Vaccination Programs in Schools and Organized Child Care Centers to Increase Vaccination Coverage in Children and Adolescents: An Updated Review of Effectiveness From the Task Force On Community Preventive Services

Background: Vaccination programs in schools and organized childcare centers can play an important role in increasing coverage rates for some vaccines among children and adolescents. In 2009, the Task Force on Community Preventive Services updated their evidence-based findings regarding the use of these interventions.

Objectives: To update a prior systematic review of the evidence on effectiveness of vaccination programs in schools and organized childcare centers for increasing vaccination rates and in reducing morbidity and mortality among children and adolescents.

Methods: The prior review was updated with a systematic search for the period 1998–2009. Intervention studies and economic evaluations were abstracted, and findings were summarized and translated into conclusions on effectiveness and economic efficiency according to Community Guide methods and rules of evidence.

Results: Eighteen new studies were added for a total body of evidence of 29 intervention studies for the period 1980–2009. Of these, 16 studies (19 study arms) provided a common measurement of change in vaccination rates with a median absolute percentage increase of 41 percentage points (Interquartile Interval: 13.0 to 64.0). Eleven studies evaluated morbidity and mortality outcomes. Three studies documented reductions in the incidence rates of measles and hepatitis B. Eight studies documented mixed results from the provision of influenza vaccine in schools and childcare centers. Finally, results from 10 economic evaluations suggest that school-based programs could be less expensive than those in healthcare settings due to lower vaccine costs and the averted loss of parental income associated with children’s clinic visits.

Conclusions: Based on Community Guide rules of evidence, there is strong evidence that vaccination programs in schools and organized childcare centers are effective in improving vaccination rates among children and adolescents for a range of vaccines. Programs in these settings may be most useful for new vaccines and vaccines with new, expanded recommendations.