School Vaccination Research Articles

Parental Views of School-Located Delivery of Adolescent Vaccines

School-located immunization has the potential to increase adolescent vaccination rates. This study assessed parents' attitudes toward administration of adolescent vaccines (tetanus, diphtheria, acellular pertussis [Tdap], meningococcal conjugate [MenACWY], human papillomavirus [HPV], and influenza) at school. We conducted a mailed survey of parents of sixth graders from July 2009 to September 2009 in three urban/suburban (Aurora, CO) middle schools assessing barriers and facilitators to school vaccination and willingness to consent for vaccines at school. Unadjusted and adjusted analyses examined the association of parent and student characteristics with parent willingness to consent to school-located vaccination. The response rate was 62% (500/806). Parents reported 82% of teens had a regular site of health care, and 17% were uninsured. Overall, 71% of parents would consent for vaccines at school; 72% for Tdap, 71% for MenACWY, 53% for HPV (parents of girls), and 67% for seasonal influenza. Among parents who answered it was important their child receives recommended vaccines, (88%) would consent for influenza vaccine at school, compared with Tdap (76%), MenACWY (74%), and HPV (72%). Multivariable logistic regression analysis demonstrated parents of uninsured teens (odds ratio [OR] 3.77, 95% confidence interval [CI]: 1.40, 12.23), who were unmarried (OR 1.90, 95% CI: 1.14, 3.25), or had a child attending the school with the highest percent eligibility for free/reduced lunch (OR 2.75, 95% CI: 1.36, 5.80) were significantly more willing to consent for vaccines at school. These data suggest parents are generally supportive of school-located vaccine delivery, particularly for annual influenza vaccination and for uninsured and low-income adolescents.

Ontario’s School-based HPV Immunization Program: School Board Assent and Parental Consent

To evaluate the implementation of Ontario's publicly-funded, school-based HPV immunization program through a process evaluation. The immunization program targets grade 8 females. Ontario vaccine-preventable disease managers were the key informants for this evaluation. Ontario, Canada. Ontario's Public Health Units (HUs) are responsible for the local implementation of the immunization program. The process evaluation involved a telephone-based, semi-structured questionnaire which included questions on stakeholder engagement; school and school board participation; communication strategies; and processes for obtaining informed consent. All 36 HUs participated; 16 (44%) reported difficulties receiving agreement from local school boards to administer HPV vaccine in schools. Two Catholic school boards have not permitted HPV vaccine clinics in their schools: 1 only during the first year and 1 in the second and third years. All HUs request parental consent for students to receive the HPV vaccine and 5/36 also request or encourage student consent; 14 HUs indicated they would immunize a grade 8 girl at a school clinic, in the absence of parental consent, if the student requested immunization and was judged capable of providing informed consent. Many HUs reported challenges in receiving support from local school boards. Despite this, vaccine clinics have been offered in all but 2 public school boards since 2007. All HUs request parental consent before HPV immunization at school-based clinics; 39% would consider immunizing in absence of parental consent. The results of this process evaluation will inform the HPV immunization program evaluation that is currently underway in Ontario.

Finding Eldorado: Slavery and Long-Run Development in Colombia

Slavery has been a major institution of labor coercion throughout history. Colonial societies used slavery intensively across the Americas, and slavery remained prevalent in most countries after independence from the European powers. We investigate the impact of slavery on long-run development in Colombia. Our identification strategy compares municipalities that had gold mines during the 17th and 18th centuries to neighboring municipalities without gold mines. Gold mining was a major source of demand for slave labor during colonial times, and all colonial gold mines are now depleted. We find that the historical presence of slavery is associated with increased poverty and reduced school enrollment, vaccination coverage and public good provision. We also find that slavery is associated with higher contemporary land inequality.

The Impact of Childhood Health on Adult Educational Attainment: Evidence from Mandatory School Vaccination Laws

This paper investigates the effects of mandatory vaccination laws on childhood health and adult educational attainment in the United States. After the invention of a number of key vaccines, states began to require proof of immunization against certain infectious diseases for first-time school entry beginning in the 1960s. I exploit the staggered implementation of mandatory vaccination laws across states to identify both the short-run impacts on childhood morbidity and long-term effects on adult educational attainment. First, I show that the state mandates were effective in reducing the incidence rates of the targeted diseases, suggesting that the mandates did improve child health. Next, I find sizable and positive effects on educational attainment.

Opportunistic MMR vaccination for unimmunized children at the time of routine teenage booster vaccination in secondary schools: implications for policy

With the aim of minimizing adverse health outcomes and reducing the risk of outbreaks, we offered one dose of MMR vaccine to children known to be incompletely immunized at the time of teenage booster vaccination in secondary schools in Swindon in 2011. The Child Health Department database was queried to identify Year 10 children who had had zero or one dose of MMR vaccine previously. Of the 316 children offered vaccination, 60 received a first dose and 87 received a second dose of MMR vaccine. Fourteen children had two documented doses in the past and two had contraindications to the vaccine. Overall uptake of two doses of MMR vaccine increased from 86·3% to 90·6%. The valuable uptake achieved demonstrates that an opportunistic offer of MMR vaccine for unimmunized children at schools is feasible and beneficial. MMR vaccine should be offered routinely to unimmunized children at the time of school vaccination programmes, especially in areas with sub-optimal coverage.

Finding the Proper Balance between Freedom and Justice: Why We Should Not Eliminate Personal Belief Exemptions to Vaccine Mandates

Lantos and colleagues (this issue) propose to eliminate personal belief exemptions from school vaccine mandates, particularly for those vaccines that target deadly contagious childhood disease. They argue that not doing so would be unjust. In this counterpoint, we argue that, for reasons grounded in both health policy and morality, a just vaccine policy need not prohibit parents from claiming personal belief exemptions.

A cost-benefit analysis of the influenza H1N1 vaccination in the primary and junior school in Shanghai

To evaluate the cost-benefit for the Influenza Type A H1N1 Virus (Influenzae H1N1) vaccination in Shanghai primary and junior schools. A semi-experiment study was selected to evaluate the cost-benefit for Influenza H1N1 vaccination in primary and junior schools in 6 districts of Shanghai, including 414 636 students in total. According to the voluntary principle, the students were divided into the vaccinated group (233 445 students) and control group (181 191 students). The information of vaccine cost was collected from CDC in 19 districts in Shanghai by questionnaire; and the information of medical treatment cost was collected from questionnaire and abstracts of retrospective medical records, which included 31 mild cases and 15 severe cases. The cost-benefit analysis was conducted by health economic evaluation. In total, there were 414 636 students enrolled in this study; while 233 445 (56.3%) students were in the vaccinated group and 181 191 in the control group. The attack rate in vaccinated group and control group was 0.61% (1433/233 445) and 1.76% (3166/181 191) respectively. The protection ratio was 65.34% ((1.76 - 0.61)/1.76) in the vaccinated group. The average cost of Influenza H1N1 was 36.81 yuan/person; and the average cost of medical treatment was (358.3 ± 243.6) yuan/mild case and (49 188.4 ± 99 917.3) yuan/severe case. The total benefit of vaccination in schools was 19 155 566.3 yuan, and the net benefit was 10 560 673.7 yuan. Therefore, the benefit-cost ratio was 2.24:1. Influenza H1N1 vaccine could protect the students from Influenza H1N1 infection, and the cost-benefit analysis showed that the intervention strategy was worth trying.

The domino effect: adolescent girls’ response to human papillomavirus vaccination

To examine the experience of fear, the fear response, and factors affecting fear in adolescents undergoing school-based human papillomavirus (HPV) vaccination. A purposive sampling strategy and qualitative methods, including observation and face-to-face interviews. Focus groups comprised adolescent girls who were involved in HPV vaccination in 2007 at schools in Sydney, New South Wales. Individual interviews were conducted with parents, teachers and vaccination nurses. Data from observing vaccination days at three schools and from interviewing 130 adolescents in 20 focus groups, 38 parents, 10 teachers and seven nurses were included in the analysis. All participants discussed the issue of fear and distress experienced by adolescent girls in relation to HPV vaccination. Observations corroborated the focus group and interview data. Our results indicated that fear was promoted by witnessing the fear reactions of peers; perceived judgement by peers; lack of information or misinformation; and being vaccinated later in the day. Fear was moderated by procedural factors, the support of peers, appropriate knowledge, and nurses' distraction techniques or approach. Fear also affected acceptance of HPV vaccination. Fear of HPV vaccination was a near universal experience among adolescents in the school setting and was often associated with significant distress that had an adverse impact on the vaccination process. School vaccination could be improved by proactively managing fear and distress.

Mothers’ support for voluntary provision of HPV vaccine in schools

HPV vaccination rates among adolescents in the United States lag behind some other developed countries, many of which routinely offer the vaccine in schools. We sought to assess mothers’ willingness to have their adolescent daughters receive HPV vaccine at school. A national sample of mothers of adolescent females ages 11–14 completed our internet survey (response rate = 66%). The final sample ( n = 496) excluded mothers who did not intend to have their daughters receive HPV vaccine in the next year. Overall, 67% of mothers who intended to vaccinate their daughters or had vaccinated their daughters reported being willing to have their daughters receive HPV vaccine at school. Mothers were more willing to allow their daughters to receive HPV vaccine in schools if they had not yet initiated the vaccine series for their daughters or resided in the Midwest or West (all p < .05). The two concerns about voluntary school-based provision of HPV vaccine that mothers most frequently cited were that their daughters’ doctors should keep track of her shots (64%) and that they wished to be present when their daughters were vaccinated (40%). Our study suggests that most mothers who support adolescent vaccination for HPV find school-based HPV vaccination an acceptable option. Ensuring communication of immunization records with doctors and allowing parents to be present during immunization may increase parental support.

Mothers’ support for voluntary provision of HPV vaccine in schools

Mothers’ support for voluntary provision of HPV vaccine in schools

Use of multimedia as an educational tool to improve human papillomavirus vaccine acceptability—A pilot study

Objective To determine, through a pilot study, whether use of a video-based educational tool can influence overall human papillomavirus (HPV) vaccine acceptability, views on vaccine mandates, school vaccination, and acceptable age for vaccination. Methods Written surveys addressing HPV knowledge and vaccine acceptability were administered to study participants from January to March 2007. An initial 32-question survey was completed, followed by an 8-minute educational video, and a post-video assessment. Results Out of 256 subjects, 73.0% watched the video and completed all surveys. Eighty percent of the subjects had heard of HPV, while 65.0% knew, prior to viewing the video, that the vaccine was available. Individual vaccine acceptability increased from 66.7% to78.0% after the video ( p = .0014). Prior to the video, 54.8% of subjects supported mandatory HPV vaccination, with 51.1% supporting school vaccination, and 66.7% accepting vaccination if it were free. After the video, these percentages increased to 72.6% ( p < .0001), 65.1% ( p < .0001) and 86.6% ( p < .0001) respectively. Initially, 56.5% of subjects would vaccinate their child at 15 years of age or younger. After the video, 94.1% approved of vaccination from age 9 ( p < .0001). Secondary analysis revealed Hispanics, African Americans, and lower income families were more likely to accept HPV vaccination after the video. A perception that vaccination promotes sex, and whether or not participants talk to their children about sex, did not affect acceptability. Conclusion Using an educational video significantly increased overall HPV vaccine acceptability and acceptance in younger age groups. This may be an effective means of increasing awareness and acceptability of HPV vaccination.

Psychogenic gait disorders after mass school vaccination of influenza a.

Background and PurposePsychogenic movement disorders (PMD) after war or mass vaccination was reported and well known disease entity already. However, we have seldom been met those patients because we don’t have any chance to experience of those events. Recently, influenza A (H1N1) spreads around world, and many countries have a program of mass vaccination of H1N1. Although PMD in adult is well characterized, childhood-onset PMD has not been extensively studied.Case ReportsWe present four children of psychogenic gait disorders (PGDs) after mass school vaccination of H1N1. They had fluctuating weakness and their prognosis was good. We confirmed all patients as PGD by placebo.ConclusionsOur four cases have two common characteristics. One is that all were young and their prognosis was good. And the other is that all were induced their abnormal gait symptoms after mass school vaccination. We observed that mass PMD has a different characteristics comparing to personal PMD, and PMD in children is differ from adult onset PMD.

Parent's Willingness to Get Vaccines in Schools

Parent's Willingness to Get Vaccines in Schools

Public Health Response to Influenza A(H1N1) as an Opportunity to Build Public Trust

IN JUNE 2009, THE WORLD HEALTH ORGANIZATION (WHO) declared the 2009 influenza A(H1N1) pandemic and in October 2009, President Obama declared it a national emergency. The influenza A(H1N1) virus is being monitored around the world for changes in virulence or epidemiology. There has been a push to have vaccines ready, yet vaccine supply may be insufficient in some areas. The public wants to be assured that there is enough vaccine, but at the same time, some are questioning the safety and effectiveness of the vaccine. It is a time of uncertainty both for the public health community and for the public. Times of uncertainty and risk are times when public trust is most needed. But trust is built long before the time that trust matters most. As the public weighs the perceived risks of the A(H1N1) virus against the perceived risks of vaccination, they are taking into account multiple, often conflicting, sources of current and historic information, as well as their own personal experiences. Questioning the safety of A(H1N1) vaccines is for some influenced by memories of the 1976 US swine flu alert, of the follow-up swine flu vaccination campaign and the ensuing cases of GuillainBarre syndrome (GBS), and of a swine flu pandemic that never materialized. For others, questioning may come from memories of severe acute respiratory syndrome (SARS), which had severe but rapidly contained health effects; for others, questions may arise from warnings about avian influenza A(H5N1) and its continued pandemic threat. Perception of risk about A(H1N1) vaccination is also influenced by a broader environment of distrust and vocal antivaccine groups. Questioning and mistrust of the measles-mumpsrubella (MMR) vaccine in the United Kingdom that began during the late 1990s was prompted by the claimed association between the MMR vaccine, bowel disease, and autism. This claim came shortly after a loss of public trust around the government’s lack of transparency and understating of the risks of bovine spongiform encephalopathy. Even after clear evidence emerged that these claims about autism being related to vaccines were unfounded, historic levels of distrust, compounded by massive media coverage that amplified the unproven links between the MMR vaccine and bowel disease, played a role in contributing to lower vaccine coverage and consequent disease outbreaks. In France, public trust in hepatitis B vaccine plummeted after the government’s precautionary decision to stop the school vaccination program because of suspected, but not proven, links with multiple sclerosis, despite recommendations by WHO and French pediatricians to continue the program. This followed concerns over the French government’s management of the human immunodeficiency virus (HIV)–contaminated blood crisis in the mid-1980s, and public opposition and rumors associating hepatitis B vaccines with not only multiple sclerosis but also autism and leukemia led to low levels of hepatitis B vaccination. In Nigeria, the mistrust and 2003-2004 boycott of the polio vaccination program by predominantly Muslim states in Northern Nigeria emerged at a time when false rumors of the safety of polio vaccine—linked to HIV, hormonal contamination, or both—weakened trust in global initiatives such as polio eradication. This followed a 1996 drug trial of an antibiotic for meningitis in Nigeria in which children died. Adding to the mistrust, repeated door-to-door polio vaccination campaigns are thought to have increased levels of suspicion in historically marginalized states. In these states, health services are inadequate, immunization coverage is lower than in the rest of the country, and communities questioned why other diseases, perceived by them to be more important, continued to be neglected. The loss of public confidence and vaccination boycott led to a resurgence of polio cases in Nigeria. The Nigerian virus spread to more than 12 neighboring countries that had been certified as poliofree and polio caused by the Nigerian strain was traced as far as Indonesia. Significant efforts have since been made at the community level in Northern Nigeria to build public

Impact of the compulsory school vaccination against hepatitis B in adolescents: exploratory-descriptive study

Introduction: In adolescence, the risk of sexually transmissible diseases has increased, becoming necessary the implementation of prevention measures. Objective: to investigate the impact of the law of compulsory immunization on the immunization coverage against Hepatitis B in adolescents in the municipal district of Maringa-Pr. Method: This is a descriptive-exploratory study, of retrospective character, regarding the number of doses of the vaccine against Hepatitis B administered in the group of 10-19 years of age, from 2001 to 2008. Data was obtained from the records of the bank “Evaluation of the Immunization Program (EIP) – municipal module” and analyzed by the statistical tests: Analysis of Variance and Tukey. Results: Statistical difference was observed in the immunization coverage against Hepatitis B before and after the compulsory nature of the immunization certificate, and also among the months with greater interest for the vaccine in the period from October to February, which is school registration time. In the 15-19 year old group, an increase on the immunization coverage was observed from 2004 to 2006, with expressive drop in 2007 and 2008 when the two larger high education institutions ceased to ask for updated immunization records in the registration. Implications on Nursing: The results show the importance of health education for the adolescents and, in the mentioned scenario, the need for discussion of the results found together with the directors of high education institutions, in order to make them aware of the importance of including the immunization records among the documents demanded in the registration.

The macroeconomic impact of pandemic influenza: estimates from models of the United Kingdom, France, Belgium and The Netherlands

The 2003 outbreak of severe acute respiratory syndrome (SARS) showed that infectious disease outbreaks can have notable macroeconomic impacts. The current H1N1 and potential H5N1 flu pandemics could have a much greater impact. Using a multi-sector single country computable general equilibrium model of the United Kingdom, France, Belgium and The Netherlands, together with disease scenarios of varying severity, we examine the potential economic cost of a modern pandemic. Policies of school closure, vaccination and antivirals, together with prophylactic absence from work are evaluated and their cost impacts are estimated. Results suggest GDP losses from the disease of approximately 0.5-2% but school closure and prophylactic absenteeism more than triples these effects. Increasing school closures from 4 weeks at the peak to entire pandemic closure almost doubles the economic cost, but antivirals and vaccinations seem worthwhile. Careful planning is therefore important to ensure expensive policies to mitigate the pandemic are effective in minimising illness and deaths.

Challenges, lessons learned and results following the implementation of a human papilloma virus school vaccination program in South Australia

To describe the process and challenges in the roll out of a large cervical cancer vaccination program to protect against human papilloma virus (HPV) infection. This article describes the process of planning and implementing a HPV vaccination program using the existing state-wide framework that supports vaccine delivery to all 219 high schools in South Australia. The decision was made to offer three doses of HPV vaccine to 50,191 female students in Years 8-12 during the 2007 school year. By November 2007, despite many challenges, the school vaccination program had delivered 107,541 doses of HPV vaccine. Coverage of dose 1 was highest in Years 8 (83%) and 10 (70%), but was reduced for doses 2 and 3 in all year levels, with dose 3 coverage ranging from 55% (Year 11) to 77% (Year 8). The introduction of a large school-based vaccination program at short notice posed new challenges for the co-ordination and implementation. Not all schools supported the introduction of HPV vaccine, resulting in reduced access for some students. Negative media messages provided a strong platform for individuals who opposed vaccination. These factors may have contributed to the less-than-expected uptake of HPV vaccine. Historically, there has been high uptake of other vaccines given to adolescents. However, the introduction of HPV vaccine may have adversely affected the uptake of Hepatitis B vaccine, given concurrently in the school program. Further studies are needed to determine if this is likely to have a negative effect on the public perception of the value of vaccine programs in general.

Effectiveness on post-exposure vaccination of varicella and its influencing factors in elementary schools in Beijing

To evaluate the effectiveness of post-exposure varicella vaccination in elementary schools in Beijing and to explore its influencing factors. From May to July 2007, varicella cases from 49 elementary schools in 4 districts in Beijing were observed prospectively. The study included 7882 children who were from the same classrooms, same floor or same bungalow areas with the varicella cases. Vaccination status, history on varicella and onset of rashes were collected to calculate the secondary attack rate among those children under observation and then the effectiveness of vaccine was calculated. The protection rate on post-exposure vaccination among children under observation was 85.26%. The rates were higher when the 1st case had received varicella vaccine before the onset, vaccines were administered soon after the exposure or there were less varicella cases occurred in the schools. For children in the same class, same floor or bungalow with varicella cases before post-exposure vaccination, the average rates of protection by vaccination were 84.26% and 87.06%, respectively. When the 1st case had received varicella vaccine prior to the onset, the post-exposure protection rates reached 92.09% and 93.06%, respectively, higher than that of the case when the 1st case had received no vaccination. When the administration of vaccine right after the occurrence of first varicella case, the rates of the effectiveness of vaccine were 83.09% and 93.02%, both of which were higher than that of vaccine administered after the occurrence of 2 or 3 cases. When the vaccine administration of vaccination combined with the isolation of the already infected cases or within 5 days after the onset of the 1st case, the vaccine effectiveness could reach 86.60% and 92.73%, both were higher than otherwise. However, in those schools that bungalows were used as classrooms but without bus, canteen from school or student lodgings, it seemed that post exposure vaccination was more effective in preventing varicella from occurring. Varicella vaccination after exposure in elementary schools in Beijing was effective in prevention and control of the disease. Immediate administration together with the isolation of cases could maximize the effectiveness of the vaccine.

Clinical role of cervical cancer vaccination: When and whom to vaccinate?

The recent development of two highly effective vaccines against persistent infection by the 2 most important types of human papillomavirus (HPV) (16 and 18) and against high grade premalignant lesions (CIN2+) has opened a new scenario for the primary prevention of cervical cancer. The optimum target population for vaccination should be individually defined taking the following into account: 1) the efficacy of the vaccine, 2) the epidemiological context and 3) the vaccination programs available in each country. To achieve the maximum preventive benefits, the vaccine should be administered before the initiation of sexual relations. So, the HPV vaccine should be integrated in the school vaccination programs of adolescents together with other vaccines. The vaccination of sexually active women may considerably increase the speed with which results in the fight against this disease will be achieved. Developed countries will probably consider the vaccination of these women, although vaccination strategies and the efforts to reach this population will be conditioned by the resources of each country and by the estimations of the cost-efficacy relationship in each situation. Women with a previous history of premalignant cervical disease or with an abnormal screening test should not be excluded from the potential benefits which the vaccine may provide. There is no contraindication for the administration of the vaccine in immunosupressed women. However, it is still unknown under what specific circumstances of immunosuppression the immunogenicity of the vaccine may be affected and there are currently ongoing studies for an answer to this question.

HPV vaccine: positive insights from universal adolescent HepB vaccination

The introduction of universal adolescent HPV vaccination in schools has a positive outlook Preventing cervical cancer by vaccination has become a reality, complementing highly successful screening programmes. One vaccine against...