Immunization Reminder/Recall for 6th Graders at School-Based Health Centers

Background: Although reminder/recall has been shown to improve Iz rates in young children in office-based settings, effectiveness for adolescents in school-based health center (SBHC) settings has not been examined. 

Objectives: To assess 1) Iz rates achievable with reminder/recall by SBHCs among 6th grade females needing Tdap, MCV4 or the first HPV (demonstration study) and 2) the effectiveness of SBHC-based reminder/recall among 6th grade males in increasing rates of receipt of Tdap and MCV4 (randomized controlled trial, RCT).

Methods: During 10/2008-3/2009 we conducted 2 studies among eligible 6th graders enrolled in 4 Denver Public SBHCs. Eligibility was defined as needing either Tdap, MCV4 or the first HPV (females only). Receipt of all needed vaccines was defined as receipt of Tdap, MCV4 and one HPV (females only). Among 265 eligible females, a demonstration study was conducted to assess Iz rates achieved with SBHC-based reminder/recall. Among 264 eligible males, a RCT was conducted with half receiving reminder/recall and the other half receiving usual care. Iz rates were assessed 5 months after the reminder/recall.

Results: At the end of the demonstration study, 72% of females had received at least one vaccine and 45% had received all needed vaccines. Rates of receipt of each vaccine among females were 68% for Tdap, 57% for MCV4 and 59% for the first HPV. Twenty-five percent received 2 HPV shots during the study. At the end of the RCT, 64% of recalled males had received at least one vaccine and 59% had received all needed, compared with 40% and 36% respectively of the control group (p<0.001).

Conclusions: Recall by a SBHC was effective in improving Iz rates for all adolescent vaccines, with effects sizes exceeding those achieved with younger children in practice settings. The captive audience for school-based recall may be particularly helpful in vaccinating adolescents, a group that has historically been difficult to reach.