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Zornoza Moreno M, Pérez-Martín J, Robles Mañueco M. Parents and teachers' perspectives on a school-located influenza vaccination program: A pilot study in the Region of Murcia, Spain. Hum Vaccin Immunother 2024; 20:2328406. [PMID: 38573783 PMCID: PMC10996829 DOI: 10.1080/21645515.2024.2328406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
During the 2022-2023 season, the Region of Murcia (an autonomous community of Spain) introduced the influenza vaccination campaign in children aged 24-59 months with the live-attenuated influenza nasal spray vaccine. To expand coverage, a pilot study was conducted to include the 3- to 4-year population in 24 public schools. The aim of the study was to assess the experiences of parents and teachers involved in the project. This was a psychosocial qualitative study in which information was collected from a cohort of 23 parents and 17 teachers who attended three and two focus group sessions, respectively. A high degree of satisfaction with the school-located influenza vaccination program was consistently reported. The teachers reported creating a friendly environment and acting as companions to support children in the absence of their parents. They also considered the intranasal route, which avoids intramuscular puncture, as a facilitating element that turned the vaccination process into a kind of game. Parents emphasized the importance of vaccination to protect their children, and secondarily, to ensure protection of the family nucleus. Some parents who had their children already vaccinated in the health care center reported preference for the school setting, probably selecting this option in the future. The availability of school-based influenza vaccination promoted greater equity in accessing the vaccine and facilitated family reconciliation. To optimize coverage and minimize potential reluctance, providing the necessary information to parents both before and after vaccination was considered. School-located influenza vaccination was feasible and is a valuable strategy to be implemented in future campaigns.
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Affiliation(s)
- Matilde Zornoza Moreno
- Health Prevention and Protection Service, General Directorate of Public Health and Addictions, Health Council, Region de Murcia, Spain
| | - Jaime Pérez-Martín
- Health Prevention and Protection Service, General Directorate of Public Health and Addictions, Health Council, Region de Murcia, Spain
| | - Marta Robles Mañueco
- Immunotherapy and Vaccines Unit, AstraZeneca Farmacéutica Spain SA, Medical Department, Madrid, Spain
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Kempe A, Allison MA, Daley MF. Can School-Located Vaccination Have a Major Impact on Human Papillomavirus Vaccination Rates in the United States? Acad Pediatr 2018; 18:S101-S105. [PMID: 29502627 DOI: 10.1016/j.acap.2017.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 08/15/2017] [Accepted: 08/19/2017] [Indexed: 10/17/2022]
Abstract
School-local vaccination (SLV) has been a highly effective method of increasing rates of human papillomavirus (HPV) vaccination in many countries internationally in which vaccines are purchased by national, regional, or local public health authorities and offered free of charge within schools. However, the effectiveness of SLV for increasing HPV vaccination rates in the United States is likely to be substantially limited due to a number of identified barriers, the most significant of which is with the need to bill for vaccines among adolescents not covered under the Vaccines for Children Program. HPV vaccination within school-based health centers (SBHCs) has been much more effective than SLV, but SBHCs exist in only 2% of schools in the United States. The opportunity gap between the United States and other countries will remain unless reimbursement issues related to HPV delivery in schools can be addressed in a sustainable manner or SBHCs become much more common.
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Affiliation(s)
- Allison Kempe
- ACCORDS (Adult and Child Consortium for Health Outcomes and Delivery Science), University of Colorado Anschutz Medical Campus, Aurora, Colo; Children's Hospital Colorado, Aurora, Colo; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colo.
| | - Mandy A Allison
- ACCORDS (Adult and Child Consortium for Health Outcomes and Delivery Science), University of Colorado Anschutz Medical Campus, Aurora, Colo; Children's Hospital Colorado, Aurora, Colo; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver
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Szilagyi PG, Schaffer S, Rand CM, Vincelli P, Eagan A, Goldstein NPN, Hightower AD, Younge M, Blumkin A, Albertin CS, Yoo BK, Humiston SG. School-Located Influenza Vaccinations: A Randomized Trial. Pediatrics 2016; 138:peds.2016-1746. [PMID: 27940785 DOI: 10.1542/peds.2016-1746] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Assess impact of offering school-located influenza vaccination (SLIV) clinics using both Web-based and paper consent upon overall influenza vaccination rates among elementary school children. METHODS We conducted a cluster-randomized trial (stratified by suburban/urban districts) in upstate New York in 2014-2015. We randomized 44 elementary schools, selected similar pairs of schools within districts, and allocated schools to SLIV versus usual care (control). Parents of children at SLIV schools were sent information and vaccination consent forms via e-mail, backpack fliers, or both (depending on school preferences) regarding school vaccine clinics. Health department nurses conducted vaccine clinics and billed insurers. For all children registered at SLIV/control schools, we compared receipt of influenza vaccination anywhere (primary outcome). RESULTS The 44 schools served 19 776 eligible children in 2014-2015. Children in SLIV schools had higher influenza vaccination rates than children in control schools county-wide (54.1% vs 47.4%, P < .001) and in suburban (61.9% vs 53.6%, P < .001) and urban schools (43.9% vs 39.2%; P < .001). Multivariate analyses (controlling for age, grade, vaccination in previous season) confirmed bivariate findings. Among parents who consented for SLIV, nearly half of those notified by backpack fliers and four-fifths of those notified by e-mail consented online. In suburban districts, SLIV did not substitute for primary care influenza vaccination. In urban schools, some substitution occurred. CONCLUSIONS SLIV raised seasonal influenza vaccination rates county-wide and in both suburban and urban settings. SLIV did not substitute for primary care vaccinations in suburban settings where pediatricians often preorder influenza vaccine but did substitute somewhat in urban settings.
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Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California;
| | - Stanley Schaffer
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - Cynthia M Rand
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - Phyllis Vincelli
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - Ashley Eagan
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - Nicolas P N Goldstein
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - A Dirk Hightower
- Department of Clinical and Social Psychology, Children's Institute Rochester, University of Rochester, Rochester, New York
| | - Mary Younge
- Department of Public Health, Monroe County, New York
| | - Aaron Blumkin
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - Christina S Albertin
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California
| | - Byung-Kwang Yoo
- Department of Public Health Sciences, University of California at Davis, Davis, California; and
| | - Sharon G Humiston
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
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Robison SG. Impact of pharmacists providing immunizations on adolescent influenza immunization. J Am Pharm Assoc (2003) 2016; 56:446-9. [DOI: 10.1016/j.japh.2016.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 03/15/2016] [Accepted: 03/27/2016] [Indexed: 10/21/2022]
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Bobo N. Increasing immunization rates through the immunization neighborhood recognizing school-located immunization programs. NASN Sch Nurse 2014; 29:224-8. [PMID: 25272406 DOI: 10.1177/1942602x14545330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vaccines are considered one of the top 10 public health achievements in the United States; however, coverage rates for many of the recommended child and adolescent vaccines fall short of Healthy People 2020 goals. The vaccine delivery infrastructure in our country might be the most important limiting factor in achieving the vaccine uptake targets. Renewing the focus on schools for both vaccine delivery and vaccine promotion has the potential to augment other emerging alternate vaccination sites within the immunization neighborhood. School nurses are leading the way, and three national award winners are recognized for their immunization programming efforts. All school nurses can be immunization champions, advocating for the role of schools as key sites to promote the importance of vaccines in protecting the health and ensuring academic success of the students they serve.
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Kempe A, Daley MF, Pyrzanowski J, Vogt T, Fang H, Rinehart DJ, Morgan N, Riis M, Rodgers S, McCormick E, Hammer A, Campagna EJ, Kile D, Dickinson M, Hambidge SJ, Shlay JC. School-located influenza vaccination with third-party billing: outcomes, cost, and reimbursement. Acad Pediatr 2014; 14:234-40. [PMID: 24767776 DOI: 10.1016/j.acap.2014.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/10/2014] [Accepted: 01/21/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess rates of immunization; costs of conducting clinics; and reimbursements for a school-located influenza vaccination (SLIV) program that billed third-party payers. METHODS SLIV clinics were conducted in 19 elementary schools in the Denver Public School district (September 2010 to February 2011). School personnel obtained parental consent, and a community vaccinator conducted clinics and performed billing. Vaccines For Children vaccine was available for eligible students. Parents were not billed for any fees. Data were collected regarding implementation costs and vaccine cost was calculated using published private sector prices. Reimbursement amounts were compared to costs. RESULTS Overall, 30% of students (2784 of 9295) received ≥1 influenza vaccine; 39% (1079 of 2784) needed 2 doses and 80% received both. Excluding vaccine costs, implementation costs were $24.69 per vaccination. The percentage of vaccine costs reimbursed was 62% overall (82% from State Child Health Insurance Program (SCHIP), 50% from private insurance). The percentage of implementation costs reimbursed was 19% overall (23% from private, 27% from Medicaid, 29% from SCHIP and 0% among uninsured). Overall, 25% of total costs (implementation plus vaccine) were reimbursed. CONCLUSIONS A SLIV program resulted in vaccination of nearly one third of elementary students. Reimbursement rates were limited by 1) school restrictions on charging parents fees, 2) low payments for vaccine administration from public payers and 3) high rates of denials from private insurers. Some of these problems might be reduced by provisions in the Affordable Care Act.
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Affiliation(s)
- Allison Kempe
- Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Department of Pediatrics, University of Colorado, Aurora, Colo; Colorado Health Outcomes Program, University of Colorado, Aurora, Colo.
| | - Matthew F Daley
- Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Department of Pediatrics, University of Colorado, Aurora, Colo; Institute for Health Research, Kaiser Permanente, Denver, Colo
| | | | - Tara Vogt
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Hai Fang
- Department of Health System, Management and Policy, University of Colorado, Aurora, Colo
| | | | | | - Mette Riis
- Denver Public Health, Denver Health, Denver, Colo
| | | | - Emily McCormick
- Institute for Health Research, Kaiser Permanente, Denver, Colo; Public Health Prevention Services, Centers for Disease Control and Prevention, Atlanta, Ga; Denver Public Health, Denver Health, Denver, Colo
| | - Anne Hammer
- Community Health Services, Denver Health, Denver, Colo
| | | | - Deidre Kile
- Colorado Health Outcomes Program, University of Colorado, Aurora, Colo
| | - Miriam Dickinson
- Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Department of Family Medicine, University of Colorado, Aurora, Colo
| | - Simon J Hambidge
- Department of Pediatrics, University of Colorado, Aurora, Colo; Denver Public Health, Denver Health, Denver, Colo; Community Health Services, Denver Health, Denver, Colo
| | - Judith C Shlay
- Department of Family Medicine, University of Colorado, Aurora, Colo; Denver Public Health, Denver Health, Denver, Colo
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Kempe A, Daley MF, Pyrzanowski J, Vogt TM, Campagna EJ, Dickinson LM, Hambidge SJ, Shlay JC. School-located influenza vaccination with third-party billing: what do parents think? Acad Pediatr 2014; 14:241-8. [PMID: 24767777 DOI: 10.1016/j.acap.2014.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/10/2014] [Accepted: 01/21/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE School-located influenza vaccination (SLIV) may be instrumental in achieving high vaccination rates among children. Sustainability of SLIV programs may require third-party billing. This study assessed, among parents of elementary school students, the attitudes about SLIV and billing at school, as well as factors associated with being supportive of SLIV. METHODS We conducted a survey (April 2010 to June 2010) of parents of 1000 randomly selected primarily low-income children at 20 elementary schools at which SLIV with billing had occurred. RESULTS Response rate was 70% (n = 699). Eighty-one percent agreed (61% strongly) they "would be okay" with SLIV for their child. Many agreed it was better to get vaccinated at their child's doctor's office because they could take care of other health issues (72%) and the doctor knows the child's medical history (65%). However, an equal percentage (47%) thought the best place for influenza vaccination was the child's doctor's office and the child's school. Twenty-five percent did not want to give health insurance information necessary for billing at school. Factors independently associated with strongly supporting SLIV included parental education of high school or less (relative risk 1.30; 95% confidence interval 1.09-1.58), Hispanic ethnicity (1.25; 1.08-1.45); believing the vaccine is efficacious (1.49; 1.23-1.84); and finding school delivery more convenient (2.37; 1.82-3.45). Having concerns about the safety of influenza vaccine (0.80; 0.72-0.88) and not wanting their child to be vaccinated without a parent (0.74; 0.64-0.83) were negatively associated. CONCLUSIONS The majority of parents were supportive of SLIV, although parental concerns about not being present for vaccination and about the safety and efficacy of the vaccine will need to be addressed.
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Affiliation(s)
- Allison Kempe
- Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Department of Pediatrics, University of Colorado, Aurora, Colo.
| | - Matthew F Daley
- Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Institute for Health Research, Kaiser Permanente, Denver, Colo
| | | | - Tara M Vogt
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | | | - L Miriam Dickinson
- Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Department of Family Medicine, University of Colorado, Aurora, Colo
| | - Simon J Hambidge
- Department of Pediatrics, University of Colorado, Aurora, Colo; Community Health Services, Denver Health, Denver, Colo
| | - Judith C Shlay
- Department of Family Medicine, University of Colorado, Aurora, Colo; Denver Public Health, Denver Health, Denver, Colo
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School-located vaccination of adolescents with insurance billing: cost, reimbursement, and vaccination outcomes. J Adolesc Health 2014; 54:282-8. [PMID: 24560036 DOI: 10.1016/j.jadohealth.2013.12.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/10/2013] [Accepted: 12/11/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE To assess, in a school-located adolescent vaccination program that billed health insurance, the program costs, the proportion of costs reimbursed, and the likelihood of vaccination. METHODS During the 2010-2011 school year, vaccination clinics were held for sixth- to eighth-grade students at seven Denver public schools. Vaccine administration and purchase costs were compared with reimbursement by insurers. Multivariate analyses were used to compare the likelihood of vaccination among students in intervention schools with students in control schools who did not participate in the program, with analyses stratified by grade (sixth grade vs. seventh-eighth grades). RESULTS Fifteen percent (466 of 3,144) of students attending intervention schools were vaccinated at school-located vaccination clinics. Among students vaccinated at school, 41% were uninsured, 37% publicly insured, and 22% privately insured. Estimated vaccine administration costs were $23.98 per vaccine dose. Seventy-eight percent of vaccine purchase costs and 14% of vaccine administration costs were reimbursed by insurers; 41% of total program costs were reimbursed. Sixth-grade students in intervention schools were more likely than those in control schools to receive tetanus-diphtheria-acellular pertussis (risk ratio [RR], 1.30; 95% confidence interval [CI], 1.08, 1.57), meningococcal conjugate (RR, 1.42; CI, 1.18, 1.70), and human papillomavirus (for females only, RR, 1.69; CI, 1.21, 2.36) vaccines during the 2010-2011 school year, with similar results for seventh- to eighth-grade students. CONCLUSIONS Although school-located adolescent vaccination with billing appears feasible and likely to improve vaccination rates, improvements in insurance coverage and reimbursement rates may be needed for the long-term financial sustainability of such programs.
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Abstract
PURPOSE OF REVIEW To provide a clinically relevant synopsis of recent research findings as well as updated recommendations from the American Academy of Pediatrics (AAP) and Advisory Committee on Immunization Practices (ACIP) regarding adolescent immunizations. RECENT FINDINGS Coverage rates for the adolescent vaccinations continue to lag behind those of the childhood vaccinations, despite their importance. Recent research has focused on the reasons for suboptimal adolescent vaccination rates as well as strategies for improvement. By more fully understanding the barriers to immunization, efforts can be implemented to address these concerns and to ensure that all eligible adolescents receive their vaccinations. In addition, much work has focused on the duration of protection induced by childhood and adolescent vaccinations and the need for booster doses in older adolescents. Because immunity has been found to wane after vaccination, these booster doses can serve to more fully protect adolescents. This article reviews selected recent publications on human papillomavirus, meningococcal conjugate, and tetanus and diphtheria toxoids and acellular pertussis vaccines. SUMMARY Adolescent vaccinations will continue to be studied and this research will serve to shape future recommendations. Through this work, we can learn the best methods to optimize the protection of all adolescents against these very serious diseases.
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