A School-Based Influenza Vaccination Pilot Campaign in An Urban Setting: An Analysis of School District Implementation Strategies

Background:
In 2007, the Advisory Committee on Immunization Practices(ACIP) indicated its intent to recommend annual flu vaccination of school-aged children. In response, Los Angeles County(LAC) implemented a pilot program to determine school districts' abilities to vaccinate student populations against influenza using the new refrigerator-stable live-attenuated influenza vaccine(LAIV). LAC's pilot expands upon previous research by evaluating individual school district implementation strategies.

Objectives:
To evaluate school district strategies in implementing a LAIV program.

Methods:
A campaign offering FluMistŪ vaccination, the only U.S. licensed LAIV, was conducted at 42 schools (elementary-28;middle-10;high-4) in five districts during the 2007-2008 season. Participating districts didn't require health department vaccinators and used their existing infrastructure to develop implementation methods. The effect of vaccine administration method(VAM) on total doses administered and the effect of campaign promotion/distribution method(CPDM) on parents' intent to vaccinate their child were examined. District-specific VAMs included: VAM-1:traveling nurses(implemented by 3 districts-elementary/middle/high schools); VAM-2:traveling nurses, mobile clinics(1 district-elementary schools); VAM-3:traveling nurses, large centralized clinics(1 district-elementary/middle/high schools). CPDMs included: CPDM-1:letter sent home, school flyers; campaign materials sent home with student(2 districts-elementary/middle schools); CPDM-2:home letter, school flyers, email; materials sent home and mailed to parent(1 district-elementary/middle/high schools); CPDM-3:home letter, school flyers, email, parent newsletter; materials picked-up(1 district-elementary/middle/high schools).

Results:
Overall, 67% of the doses allocated to schools were administered to students and staff (district range: 46.9%-91.0%). VAM-1 districts administered the highest percent of allocated doses (district results-91.0%,84.7%,71.3%), followed by VAM-2 (61.6%), and VAM-3 (46.9%). The CPDM-3 district had the highest proportion of parents intending to vaccinate their child with LAIV (88.5%), followed by CPDM-1 (65.1%,73.5%) and CPDM-2 (69.5%).

Conclusions:
Both the type of vaccination promotion strategy and administration model employed by schools play a critical role in the success of school-based influenza vaccination programs.