Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States; Department of Epidemiology and Population Health, Stanford University, Stanford, CA, United States.
Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, United States.
Vaccine. 2022 Jan 21;40(2):266-274. doi: 10.1016/j.vaccine.2021.11.073. Epub 2021 Dec 3.
Increasing influenza vaccination coverage in school-aged children may substantially reduce community transmission. School-located influenza vaccinations (SLIV) aim to promote vaccinations by increasing accessibility, which may be especially beneficial to race/ethnicity groups that face high barriers to preventative care. Here, we evaluate the effectiveness of a city-wide SLIV program by race/ethnicity from 2014 to 2018.
We used multivariate matching to pair schools in the intervention district in Oakland, CA with schools in a comparison district in West Contra Costa County, CA. We distributed cross-sectional surveys to measure caregiver-reported student vaccination status and estimated differences in vaccination coverage levels and reasons for non-vaccination between districts stratifying by race/ethnicity. We estimated difference-in-differences (DID) of laboratory confirmed influenza hospitalization incidence between districts stratified by race/ethnicity using surveillance data.
Differences in influenza vaccination coverage in the intervention vs. comparison district were larger among White (2017-18: 21.0% difference [95% CI: 9.7%, 32.3%]) and Hispanic/Latino (13.4% [8.8%, 18.0%]) students than Asian/Pacific Islander (API) (8.9% [1.3%, 16.5%]), Black (5.9% [-2.2%, 14.0%]), and multiracial (6.3% [-1.8%, 14.3%)) students. Concerns about vaccine effectiveness or safety were more common among Black and multiracial caregivers. Logistical barriers were less common in the intervention vs. comparison district, with the largest difference among White students. In both districts, hospitalizations in 2017-18 were higher in Blacks (Intervention: 111.5 hospitalizations per 100,00; Comparison: 134.1 per 100,000) vs. other races/ethnicities. All-age influenza hospitalization incidence was lower in the intervention site vs. comparison site among White/API individuals in 2016-17 (DID -25.14 per 100,000 [95% CI: -40.14, -10.14]) and 2017-18 (-36.6 per 100,000 [-52.7, -20.5]) and Black older adults in 2017-18 (-282.2 per 100,000 (-508.4, -56.1]), but not in other groups.
SLIV was associated with higher vaccination coverage and lower influenza hospitalization, but associations varied by race/ethnicity. SLIV alone may be insufficient to ensure equitable influenza outcomes.
提高学龄儿童的流感疫苗接种率可能会显著减少社区传播。学校所在地流感疫苗接种（SLIV）旨在通过提高可及性来促进接种，这可能对面临高预防性护理障碍的种族/族裔群体特别有益。在这里，我们评估了 2014 年至 2018 年全市范围内 SLIV 计划的有效性。
我们使用多元匹配将加利福尼亚州奥克兰市的干预区的学校与加利福尼亚州西康特拉科斯塔县的对照区的学校进行匹配。我们分发了横断面调查，以衡量照顾者报告的学生疫苗接种状况，并根据种族/族裔分层，估计疫苗接种覆盖率水平和未接种疫苗的原因在各地区之间的差异。我们使用监测数据根据种族/族裔分层，估计了各地区之间实验室确诊的流感住院发病率的差异差异（DID）。
与比较区相比，干预区的白种人（2017-18 年：21.0%的差异[95%置信区间：9.7%，32.3%]）和西班牙裔/拉丁裔（13.4%[8.8%，18.0%]）学生的流感疫苗接种率更高，而亚洲/太平洋岛民（API）（8.9%[1.3%，16.5%]）、黑种人（5.9%[-2.2%，14.0%]）和多种族（6.3%[-1.8%，14.3%））学生。黑人和多种族照顾者更关注疫苗的有效性或安全性。与比较区相比，干预区的后勤障碍较少，其中白种人差异最大。在两个地区，2017-18 年的住院率黑人较高（干预：每 100,000 人中有 111.5 人住院；比较：每 100,000 人中有 134.1 人住院）与其他种族/族裔相比。在 2016-17 年（干预-25.14 每 100,000 人[95%置信区间：-40.14，-10.14]）和 2017-18 年（干预-36.6 每 100,000 人[52.7，-20.5]）和 2017-18 年（黑人老年人-282.2 每 100,000 人[-508.4，-56.1]）中，干预地点的全年龄段流感住院发病率均低于比较地点，而在其他人群中则没有。
SLIV 与更高的疫苗接种率和更低的流感住院率相关，但关联因种族/族裔而异。单独的 SLIV 可能不足以确保公平的流感结果。
