Pediatrician attitudes concerning school-located vaccination clinics for seasonal influenza.

OBJECTIVE: Vaccinating all children aged 6 months to 18 years every year has potentially large ramifications for office-based primary care pediatricians. We determined the degree to which pediatricians support routine annual influenza vaccination outside the medical home, especially in school-located mass influenza vaccination clinics. METHODS: Internet-based survey sent in May and June 2009 to all 623 currently practicing primary care general pediatricians who were members of the Maryland Chapter of the American Academy of Pediatrics. RESULTS: Of those surveyed, 193 (31%) responded. Approximately 67% reported they vaccinated more than half the children in their practice with at least one dose in the 2008-2009 influenza season, and about half anticipated that, in their office, they would not attain ≥75% coverage of all patients older than 5 months of age. Approximately 27% of respondents predicted they would likely have difficulty obtaining sufficient vaccine to cover commercially insured patients, and 32% were likely to have difficulty getting sufficient vaccine to cover Medicaid, underinsured, and uninsured patients because of ordering or distribution problems. Approximately 78% of respondents cited borderline or poor reimbursement for influenza vaccinations, and 53% had unused vaccine at the end of the 2008-2009 influenza season. Ninety-six percent of respondents supported school-located influenza vaccination programs in their community for their patients. CONCLUSIONS: These results indicate awareness by primary care pediatricians in Maryland of the potential difficulties involved in implementing universal influenza vaccinations in their practice and their support of school-located vaccination programs managed by the local health department in their community.

Benefits and costs of immunizing children against influenza at school: an economic analysis based on a large-cluster controlled clinical trial.

Current influenza vaccination recommendations focus on immunizing high-risk people; however, influenza mortality and morbidity remain elevated. U.S. policymakers are considering expansion of flu vaccination recommendations to include school-age children (ages 5-18). Children are at risk for flu and propagate epidemic spread. Immunizing children at school offers an efficient approach to covering this population. This study examines the cost consequences of a large multistate, school-based influenza immunization program. The results show that immunization reduces disease among children and adults and is cost-saving to society. An epidemiologically based influenza immunization policy might be an important supplement to the existing risk-based policy.

Effectiveness of school-based influenza vaccination.

BACKGROUND: Vaccination of children in school is one strategy to reduce the spread of influenza in households and communities. METHODS: We identified 11 demographically similar clusters of elementary schools in four states, consisting of one school we assigned to participate in a vaccination program (intervention school) and one or two schools that did not participate (control schools). During a predicted week of peak influenza activity in each state, all households with children in intervention and control schools were surveyed regarding demographic characteristics, influenza vaccination, and outcomes of influenza-like illness during the previous 7 days. RESULTS: In all, 47% of students in intervention schools received live attenuated influenza vaccine. As compared with control-school households, intervention-school households had significantly fewer influenza-like symptoms and outcomes during the recall week. Paradoxically, intervention-school households (both children and adults) had higher rates of hospitalization per 100 persons than did control-school households. However, there was no difference in the overall hospitalization rates for children or adults in households with vaccinated children, as compared with those with unvaccinated children, regardless of study-group assignment. Rates of school absenteeism for any cause (based on school records) were not significantly different between intervention and control schools. CONCLUSIONS: Most outcomes related to influenza-like illness were significantly lower in intervention-school households than in control-school households. (ClinicalTrials.gov number, NCT00192218.)