School-Located Influenza Vaccination Decreases Laboratory-Confirmed Influenza and Improves School Attendance

Pannaraj, Pia S.; Wang, Hailin-L.; Rivas, Hector; Wiryawan, Hilda; Smit, Michael; Green, Nicole; Aldrovandi, Grace M.; Amin, Alvin Nelson El; Mascola, Laurene

doi:10.1093/cid/ciu340

Cited by 66 publications

(73 citation statements)

References 32 publications

(37 reference statements)

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“…9 Other studies have reported significant VE for LAIV against outpatient and inpatient medically attended H1N1pdm09-related illness among school-aged children in the United States in 2009 to 2010 and 2010 to 2011. 24–26 However, reduced LAIV effectiveness against A/H1N1pdm09 was observed during 2010 to 2011 among adults in the US military. 27 One Canadian study reported effectiveness of trivalent LAIV against influenza A during the 2013–2014 season; however, the study had few participants who received LAIV.…”

Section: Discussionmentioning

confidence: 99%

Seasonal Effectiveness of Live Attenuated and Inactivated Influenza Vaccine

et al. 2016

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BACKGROUND Few observational studies have evaluated the relative effectiveness of live attenuated (LAIV) and inactivated (IIV) influenza vaccines against medically attended laboratory-confirmed influenza. METHODS We analyzed US Influenza Vaccine Effectiveness Network data from participants aged 2 to 17 years during 4 seasons (2010–2011 through 2013–2014) to compare relative effectiveness of LAIV and IIV against influenza-associated illness. Vaccine receipt was confirmed via provider/electronic medical records or immunization registry. We calculated the ratio (odds) of influenza-positive to influenza-negative participants among those age-appropriately vaccinated with either LAIV or IIV for the corresponding season. We examined relative effectiveness of LAIV and IIV by using adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression. RESULTS Of 6819 participants aged 2 to 17 years, 2703 were age-appropriately vaccinated with LAIV (n = 637) or IIV (n = 2066). Odds of influenza were similar for LAIV and IIV recipients during 3 seasons (2010–2011 through 2012–2013). In 2013–2014, odds of influenza were significantly higher among LAIV recipients compared with IIV recipients 2 to 8 years old (OR 5.36; 95% CI, 2.37 to 12.13). Participants vaccinated with LAIV or IIV had similar odds of illness associated with influenza A/H3N2 or B. LAIV recipients had greater odds of illness due to influenza A/H1N1pdm09 in 2 seasons: 2010 to 2011 (OR 5.53; 95% CI, 1.35 to 22.76) and 2013–2014 (OR 2.65; 95% CI, 1.34 to 5.27). CONCLUSIONS We observed lower effectiveness of LAIV compared with IIV against influenza A/H1N1pdm09 but not A(H3N2) or B among children and adolescents, suggesting poor performance related to the LAIV A/H1N1pdm09 viral construct.

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Section: Discussionmentioning

confidence: 99%

Seasonal Effectiveness of Live Attenuated and Inactivated Influenza Vaccine

et al. 2016

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“…One fifth of the children received influenza vaccine though the SLV programs or at a community site as documented in CAIR (Table 2). Most (83.1%) received LAIV, which the SLV program gave preferentially (17). We compared outcomes of obese children with different groupings of non-obese categories including: healthy weight alone, healthy weight and underweight, and overweight, healthy weight, and underweight.…”

Section: Resultsmentioning

confidence: 99%

“…Data were analyzed from a previously conducted prospective study to evaluate the impact of school-located influenza vaccination (SLV) programs on influenza rates and absenteeism (17). The original study group consisted of 4,455 children enrolled in eight elementary schools in two Los Angeles County (LAC) school districts.…”

Section: Methodsmentioning

confidence: 99%

“…Prospective active ILI surveillance was conducted during the period in which at least 5% of specimens from nine sentinel community surveillance sites located throughout LAC tested positive for influenza (17). ILI was defined as fever (temperature ≥ 100.4°F [38.0°C]) or feverishness and at least one of the following: cough, sore throat, runny nose, nasal congestion, headache, earache, wheezing, muscle aches, chills, anorexia, vomiting, or diarrhea (24).…”

Section: Methodsmentioning

confidence: 99%

“…Multiplex reverse transcription-polymerase chain reaction (PCR) (Luminex xTAG® respiratory virus panel, Luminex Corporation, Austin, Texas) was performed on combined nose and throat specimens for 12 viruses including influenza A (with subtype H1 and H3, neuraminidase component not identified), influenza B, respiratory syncytial virus (subgroups A and B), parainfluenza virus (types 1, 2, and 3), rhinovirus, adenovirus, and human metapneumovirus as previously described (17). Specimens positive for influenza A and negative for subtype H1 and H3 was presumed to be 2009 H1N1 based on the epidemic strains in LAC during the surveillance period (22).…”

Section: Methodsmentioning

confidence: 99%

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Influenza Vaccine is Protective Against Laboratory-confirmed Influenza in Obese Children

Smit

Wang

Kim

et al. 2016

Pediatric Infectious Disease Journal

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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.

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Effectiveness of Multifaceted Strategies to Increase Influenza Vaccination Uptake

Hu,

Yan,

Yin

et al. 2024

JAMA Netw Open

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ImportanceInfluenza vaccination rates remain low among primary school students and vary by school in Beijing, China. Theory-informed, multifaceted strategies are needed to improve influenza vaccination uptake.ObjectiveTo evaluate the effectiveness of multifaceted strategies in improving influenza vaccination uptake among primary school students.Design, Setting, and ParticipantsThis cluster randomized trial was conducted from September 2022 to May 2023 across primary schools in Beijing, China. Schools were allocated randomly in a 1:1 ratio to multifaceted strategies or usual practice. Schools were deemed eligible if the vaccination rates in the 2019 to 2020 season fell at or below the district-wide average for primary schools. Eligible participants included students in grades 2 and 3 with no medical contraindications for influenza vaccination.InterventionThe multifaceted strategies intervention involved system-level planning and coordination (eg, developing an implementation blueprint, building social norms, and enhancing supervision), school-level training and educating school implementers (eg, conducting a 1-hour training and developing educational materials), and individual-level educating and reminding students and parents (eg, conducting educational activities and sending 4 reminders about vaccination).Main Outcomes and MeasuresThe primary outcomes were influenza vaccination uptake at school reported by school clinicians as well as overall vaccine uptake either at school or outside of school as reported by parents at 3 months. Generalized linear mixed models were used for analysis.ResultsA total of 20 schools were randomized. One intervention school and 2 control schools did not administer vaccination on school grounds due to COVID-19, resulting in a total of 17 schools (9 intervention and 8 control). There was a total of 1691 students aged 7 to 8 years (890 male [52.6%]; 801 female [47.4%]) including 915 in the intervention group and 776 in the control group. Of all participants, 848 (50.1%) were in grade 2, and 1209 (71.5%) were vaccinated in the 2021 to 2022 season. Participants in the intervention and control groups shared similar characteristics. At follow-up, of the 915 students in the intervention group, 679 (74.5%) received a vaccination at school, and of the 776 students in the control group, 556 (71.7%) received a vaccination at school. The overall vaccination rates were 76.0% (695 of 915 students) for the intervention group and 71.3% (553 of 776 students) for the control group. Compared with the control group, there was significant improvement of vaccination uptake at school (odds ratio, 1.40; 95% CI, 1.06–1.85; P = .02) and overall uptake (odds ratio, 1.49; 95% CI, 1.12–1.99; P = .01) for the intervention group.Conclusions and RelevanceIn this study, multifaceted strategies showed modest effectiveness in improving influenza vaccination uptake among primary school students, which provides a basis for the implementation of school-located vaccination programs of other vaccines in China, and in other countries with comparable programs.Trial registrationChinese Clinical Trial Registry: ChiCTR2200062449

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School-Located Influenza Vaccination Decreases Laboratory-Confirmed Influenza and Improves School Attendance

Abstract: 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%.

Cited by 66 publications

References 32 publications

Seasonal Effectiveness of Live Attenuated and Inactivated Influenza Vaccine

Seasonal Effectiveness of Live Attenuated and Inactivated Influenza Vaccine

Influenza Vaccine is Protective Against Laboratory-confirmed Influenza in Obese Children

Effectiveness of Multifaceted Strategies to Increase Influenza Vaccination Uptake

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