School-located influenza vaccination reduces community risk for influenza and influenza-like illness emergency care visits

Cuc H Tran, Jonathan D Sugimoto, Juliet R C Pulliam, Kathleen A Ryan, Paul D Myers, Joan B Castleman, Randell Doty, Jackie Johnson, Jim Stringfellow, Nadia Kovacevich, Joe Brew, Lai Ling Cheung, Brad Caron, Gloria Lipori, Christopher A Harle, Charles Alexander, Yang Yang, Ira M Longini Jr, M Elizabeth Halloran, J Glenn Morris Jr, Parker A Small Jr, Cuc H Tran, Jonathan D Sugimoto, Juliet R C Pulliam, Kathleen A Ryan, Paul D Myers, Joan B Castleman, Randell Doty, Jackie Johnson, Jim Stringfellow, Nadia Kovacevich, Joe Brew, Lai Ling Cheung, Brad Caron, Gloria Lipori, Christopher A Harle, Charles Alexander, Yang Yang, Ira M Longini Jr, M Elizabeth Halloran, J Glenn Morris Jr, Parker A Small Jr

Abstract

Background: School-located influenza vaccination (SLIV) programs can substantially enhance the sub-optimal coverage achieved under existing delivery strategies. Randomized SLIV trials have shown these programs reduce laboratory-confirmed influenza among both vaccinated and unvaccinated children. This work explores the effectiveness of a SLIV program in reducing the community risk of influenza and influenza-like illness (ILI) associated emergency care visits.

Methods: For the 2011/12 and 2012/13 influenza seasons, we estimated age-group specific attack rates (AR) for ILI from routine surveillance and census data. Age-group specific SLIV program effectiveness was estimated as one minus the AR ratio for Alachua County versus two comparison regions: the 12 county region surrounding Alachua County, and all non-Alachua counties in Florida.

Results: Vaccination of ∼50% of 5-17 year-olds in Alachua reduced their risk of ILI-associated visits, compared to the rest of Florida, by 79% (95% confidence interval: 70, 85) in 2011/12 and 71% (63, 77) in 2012/13. The greatest indirect effectiveness was observed among 0-4 year-olds, reducing AR by 89% (84, 93) in 2011/12 and 84% (79, 88) in 2012/13. Among all non-school age residents, the estimated indirect effectiveness was 60% (54, 65) and 36% (31, 41) for 2011/12 and 2012/13. The overall effectiveness among all age-groups was 65% (61, 70) and 46% (42, 50) for 2011/12 and 2012/13.

Conclusion: Wider implementation of SLIV programs can significantly reduce the influenza-associated public health burden in communities.

Conflict of interest statement

Competing Interests: The authors of this manuscript have read the journal's policy and have the following competing interests: CHT, MEH, & JGM have received unrelated grant funding in the past from MedImmune in the previous 3 years. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Figure 1. Establishing Influenza Epidemic Periods.
Figure 1. Establishing Influenza Epidemic Periods.
The proportion of the laboratory specimens positive for influenza A (light bar) and B (dark bar) viruses among isolates submitted by the states of the Health and Human Services Southeastern Health Region 4 to the National Respiratory and Enteric Virus Surveillance System maintained by the United States Centers for Disease Control and Prevention (CDC). Data are shown for 2011/12 and 2012/13. Influenza epidemic periods (horizontal bars) for each year are defined using CDC criteria , .
Figure 2. Number of cases (per 100,000…
Figure 2. Number of cases (per 100,000 residents) of influenza-like illness (ILI) associated outpatient visits by geographic region and calendar week.
Chief complaint information is reported for outpatient visits to 183 emergency departments and urgent care facilities located throughout the state of Florida. Rates are presented for Alachua County (bars), the location of a novel school-located influenza vaccination program, and two comparison regions: the nearby 12 counties (Region 3, dashed line) and all non-Alachua counties (Florida, solid line). The map inset depicts the locations of Alachua and Region 3 within the state of Florida.
Figure 3. Estimated effectiveness of the Alachua…
Figure 3. Estimated effectiveness of the Alachua County school-located influenza vaccination (SLIV) program (upper panel) and attack rates for influenza-like illness (ILI) associated outpatient visit to sentinel emergency care facilities (lower panel) by age-group and epidemic periods.
School-age children (5–17 years) are the target age-group for the SLIV; thus, the SLIV effect in this age-group is considered a measure of the program's overall effectiveness. SLIV effects in all other age-groups are considered measures of indirect effectiveness. SLIV effectiveness is defined as 1 minus the ratio of the age-group specific seasonal attack rates for ILI-associated outpatient visits in Alachua County versus the rates for one of two comparison regions: the surrounding 12 counties (Region 3, open circles) and all non-Alachua counties of Florida (squares). Vertical error bars represent 95% confidence intervals.

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Source: PubMed

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