A survey of state and local practices encouraging pediatric COVID-19 vaccination of children ages 6 months through 11 years.

OBJECTIVE: This report highlights state and local practices for optimizing the pediatric COVID-19 vaccination program for children ages 6 months through 11 years. METHODS: State and local practices designed to optimize pediatric COVID-19 vaccine uptake were identified from a range of sources, including immunization program, CDC, and partner staff; and media stories or program descriptions identified via online searches. RESULTS: A range of practices were identified across different categories: provider-focused practices, school-based practices, jurisdiction or health department-based activities, community-focused practices involving partners, use of vaccination incentives, and Medicaid-related practices. CONCLUSIONS: Immunization programs and stakeholders implemented a variety of practices to meet the challenge of the pediatric COVID-19 vaccination program. The key findings may serve to inform not only the current pediatric COVID-19 vaccination program, but also future outbreak response work and routine immunization activities.

Recovery of measles-containing and HPV vaccine ordering post-COVID-19 pandemic: Trends by public vs. private funding source, urbanicity, and state - United States, January 2018 - December 2022.

OBJECTIVE: To assess recovery in childhood and adolescent vaccine ordering since initial declines in 2020 due to COVID-19 pandemic-related disruptions. METHODS: Using vaccine ordering data provided by Merck & Co., Inc., Rahway, NJ, USA, the number of measles-containing vaccine doses ordered each month in the U.S. during January 1, 2020-May 31, 2022 were compared to doses ordered during the corresponding month in 2018 and human papillomavirus (HPV) vaccine doses ordered during January 1, 2020-December 31, 2022 were compared to corresponding month in 2019. Differences stratified by public vs. private funding source and state and urbanicity of the county where the provider is located were examined. RESULTS: The cumulative deficit for measles-containing vaccines was 1,314,179 doses (-5.7%) as of May 2022 and 3,911,020 doses (-13.6%) for HPV vaccine as of December 2022. Deficits in publicly funded doses and HPV doses ordered in rural counties were greater than deficits in privately funded doses and HPV doses ordered in urban counties. CONCLUSIONS: Findings show that monthly measles-containing and HPV vaccine ordering has recovered; however, deficits remain. Greater deficits in publicly funded vaccine doses and HPV ordering in rural counties suggest varying level of recovery. To reduce gaps in deficits, health care providers are strongly encouraged to use every visit to recommend needed vaccines.

An overview of the COVID-19 pediatric vaccine program - The U.S. experience vaccinating children ages 6 months through 17 years.

COVID-19 vaccination decreases risk for COVID-19 illness and severe disease in children, including multisystem inflammatory syndrome (MIS-C) and death. On December 13, 2020, CDC recommended COVID-19 vaccination for persons ages ≥16 years, with expansion on May 12, 2021, to adolescents ages 12-15 years; to children ages 5-11 years on November 2, 2021; and to children ages 6 months-4 years on June 18, 2022. Following each age-specific recommendation, the U.S. government collaborated with state and local governments, vaccine manufacturers, and numerous other public and private entities, to ensure rapid, broad, and equitable COVID-19 vaccine distribution to strategic locations across the country to maximize access. However, vaccination coverage among children has been lower than among adults and lower among younger children than adolescents. As of May 10, 2023, COVID-19 primary series vaccination coverage was 61.8% among U.S. children ages 12-17 years, 32.9% among those ages 5-11 years, and 5.5% among those ages 6 months-4 years. This manuscript describes the planning and implementation of the U.S. COVID-19 pediatric vaccine program, including successes (e.g., the availability of pharmacy vaccination to extend access beyond more traditional pediatric vaccine providers) and challenges (e.g., multi-dose vaccine vials instead of single-dose vials, leading to concerns about wastage) to provide a historical record of the program and to help inform planning and implementation of future routine or pandemic-related pediatric vaccination campaigns.

School-Based Interventions to Increase Student COVID-19 Vaccination Coverage in Public School Populations with Low Coverage - Seattle, Washington, December 2021-June 2022.

COVID-19 can lead to severe outcomes in children (1). Vaccination decreases risk for COVID-19 illness, severe disease, and death (2). On December 13, 2020, CDC recommended COVID-19 vaccination for persons aged ≥16 years, with expansion on May 12, 2021, to children and adolescents (children) aged 12-15 years, and on November 2, 2021, to children aged 5-11 years (3). As of March 8, 2023, COVID-19 vaccination coverage among school-aged children remained low nationwide, with 61.7% of children aged 12-17 years and approximately one third (32.7%) of those aged 5-11 years having completed the primary series (3). Intention to receive COVID-19 vaccine and vaccination coverage vary by demographic characteristics, including race and ethnicity and socioeconomic status (4-6). Seattle Public Schools (SPS) implemented a program to increase COVID-19 vaccination coverage during the 2021-22 school year, focusing on children aged 5-11 years during November 2021-June 2022, with an added focus on populations with low vaccine coverage during January 2022-June 2022.† The program included strategic messaging, school-located vaccination clinics, and school-led community engagement. Vaccination data from the Washington State Immunization Information System (WAIIS) were analyzed to examine disparities in COVID-19 vaccination by demographic and school characteristics and trends over time. In December 2021, 56.5% of all SPS students, 33.7% of children aged 5-11 years, and 81.3% of children aged 12-18 years had completed a COVID-19 primary vaccination series. By June 2022, overall series completion had increased to 80.3% and was 74.0% and 86.6% among children aged 5-11 years and 12-18 years, respectively. School-led vaccination programs can leverage community partnerships and relationships with families to improve COVID-19 vaccine access and coverage.

Vaccines for Children Provider Practices in the COVID-19 Vaccination Program: Barriers to Participation, Intentions to Offer COVID-19 Vaccination to Children Aged <5 Years, and Vaccination Promotion, United States, March 2022.

The aim of the study was to assess barriers to Vaccines for Children (VFC) provider practices participating in the COVID-19 Vaccination Program and intentions to offer COVID-19 vaccination to children aged <5 years. We invited a random sample of 15 000 VFC provider practices in the United States to complete an online survey during February 28 to March 11, 2022. Of 2809 practices that completed the survey, 2246 (80.0%) were enrolled in the COVID-19 Vaccination Program. Concerns around staff resources, vaccine and supply storage space, and vaccine wastage from multidose vials were the most frequently reported program-enrollment barriers. Among enrolled practices that have decided whether to offer COVID-19 vaccination to the children aged <5 years, 1641 (88.8% of 1848) reported likely offering it to current patients, and 1165 reported likely offering it to children who are not current patients. Addressing participation barriers and encouraging active promotion may increase COVID-19 vaccination coverage of children.

COVID-19 Vaccination Coverage and Demographic Characteristics of Infants and Children Aged 6 Months-4 Years - United States, June 20-December 31, 2022.

Although severe COVID-19 illness and hospitalization are more common among older adults, children can also be affected (1). More than 3 million cases of COVID-19 had been reported among infants and children aged <5 years (children) as of December 2, 2022 (2). One in four children hospitalized with COVID-19 required intensive care; 21.2% of cases of COVID-19-related multisystem inflammatory syndrome in children (MIS-C) occurred among children aged 1-4 years, and 3.2% of MIS-C cases occurred among infants aged <1 year (1,3). On June 17, 2022, the Food and Drug Administration issued an Emergency Use Authorization (EUA) of the Moderna COVID-19 vaccine for children aged 6 months-5 years and the Pfizer-BioNTech COVID-19 vaccine for children aged 6 months-4 years. To assess COVID-19 vaccination coverage among children aged 6 months-4 years in the United States, coverage with ≥1 dose* and completion of the 2-dose or 3-dose primary vaccination series† were assessed using vaccine administration data for the 50 U.S. states and District of Columbia submitted from June 20 (after COVID-19 vaccine was first authorized for this age group) through December 31, 2022. As of December 31, 2022, ≥1-dose COVID-19 vaccination coverage among children aged 6 months-4 years was 10.1% and was 5.1% for series completion. Coverage with ≥1 dose varied by jurisdiction (range = 2.1% [Mississippi] to 36.1% [District of Columbia]) as did coverage with a completed series (range = 0.7% [Mississippi] to 21.4% [District of Columbia]), respectively. By age group, 9.7 % of children aged 6-23 months and 10.2% of children aged 2-4 years received ≥1 dose; 4.5% of children aged 6-23 months and 5.4% of children aged 2-4 years completed the vaccination series. Among children aged 6 months-4 years, ≥1-dose COVID-19 vaccination coverage was lower in rural counties (3.4%) than in urban counties (10.5%). Among children aged 6 months-4 years who received at least the first dose, only 7.0% were non-Hispanic Black or African American (Black), and 19.9% were Hispanic or Latino (Hispanic), although these demographic groups constitute 13.9% and 25.9% of the population, respectively (4). COVID-19 vaccination coverage among children aged 6 months-4 years is substantially lower than that among older children (5). Efforts are needed to improve vaccination coverage among children aged 6 months-4 years to reduce COVID-19-associated morbidity and mortality.

Analysis of School-Day Disruption of Administering School-Located Vaccination to Children in Three Local Areas, 2012-2013 School Year.

The purpose of this study was to determine the amount of time elementary and middle-school students spend away from the classroom and clinic time required to administer vaccines in school-located vaccination (SLV) clinics. We conducted a time study and estimated average time away from class and time to administer vaccine by health department (HD), student grade level, vaccine type, and vaccination process for SLV clinics during the 2012-2013 school year. Average time away from classroom was 10 min (sample: 688 students, 15 schools, three participating HD districts). Overall, time to administer intranasally administered influenza vaccine was nearly half the time to administer injected vaccine (52.5 vs. 101.7 s) (sample: 330 students, two HDs). SLV administration requires minimal time outside of class for elementary and middle-school students. SLV clinics may be an efficient way to administer catch-up vaccines to children who missed routine vaccinations during the coronavirus disease-2019 pandemic.

Sociodemographic Variation in Early Uptake of COVID-19 Vaccine and Parental Intent and Attitudes Toward Vaccination of Children Aged 6 Months-4 Years - United States, July 1-29, 2022.

COVID-19 vaccines are safe and effective for infants and young children, and on June 18, 2022, CDC recommended COVID-19 vaccination for infants and children (children) aged 6 months-4 years (1,2). As of November 9, 2022, based on administrative data reported to CDC,* 5.9% of children aged <2 years and 8.8% of children aged 2-4 years had received ≥1 dose. To better understand reasons for low coverage among children aged <5 years, CDC analyzed data from 4,496 National Immunization Survey-Child COVID Module (NIS-CCM) interviews conducted during July 1-29, 2022, to examine variation in receipt of ≥1 dose of COVID-19 vaccine and parental intent to vaccinate children aged 6 months-4 years by sociodemographic characteristics and by parental beliefs about COVID-19; type of vaccination place was also reported. Among children aged 6 months-4 years, 3.5% were vaccinated; 59.3% were unvaccinated, but the parent was open to vaccination; and 37.2% were unvaccinated, and the parent was reluctant to vaccinate their child. Openness to vaccination was higher among parents of Hispanic or Latino (Hispanic) (66.2%), non-Hispanic Black or African American (Black) (61.1%), and non-Hispanic Asian (Asian) (83.1%) children than among parents of non-Hispanic White (White) (52.9%) children and lower among parents of children in rural areas (45.8%) than among parents of children in urban areas (64.1%). Parental confidence in COVID-19 vaccine safety and receipt of a provider recommendation for COVID-19 vaccination were lower among unvaccinated than vaccinated children. COVID-19 vaccine recommendations from a health care provider, along with dissemination of information about the safety of COVID-19 vaccine by trusted persons, could increase vaccination coverage among young children.

Where are children ages 5-17 years receiving their COVID-19 vaccinations? Variations over time and by sociodemographic characteristics, United States.

BACKGROUND: Knowing the settings where children ages 5-17 years received COVID-19 vaccination in the United States, and how settings changed over time and varied by socio-demographics, is of interest for planning and implementing vaccination programs. METHODS: Data from the National Immunization Survey-Child COVID-19 Module (NIS-CCM) were analyzed to assess place of COVID-19 vaccination among vaccinated children ages 5-17 years. Interviews from July 2021 thru May 2022 were included in the analyses for a total of n = 39,286 vaccinated children. The percentage of children receiving their COVID-19 vaccine at each type of setting was calculated overall, by sociodemographic characteristics, and by month of receipt of COVID-19 vaccine. RESULTS: Among vaccinated children ages 5-11 years, 46.9 % were vaccinated at a medical place, 37.1 % at a pharmacy, 8.1 % at a school, 4.7 % at a mass vaccination site, and 3.2 % at some other non-medical place. Among vaccinated children ages 12-17 years, 35.1 % were vaccinated at a medical place, 47.9 % at a pharmacy, 8.3 % at a mass vaccination site, 4.8 % at a school, and 4.0 % at some other non-medical place. The place varied by time among children ages 12-17 years but minimally for children ages 5-11 years. There was variability in the place of COVID-19 vaccination by age, race/ethnicity, health insurance, urbanicity, and region. CONCLUSION: Children ages 5-17 years predominantly received their COVID-19 vaccinations at pharmacies and medical places. The large proportion of vaccinated children receiving vaccination at pharmacies is indicative of the success in the United States of expanding the available settings where children could be vaccinated. Medical places continue to play a large role in vaccinating children, especially younger children, and should continue to stock COVID-19 vaccine to keep it available for those who are not yet vaccinated, including the newly recommended group of children < 5 years.

COVID-19 Vaccine Provider Availability and Vaccination Coverage Among Children Aged 5-11 Years - United States, November 1, 2021-April 25, 2022.

COVID-19 can lead to severe outcomes in children, including multisystem inflammatory syndrome, hospitalization, and death (1,2). On November 2, 2021, the Advisory Committee on Immunization Practices issued an interim recommendation for use of the BNT162b2 (Pfizer-BioNTech) vaccine in children aged 5-11 years for the prevention of COVID-19; however, vaccination coverage in this age group remains low (3). As of June 7, 2022, 36.0% of children aged 5-11 years in the United States had received ≥1 of COVID-19 vaccine (3). Among factors that might influence vaccination coverage is the availability of vaccine providers (4). To better understand how provider availability has affected COVID-19 vaccination coverage among children aged 5-11 years, CDC analyzed data on active COVID-19 vaccine providers and county-level vaccine administration data during November 1, 2021-April 25, 2022. Among 2,586 U.S. counties included in the analysis, 87.5% had at least one active COVID-19 vaccine provider serving children aged 5-11 years. Among the five assessed active provider types, most counties had at least one pharmacy (69.1%) or public health clinic (61.3%), whereas fewer counties had at least one pediatric clinic (29.7%), family medicine clinic (29.0%), or federally qualified health center (FQHC)* (22.8%). Median county-level vaccination coverage was 14.5% (IQR = 8.9%-23.6%). After adjusting for social vulnerability index (SVI)† and urbanicity, the analysis found that vaccination coverage among children aged 5-11 years was higher in counties with at least one active COVID-19 vaccine provider than in counties with no active providers (adjusted rate ratio [aRR] = 1.66). For each provider type, presence of at least one provider in the county was associated with higher coverage; the largest difference in vaccination coverage was observed between counties with and without pediatric clinics (aRR = 1.37). Ensuring broad access to COVID-19 vaccines, in addition to other strategies to address vaccination barriers, could help increase vaccination coverage among children aged 5-11 years.

COVID-19 Vaccine Provider Access and Vaccination Coverage Among Children Aged 5-11 Years - United States, November 2021-January 2022.

On October 29, 2021, the Pfizer-BioNTech pediatric COVID-19 vaccine received Emergency Use Authorization for children aged 5-11 years in the United States.† For a successful immunization program, both access to and uptake of the vaccine are needed. Fifteen million doses were initially made available to pediatric providers to ensure the broadest possible access for the estimated 28 million eligible children aged 5-11 years, especially those in high social vulnerability index (SVI)§ communities. Initial supply was strategically distributed to maximize vaccination opportunities for U.S. children aged 5-11 years. COVID-19 vaccination coverage among persons aged 12-17 years has lagged (1), and vaccine confidence has been identified as a concern among parents and caregivers (2). Therefore, COVID-19 provider access and early vaccination coverage among children aged 5-11 years in high and low SVI communities were examined during November 1, 2021-January 18, 2022. As of November 29, 2021 (4 weeks after program launch), 38,732 providers were enrolled, and 92% of U.S. children aged 5-11 years lived within 5 miles of an active provider. As of January 18, 2022 (11 weeks after program launch), 39,786 providers had administered 13.3 million doses. First dose coverage at 4 weeks after launch was 15.0% (10.5% and 17.5% in high and low SVI areas, respectively; rate ratio [RR] = 0.68; 95% CI = 0.60-0.78), and at 11 weeks was 27.7% (21.2% and 29.0% in high and low SVI areas, respectively; RR = 0.76; 95% CI = 0.68-0.84). Overall series completion at 11 weeks after launch was 19.1% (13.7% and 21.7% in high and low SVI areas, respectively; RR = 0.67; 95% CI = 0.58-0.77). Pharmacies administered 46.4% of doses to this age group, including 48.7% of doses in high SVI areas and 44.4% in low SVI areas. Although COVID-19 vaccination coverage rates were low, particularly in high SVI areas, first dose coverage improved over time. Additional outreach is critical, especially in high SVI areas, to improve vaccine confidence and increase coverage rates among children aged 5-11 years.

Disparities in First Dose COVID-19 Vaccination Coverage among Children 5-11 Years of Age, United States.

We analyzed first-dose coronavirus disease vaccination coverage among US children 5-11 years of age during November-December 2021. Pediatric vaccination coverage varied widely by jurisdiction, age group, and race/ethnicity, and lagged behind vaccination coverage for adolescents aged 12-15 years during the first 2 months of vaccine rollout.

US Primary Care Providers' Experiences and Practices Related to Routine Pediatric Vaccination During the COVID-19 Pandemic.

OBJECTIVE: To describe, among pediatricians (Peds) and family physicians (FPs), 1) changes made to routine childhood vaccination delivery as a result of the pandemic, and 2) perceived barriers to delivering vaccinations from March 2020 through the time of the survey. METHODS: A nationally representative survey among Peds and FPs was administered by mail or Internet in October-December 2020. RESULTS: Response rate was 64% (579/909). For children aged 0 to 2 years, among those who vaccinated that age group prepandemic (Peds n = 265, FPs n = 222), 5% of Peds and 15% of FPs reported they had stopped vaccinating these children at any time. For children aged 4 to 6 years (Peds n=264, FPs n = 229), 19% of Peds and 17% of FPs reported they had stopped vaccinating at any time. For children aged 11-18 years (Peds n = 265, FPs n = 251), 24% of Peds and 19% of FPs reported they had stopped vaccinating at any time. Nearly all reported returning to prepandemic vaccination services at the time of the survey. Factors most frequently reported as major/moderate barriers to providing vaccinations included fewer in-person visits because patients/parents were concerned about risk of SARS-CoV-2 infection (Peds, 52%; FPs, 54%), fewer in-person visits for sports clearance (Peds, 39%; FPs, 44%), and fewer back-to-school in-person visits because some children were in virtual learning (Peds, 25%; FPs, 33%). CONCLUSIONS: Although some physicians reported interrupting vaccination services at some point during the pandemic, the majority reported continuing to provide vaccinations throughout, with essentially all returning to prepandemic vaccination services by end of 2020.

Patient Characteristics and Costs Associated With COVID-19-Related Medical Care Among Medicare Fee-for-Service Beneficiaries.

BACKGROUND: New cases of COVID-19 continue to occur daily in the United States, and the need for medical treatments continues to grow. Knowledge of the direct medical costs of COVID-19 treatments is limited. OBJECTIVE: To examine the characteristics of older adults with COVID-19 and their costs for COVID-19-related medical care. DESIGN: Retrospective observational study. SETTING: Medical claims for Medicare fee-for-service (FFS) beneficiaries. PATIENTS: Medicare FFS beneficiaries aged 65 years or older who had a COVID-19-related medical encounter during April through December 2020. MEASUREMENTS: Patient characteristics and direct medical costs of COVID-19-related hospitalizations and outpatient visits. RESULTS: Among 28.1 million Medicare FFS beneficiaries, 1 181 127 (4.2%) sought COVID-19-related medical care. Among these patients, 23.0% had an inpatient stay and 4.2% died during hospitalization. The majority of the patients were female (57.0%), non-Hispanic White (79.6%), and residents of an urban county (77.2%). Medicare FFS costs for COVID-19-related medical care were $6.3 billion; 92.6% of costs were for hospitalizations. The mean hospitalization cost was $21 752, and the mean length of stay was 9.2 days; hospitalization cost and length of stay were higher if the patient needed a ventilator ($49 441 and 17.1 days) or died ($32 015 and 11.3 days). The mean cost per outpatient visit was $164. Patients aged 75 years or older were more likely to be hospitalized, but their hospitalizations were associated with lower costs than for younger patients. Male sex and non-White race/ethnicity were associated with higher probability of being hospitalized and higher medical costs. LIMITATION: Results are based on Medicare FFS patients. CONCLUSION: The COVID-19 pandemic has resulted in substantial disease and economic burden among older Americans, particularly those of non-White race/ethnicity. PRIMARY FUNDING SOURCE: None.

Provision of Pediatric Immunization Services During the COVID-19 Pandemic: an Assessment of Capacity Among Pediatric Immunization Providers Participating in the Vaccines for Children Program - United States, May 2020.

Recent reports suggest that routine childhood immunization coverage might have decreased during the coronavirus disease 2019 (COVID-19) pandemic (1,2). To assess the capacity of pediatric health care practices to provide immunization services to children during the pandemic, a survey of practices participating in the Vaccines for Children (VFC) program was conducted during May 12-20, 2020. Data were weighted to account for the sampling design; thus, all percentages reported are weighted. Among 1,933 responding practices, 1,727 (89.8%) were currently open; 1,397 (81.1%) of these reported offering immunization services to all of their patients. When asked whether the practice would likely be able to accommodate new patients to assist with provision of immunization services through August, 1,135 (59.1%) respondents answered affirmatively. These results suggest that health care providers appear to have the capacity to deliver routinely recommended childhood vaccines, allowing children to catch up on vaccines that might have been delayed as a result of COVID-19-related effects on the provision of or demand for routine well child care. Health care providers and immunization programs should educate parents on the need to return for well-child and immunization visits or refer patients to other practices, if they are unable to provide services (3).

Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration - United States, 2020.

On March 13, 2020, the president of the United States declared a national emergency in response to the coronavirus disease 2019 (COVID-19) pandemic (1). With reports of laboratory-confirmed cases in all 50 states by that time (2), disruptions were anticipated in the U.S. health care system's ability to continue providing routine preventive and other nonemergency care. In addition, many states and localities issued shelter-in-place or stay-at-home orders to reduce the spread of COVID-19, limiting movement outside the home to essential activities (3). On March 24, CDC posted guidance emphasizing the importance of routine well child care and immunization, particularly for children aged ≤24 months, when many childhood vaccines are recommended.

Pediatricians' Experiences With and Perceptions of the Vaccines for Children Program.

BACKGROUND AND OBJECTIVES: The Vaccines for Children Program (VFC) provides vaccines for children who may not otherwise be vaccinated because of financial barriers. Pediatrician participation is crucial to the VFC's ongoing success. Our objectives were to assess, among a national sample of pediatricians, (1) VFC program participation, (2) perceived burden versus benefit of participation, and (3) knowledge and perception of a time-limited increased payment for VFC vaccine administration under the Patient Protection and Affordable Care Act. METHODS: An electronic and mail survey was conducted from June 2017 to September 2017. RESULTS: Response rate was 79% (372 of 471); 86% of pediatricians reported currently participating in the VFC; among those, 85% reported never having considered stopping, 10% considered it but not seriously, and 5% seriously considered it. Among those who had considered no longer participating (n = 47), the most commonly reported reasons included difficulty meeting VFC record-keeping requirements (74%), concern about action by the VFC for noncompliance (61%), and unpredictable VFC vaccine supplies (59%). Participating pediatricians rated, on a scale from -5 (high burden) to +5 (high benefit), their overall perception of the VFC: 63% reported +4 or +5, 23% reported +1 to +3, 5% reported 0, and 9% reported -1 to -5. Of pediatricians, 39% reported awareness of temporary increased payment for VFC vaccine administration. Among those, 10% reported that their practice increased the proportion of Medicaid and/or VFC-eligible patients served on the basis of this change. CONCLUSIONS: For most pediatricians, perceived benefits of VFC participation far outweigh perceived burdens. To ensure the program's ongoing success, it will be important to monitor factors influencing provider participation.

Evaluation of Educational Interventions to Enhance Adolescent Specific Vaccination Coverage.

BACKGROUND: In this study, we assessed impact of two educational interventions designed to increase coverage of three vaccines recommended during adolescence among Georgia middle and high school students (tetanus diphtheria pertussis [Tdap], meningococcal [MenACWY], and human papillomavirus [HPV] vaccines). METHODS: We randomized 11 middle and high schools in one school district into one of three arms: (1) control; (2) educational intervention for parents only (P only); and (3) multicomponent educational intervention for parents and adolescents (P + A), which consisted of educational brochures for parents about vaccines recommended during adolescence and a vaccine-focused curriculum delivered to adolescents by science teachers. We obtained vaccination coverage data during intervention years from the state immunization registry. RESULTS: Odds of receiving at least one vaccine during the study were higher among adolescents in P + A arm compared to control (Odds Ratio [OR]: 1.4; 95% Confidence Interval [CI]: 1.1-2.0). Adolescents in P + A arm had greater odds of receiving at least one vaccine compared with those in P only arm (OR: 1.4; 95% CI: 1.1-1.7). CONCLUSIONS: A multicomponent educational intervention for adolescents and parents increased adolescent vaccination uptake. Results suggest similar interventions can increase awareness and demand for vaccines among parents and adolescents.

Understanding Factors Affecting University A Students' Decision to Receive an Unlicensed Serogroup B Meningococcal Vaccine.

PURPOSE: During March-November 2013, five cases of serogroup B meningococcal disease occurred among University A undergraduates. The Centers for Disease Control and Prevention used the unlicensed MenB-4C (Bexsero, Novartis Vaccines), a serogroup B meningococcal vaccine, to control the outbreak. All undergraduates (n = 19,257) were offered two doses; 51% of undergraduates received ≥1 dose of MenB-4C. We conducted a knowledge, attitudes, and practice survey to understand which factors and sources of information impacted their decision on whether or not to receive vaccine. METHODS: An anonymous online survey was sent to University A undergraduates. The survey was implemented in June 2-30, 2014, and covered demographics, MenB-4C vaccination decision, and sources of information. Descriptive analyses were conducted. RESULTS: A total of 1,341 students completed the survey (response rate = 7.0%), of these 873 received ≥1 dose of MenB-4C. Among vaccinated respondents, the predominant reasons for receiving vaccine were knowledge of disease severity, parental recommendation, and believing that vaccination offered the best protection. Among unvaccinated respondents, the predominant reasons for not receiving vaccine were perception of low disease risk and concern over vaccine newness and safety. Respondents' top primary sources of information were e-mails from the university followed by their parents. CONCLUSIONS: Reasons behind respondents' decision to receive an unlicensed vaccine were similar to those reported for routinely recommended vaccines. Given the challenges around communicating the importance of receiving a vaccine that is not routinely recommended, respondents' primary sources of information, the university and their parents, could be targeted to improve coverage rates.

Place of influenza vaccination among children--United States, 2010-11 through 2013-14 influenza seasons.

BACKGROUND: Studies are published on settings adults receive influenza vaccination but few have reported on settings children are vaccinated and how this might be changing over time or vary by socio-demographics. METHODS: Data from the National Immunization Survey-Flu were analyzed to assess place of influenza vaccination among vaccinated children 6 months-17 years during the 2010-11, 2011-12, 2012-13, and 2013-14 influenza seasons. The percentage of children vaccinated at each place was calculated overall and by age, race/ethnicity, income, and Metropolitan Statistical Area (MSA). RESULTS: The places children received influenza vaccination varied little over four recent influenza seasons. From the 2010-11 through 2013-14 influenza seasons the percentage of vaccinated children receiving influenza vaccination at a doctor's office was 64.1%, 65.1%, 65.3%, and 65.3%, respectively with no differences from one season to the next. Likewise, for vaccination at clinics or health centers (17.8%, 17.5%, 17.0%. 18.0%), health departments (3.2%, 3.6%, 3.0%, 2.8%), and other non-medical places (1.6%, 1.4%, 1.2%, 1.1%), there were no differences from one season to the next. There were some differences for vaccinations at hospitals, pharmacies, and schools. There was considerable variability in the place of influenza vaccination by age, race/ethnicity, income, and MSA. Fewer Hispanic children were vaccinated at a doctor's office than black, white, and other or multiple race children and fewer black children and children of other or multiple races were vaccinated at a doctor's office than white children. More children at or below the poverty level were vaccinated at a clinic or health center than all of the other income groups. CONCLUSION: Most vaccinated children receive their influenza vaccination at a doctor's office. Place of vaccination changed little over four recent influenza seasons. Large variability in place of vaccination exists by age, race/ethnicity, income, and MSA. Monitoring place of vaccination can help shape future immunization programs.