Description of a Large Urban School-Located 2009 Pandemic H1N1 Vaccination Campaign, New York City 2009–2010

Abstract

In the spring of 2009, New York City (NYC) experienced the emergence and rapid spread of pandemic influenza A H1N1 virus (pH1N1), which had a high attack rate in children and caused many school closures. During the 2009 fall wave of pH1N1, a school-located vaccination campaign for elementary schoolchildren was conducted in order to reduce infection and transmission in the school setting, thereby reducing the impact of pH1N1 that was observed earlier in the year. In this paper, we describe the planning and outcomes of the NYC school-located vaccination campaign. We compared consent and vaccination data for three vaccination models (school nurse alone, school nurse plus contract nurse, team). Overall, >1,200 of almost 1,600 eligible schools participated, achieving 26.8% consent and 21.5% first-dose vaccination rates, which did not vary significantly by vaccination model. A total of 189,902 doses were administered during two vaccination rounds to 115,668 students at 998 schools included in the analysis; vaccination rates varied by borough, school type, and poverty level. The team model achieved vaccination of more children per day and required fewer vaccination days per school. NYC's campaign is the largest described school-located influenza vaccination campaign to date. Despite substantial challenges, school-located vaccination is feasible in large, urban settings, and during a public health emergency.

The association between influenza vaccination and socioeconomic status in high income countries varies by the measure used: a systematic review

“…One cohort study from Ontario, Canada, determined that children from neighbourhoods with higher incomes were significantly more likely to be fully vaccinated against influenza than children from other areas [20]. Consistent with the above finding, an ecological study in New York City also found that children from neighbourhoods with higher levels of poverty had higher levels of H1N1 vaccination [23].…”

“…Adults with a family income above 200% the federal poverty level were significantly more likely to receive an influenza vaccination compared to those below it (1.3PR, 1.3–1.3CI) Lau 2013 [22]; USIncome (Household)Household income percent of federal poverty level: 0–99%, 100–199%, 200–299, 300% or moreSociodemographic variables, insurance status, and usual source of careCalifornia Health Interview Survey; State survey (2005; 2007)Positive association. After adjusting for gender, race/ethnicity, income, insurance status, and usual source of care, young adults aged 18 to 26 years with household incomes 200–299% above the federal poverty limit (1.57OR, 1.11–2.21CI) were more likely to be vaccinated compared to young adults of the same age with household incomes 0–99% FPL. Narciso 2012 [23]; USIncome (Neighbourhood)Neighbourhood poverty level (high [> 30% residents living below poverty], medium [20–29.9% residents living below poverty], low [less than 20% living below poverty level])Not reportedVaccination data from school-located vaccination campaign; New York City schools (2009–10)Positive association. The authors report lower levels of vaccination in boroughs with higher levels of poverty and provide the following vaccination prevalence rates: Manhattan (27.5%), Bronx (18.4%), Brooklyn (19.4%), Staten Island (16.9%), Queens (24.2%). Villarroel 2016 [24]; USIncome (Household)Income level (poor: below FPL, near-poor: 100% to less than 200% FPL, not poor: 200% or greater FPL)Not reportedNational Health Interview Survey; National survey (2015)Positive association.…”

Protecting the Public from H1N1 through Points of Dispensing (PODs)

“…4 PODs were initially intended to supplement the school-located vaccination program by providing H1N1 vaccine to middle school and high school students, as well as elementary school children who had missed the vaccination day at their school. DOHMH operated at least one POD in each of the 5 NYC boroughs on Saturdays and Sundays for 5 weekends in November and December.…”

The Effect of Income Disparities on Influenza Vaccination Coverage in the United States

“…[4][5][6][7][8][9][10][11][12] Furthermore, the manner in which income was measured and categorized in previous studies varied in many ways. 9,[13][14][15] In some studies, 9,[13][14][15] income was measured at national, state, county, and community levels. Such geographic comparisons do not allow for analyses of individual-level associations.…”