, requiring the main public health office to be closed.
The data in the paper shows a clear difference between school-based and provider-based programs, especially in the second year, although both school-based and provider-based counties saw an increase in vaccination coverage. Student vaccination rates in the school-based county started at 5.2 percent in the 2007-2008 season and rose to 18.9 percent in 2008-2009 and then 30.4 percent in 2009-2010.
In the provider-based county, the vaccination rate started at 10 percent and increased to 14.9 percent and then 18.4 percent. The rate for the “standard-of-care” county also increased from 6.6 percent to 8 percent and then 15.2 percent. For all three counties, some of the increase in vaccination rates in the 2009-2010 season can be attributed to media attention on the H1N1 flu epidemic, Gargano says.
“Even so, we think the educational programs were effective because both parents and students were targeted, because the programs were developed together with community members and because the study team was available during open houses and school presentations,” she says.
Even 30 percent vaccination rate is relatively low. For comparison, 61.8 percent of adults 65 and over in Georgia received a seasonal flu shot in 2010. The study did examine school absentee rates in each county as a way to gauge effectiveness, but did not see significant differences among the counties. “Herd immunity effects would not be likely with 18 or 30 percent vaccination rates,” the authors write.
Vaccine was available to students and school staff at no cost. Schools held one or two clinic days per season. Vaccinated students received a live attenuated vaccine (FluMist) by nose spray, unless they had allergies or other contraindications. In that case they received the intramuscular trivalent vaccine.
The authors write that the major obstacle was obtaining consent forms. However, Gargano notes that the study did not track whether parents refused to participate, as opposed to whether they were unable to return the forms on time. Roughly 80 percent of those who returned consents were vaccinated in both places in the first season. However, in the provider-based county, this figure decreased to 67 percent in the second year.
The research was supported by the Centers for Disease Control and Prevention and the National Institutes of Health. Live attenuated vaccine was donated by MedImmune.
L.M. Gargano et al. Multicomponent Interventions to Enhance Influenza Vaccine Delivery to Adolescents. Pediatrics 128, online ahead of print (2011).
Writer: Quinn Eastman
The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service.
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