季节性流感疫苗接种在学校：一项随机对照试验。

Seasonal influenza vaccination at school: a randomized controlled trial.

机构信息

Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.

Department of Pediatrics, University of Rochester Medical Center, Rochester, New York.

出版信息

Am J Prev Med. 2014 Jan;46(1):1-9. doi: 10.1016/j.amepre.2013.08.021.

DOI:10.1016/j.amepre.2013.08.021

PMID:24355665

Abstract

BACKGROUND

Influenza vaccination coverage for U.S. school-aged children is below the 80% national goal. Primary care practices may not have the capacity to vaccinate all children during influenza vaccination season. No real-world models of school-located seasonal influenza (SLV-I) programs have been tested.

PURPOSE

Determine the feasibility, sustainability, and impact of an SLV-I program providing influenza vaccination to elementary school children during the school day.

DESIGN

In this pragmatic randomized controlled trial of SLV-I during two vaccination seasons, schools were randomly assigned to SLV-I versus standard of care. Seasonal influenza vaccine receipt, as recorded in the state immunization information system (IIS), was measured.

SETTING/PARTICIPANTS: Intervention and control schools were located in a single western New York county. Participation (intervention or control) included the sole urban school district and suburban districts (five in Year 1, four in Year 2).

INTERVENTION

After gathering parental consent and insurance information, live attenuated and inactivated seasonal influenza vaccines were offered in elementary schools during the school day.

MAIN OUTCOME MEASURES

Data on receipt of ≥1 seasonal influenza vaccination in Year 1 (2009-2010) and Year 2 (2010-2011) were collected on all student grades K through 5 at intervention and control schools from the IIS in the Spring of 2010 and 2011, respectively. Additionally, coverage achieved through SLV-I was compared to coverage of children vaccinated elsewhere. Preliminary data analysis for Year 1 occurred in Spring 2010; final quantitative analysis for both years was completed in late Fall 2012.

RESULTS

Results are shown for 2009-2010 and 2010-2011, respectively: Children enrolled in suburban SLV-I versus control schools had vaccination coverage of 47% vs 36%, and 52% vs 36% (p<0.0001 both years). In urban areas, coverage was 36% vs 26%, and 31% vs 25% (p<0.001 both years). On multilevel logistic analysis with three nested levels (student, school, school district) during both vaccination seasons, children were more likely to be vaccinated in SLV-I versus control schools; ORs were 1.6 (95% CI=1.4, 1.9; p<0.001) and 1.5 (95% CI=1.3, 1.8; p<0.001).

CONCLUSIONS

Delivering influenza vaccine during school is a promising approach to improving pediatric influenza vaccination coverage.

TRIAL REGISTRY

ClinicalTrials.govNCT01224301.

摘要

背景

美国学龄儿童的流感疫苗接种率低于 80%的全国目标。初级保健机构可能没有在流感疫苗接种季节为所有儿童接种疫苗的能力。尚未对以学校为基础的季节性流感（SLV-I）计划进行真实世界模型测试。

目的

确定在学校日间为小学生接种季节性流感疫苗的 SLV-I 计划的可行性、可持续性和影响。

设计

在这两项 SLV-I 的实用随机对照试验中，学校被随机分配至 SLV-I 组或标准护理组。通过国家免疫信息系统（IIS）记录季节性流感疫苗接种情况。

地点/参与者：干预和对照组学校位于纽约州的一个县。参与（干预或对照）包括唯一的城市学区和郊区学区（第一年 5 所，第二年 4 所）。

干预

在收集家长同意书和保险信息后，在日间学校为小学生提供减毒活疫苗和灭活季节性流感疫苗。

主要观察指标

第一年（2009-2010 年）和第二年（2010-2011 年）所有 K-5 年级学生在干预和对照组学校的免疫信息系统中收集的数据显示，接受≥1 剂季节性流感疫苗的人数。2010 年春季和 2011 年春季分别从 IIS 收集了干预和对照组学校的所有学生的信息。此外，还比较了通过 SLV-I 获得的覆盖率与在其他地方接种疫苗的儿童的覆盖率。第一年的初步数据分析于 2010 年春季进行；两年的最终定量分析于 2012 年秋季完成。

结果

分别显示了 2009-2010 年和 2010-2011 年的数据：在郊区参加 SLV-I 的儿童与对照组儿童的疫苗接种率分别为 47%和 36%，52%和 36%（均<0.0001）。在城市地区，接种率分别为 36%和 26%，31%和 25%（均<0.001）。在两次接种季节中，采用包含 3 个嵌套层次（学生、学校、学区）的多级逻辑回归分析，接受 SLV-I 接种的儿童更有可能接种疫苗；OR 值分别为 1.6（95%CI=1.4, 1.9;p<0.001）和 1.5（95%CI=1.3, 1.8;p<0.001）。