Schools offer an opportunity to deliver new vaccines to adolescents who may not receive them in their medical home. However, school budgets and health priorities are set at the local level; consequently resources devoted to health-related activities vary widely. Partnering with schools requires soliciting buy-in from stakeholders at district and school levels and providing added value to schools. With appropriate resources and partnerships, schools could carry out vaccination-related activities from educating students, parents, and communities to developing policies supporting vaccination, providing vaccines, or serving as the site at which partners administer vaccines. Activities will vary among schools, but every school has the potential to use some strategies that promote adolescent vaccination.W ITH 3 NEW vaccines for adolescents recommended since 2005, and more on the way, effective mechanisms for delivering adolescent vaccinations are increasingly important. Because school occupies a significant part of most adolescents' lives, the potential range of roles for schools in adolescent vaccination, from education and promotion to vaccine administration, deserves special attention. Schools must devote significant energy to complying with numerous mandatory accountability measures as they fulfill their primary educational purpose, but every school has the potential to promote adolescent vaccination. Including schools as partners in promoting adolescent vaccination will complement other efforts and offer considerable access to an often hard-to-reach group.The information presented in this article rests on 3 assumptions. First, schools are not intended to replace the medical home as the primary location for vaccination of adolescents. Instead, vaccination-related activities in schools can supplement care received in the medical home. Therefore, we have focused this report on information and solutions that can be implemented in the current policy environment rather than the significant changes that would be needed to make schools the primary avenue for delivery of routine adolescent vaccinations. Second, the extent to which any strategy is implemented will vary according to vaccine and school, although every school can undertake vaccination-related activities at some level. Third, variable resources and competing priorities must be taken into account when considering options for addressing vaccination in school health programs. Issues such as pregnancy, sexually transmitted diseases, drug and alcohol abuse, obesity, and violence will often take precedence. 1 Based on these assumptions, we explore the role of schools in strengthening the delivery of vaccinations to adolescents by reviewing the current scope of school health resources, the history of US experience with school-based vaccination, and potential barriers to vaccination activities in schools. Laws that require vaccination for school attendance, which are known to be highly effective, are covered elsewhere in this supplement. 2 We have drawn on www...

In the United States, among children born during 1994-2013, vaccination will prevent an estimated 322 million illnesses, 21 million hospitalizations, and 732,000 deaths during their lifetimes (1). Since 1994, the National Immunization Survey (NIS) has monitored vaccination coverage among children aged 19-35 months in the United States. This report describes national, regional, state, and selected local area vaccination coverage estimates for children born January 2010-May 2012, based on results from the 2013 NIS. In 2013, vaccination coverage achieved the 90% national Healthy People 2020 target* for ≥1 dose of measles, mumps, and rubella vaccine (MMR) (91.9%); ≥3 doses of hepatitis B vaccine (HepB) (90.8%); ≥3 doses of poliovirus vaccine (92.7%); and ≥1 dose of varicella vaccine (91.2%). Coverage was below the Healthy People 2020 targets for ≥4 doses of diphtheria, tetanus, and pertussis vaccine (DTaP) (83.1%; target 90%); ≥4 doses of pneumococcal conjugate vaccine (PCV) (82.0%; target 90%); the full series of Haemophilus influenzae type b vaccine (Hib) (82.0%; target 90%); ≥2 doses of hepatitis A vaccine (HepA) (54.7%; target 85%); rotavirus vaccine (72.6%; target 80%); and the HepB birth dose (74.2%; target 85%). † Coverage remained stable relative to 2012 for all of the vaccinations with Healthy People 2020 objectives except for increases in the HepB birth dose (by 2.6 percentage points) and rotavirus vaccination (by 4.0 percentage points). The percentage of children who received no vaccinations remained below 1.0% (0.7%). Children living below the federal poverty level had lower vaccination coverage compared with children living at or above the poverty level for many vaccines, with the largest disparities for ≥4 doses of DTaP (by 8.2 percentage points), full series of Hib (by 9.5 percentage points), ≥4 doses of PCV (by 11.6 percentage points), and rotavirus (by 12.6 percentage points). MMR coverage was below 90% for 17 states. Reaching and maintaining high coverage across states and socioeconomic groups is needed to prevent resurgence of vaccine-preventable diseases. NIS is a random-digit-dialed cellular § and landline telephone survey of households with children aged 19-35 months

School-located vaccination against influenza (SLV-I) has been suggested to help meet the need for annual vaccination of large numbers of school-aged children with seasonal influenza vaccine. However, little is known about the cost and cost-effectiveness of SLV-I. We conducted a cost-analysis and a cost-effectiveness analysis based on a randomized controlled trial (RCT) of an SLV-I program implemented in Monroe County, New York during the 2009–2010 vaccination season. We hypothesized that SLV-I is more cost effective, or less-costly, compared to a conventional, office-located influenza vaccination delivery. First and second SLV-I clinics were offered in 21 intervention elementary schools (n=9,027 children) with standard of care (no SLV-I) in 11 control schools (n=4,534 children). The direct costs, to purchase and administer vaccines, were estimated from our RCT. The effectiveness measure, receipt of ≥1 dose of influenza vaccine, was 13.2 percentage points higher in SLV-I schools than control schools. The school costs ($9.16/dose in 2009 dollars) plus project costs ($23.00/dose) plus vendor costs excluding vaccine purchase ($19.89/dose) was higher in direct costs ($52.05/dose) than the previously reported mean/median cost [$38.23/$21.44 per dose] for providing influenza vaccination in pediatric practices. However SLV-I averted parent costs to visit medical practices ($35.08 per vaccine). Combining direct and averted costs through Monte Carlo Simulation, SLV-I costs were $19.26/dose in net costs, which is below practice-based influenza vaccination costs. The incremental cost-effectiveness ratio (ICER) was estimated to be $92.50 or $38.59 (also including averted parent costs). When additionally accounting for the costs averted by disease prevention (i.e., both reduced disease transmission to household members and reduced loss of productivity from caring for a sick child), the SLV-I model appears to be cost-saving to society, compared to “no vaccination”. Our findings support the expanded implementation of SLV-I, but also the need to focus on efficient delivery to reduce direct costs.

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For most Georgia families, out-of-pocket expenses for childhood immunizations were low, favoring compliance with the recommended immunization schedule. However, families least able to afford the expense faced disproportionately high out-of-pocket costs. Out-of-pocket costs were inversely correlated with immunization coverage levels. Uninsured children whose families lived below 250% of the federal poverty level experienced the lowest immunization coverage levels. Immunization coverage through the Vaccines for Children Program and Medicaid/State Children's Health Insurance Programs should be promoted to minimize or eliminate out-of-pocket costs related to childhood immunizations, especially among children of low-income families.

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