Vaccination of at least a quarter of the school population resulted in decreased influenza rates and improved school attendance. Herd immunity for unvaccinated children may occur in schools with vaccination coverage approaching 50%.

Vaccinations are one of public health's greatest achievements. However, an ethical dilemma lies in the balance of personal autonomy and choice versus protection of the entire at risk population. Vaccines have become readily available in most parts of the world, yet debates continue as to the appropriateness of requirements for vaccinations, including legal mandates of vaccinations during public health emergencies and more routinely for school entry. This paper addresses ethical issues concerning vaccination requirements in the context of historical as well as current immunization program activities. Five important programmatic focus areas for immunization programs are identified for minimizing conflicts among the relevant ethical principles when developing and implementing vaccination requirements; namely: 1) reviewing and evaluating current vaccination mandates in the relevant health jurisdiction; 2) increasing the use of non-compulsory vaccination strategies; 3) addressing parent/guardian vaccine safety concerns; 4) enhancing public awareness of vaccine-preventable disease risks; and 5) promoting a better public understanding of herd immunity. We suggest that strengthening these programmatic focus areas can lead to a greater public acceptance of vaccination requirements.

BackgroundSchool-located influenza vaccination (SLV) programs have the potential to mass-vaccinate all enrolled children, but parental consent is required.ObjectiveTo examine parental attitudes and determine predictors of parental consent for vaccination of schoolchildren through SLV programs.Patients/MethodsSurveys were distributed to parents of 4517 children during 2009–2010 (year 1) and 4414 children during 2010–2011 (year 2) in eight elementary schools in conjunction with a SLV program.ResultsParticipants included 1259 (27·9%) parents in year 1 and 1496 (33·9%) in year 2. Parental consent for 2009 H1N1, 2009 seasonal, and 2010 seasonal influenza vaccines was obtained from 738 (70·8%), 673 (64·5%), and 1151 (77·2%) respondents, respectively. During the 2009 pandemic, respondents concerned about influenza severity were twice as likely to consent for the 2009 H1N1 vaccination compared to unconcerned respondents (OR 2·04, 95% CI:1·19–3·51). During year 2, factors that predicted parental consent were the perception of high susceptibility to influenza infection (OR 2·19, 95% CI:1·50–3·19) and high benefit of vaccine (OR 2·23, 95% CI:1·47–3·40). In both years, college-educated parents were more likely to perceive vaccine risks (year 1: 83·6 versus 61·5%, P < 0·001 and year 2: 81·1% versus 60·6%, P < 0·001) and less likely to consent for seasonal influenza vaccine (year 1: OR 0·69, 95% CI:0·53–0·89 and year 2: OR 0·61, 95% CI:0·47–0·78) compared to non-college-educated parents.ConclusionsParents who appreciate the risks of influenza and benefits of vaccination are more likely to consent for SLV. More research is needed to determine how to address heightened safety concerns among college-educated parents.

Local health departments have typically led school-located influenza vaccination (SLIV) programs, assuming resource-intensive roles in design, coordination, and vaccination. This level of involvement is often not financially sustainable over time. Five diverse school districts in Los Angeles County designed, implemented, refined, and institutionalized their own SLIV programs over 3 years by identifying and maximizing their existing resources. School district nurses and other staff served as project leaders, designing their own vaccination administration process, parental consent, and clinic promotional models. Two districts expanded their existing school immunization clinics and three developed their vaccination capacity with community partnerships. Each district tailored its program in creative resource-minimum ways, sometimes abandoning or adopting new methods/technologies based on the effectiveness in previous seasons. The shared experiences and strategies between district nurses and the local health department described in this article illustrate a district's ability to develop a tailor-made SLIV program, often in less than ideal conditions.

Background Obesity emerged as a novel risk factor for severe disease during the 2009 H1N1 influenza pandemic. Murine studies indicate that obesity is associated with ineffective response to influenza vaccine, but few human studies exist. We aimed to determine if influenza vaccine is protective against laboratory-confirmed influenza in obese children. Methods Body mass index (BMI), vaccination status, and laboratory-confirmed influenza data were analyzed from a previously conducted prospective study in which active surveillance for influenza-like illness (ILI) was conducted in eight elementary schools in Los Angeles County during the 2010–2011 influenza season. Polymerase-chain reaction (PCR) was performed on combined nose/throat swabs collected from children with ILI at presentation to the school nurse or during absenteeism. Results Of 4,260 children with height/weight data, 1,191 (28.0%) were obese (BMI ≥95th percentile). Respiratory specimens were obtained from 858 (20.1%) children. Unvaccinated obese compared with vaccinated obese children acquired three times more PCR-confirmed influenza (62 vs. 17 per 1000 children, p=0.003) and missed more school days (4.6 vs. 3.2 per 100 school days, p<0.001) during influenza season. Obese children with PCR-confirmed influenza were more likely to present with cough (86.2 vs. 72.4%, p=0.030) and missed more school per episode (2.4 vs.1.9 days, p=0.023) compared with non-obese children. Among vaccinated children, rates of PCR-confirmed influenza were similar in obese and non-obese children (17 vs. 20 per 1000 children, p=0.77). Conclusions Obese children with PCR-confirmed influenza suffered from more cough and missed more school days than their non-obese peers. Influenza vaccination protected obese children against PCR-proven influenza illness.