Universally Recommended Vaccinations: Vaccination Programs in Schools & Organized Child Care Centers

Vaccination programs in schools or organized child care centers are multicomponent interventions delivered on-site to improve immunization rates in children and adolescents. These programs include two or more of the following components:

1. Immunization education and promotion
2. Assessment and tracking of vaccination status
3. Referral of under-immunized school or child care center attendees to vaccination providers
4. Provision of vaccinations

Additional components such as reduced client out-of-pocket costs, client incentives, and enhanced access to vaccination services may be provided.

Organized child care centers include non-home day care, nursery or pre-school, and federal Head Start settings for children aged 5 years and younger. In most states, laws establishing vaccination requirements for school and child care center attendance require assessment, documentation, and tracking specific to each vaccine. Vaccination programs considered in this review either expanded the assessment and tracking process to other immunizations or conducted additional interventions. Vaccination programs are often collaborations between the school or child care center and local health departments, private healthcare providers, or community healthcare services.

Summary of Task Force Recommendations & Findings

The Community Preventive Services Task Force recommends school and organized child care center-located vaccination programs based on strong evidence of effectiveness in increasing vaccination rates, and in decreasing rates of vaccine-preventable disease and associated morbidity and mortality.

The updated Task Force recommendation is based on findings from 27 studies in which vaccination programs in schools or child care centers:

1. Provided vaccinations on site
2. Were administered by a range of providers including school health personnel, health department staff, and other vaccination providers
3. Were delivered in a variety of different school and organized child care settings
4. Delivered one or more of a range of vaccines recommended for children and adolescents, and
5. Included additional components such as education, reduced client out-of-pocket costs, and enhanced access to vaccination services

School- and organized child care center-located vaccination programs may be most useful in improving immunization rates among children and adolescents for new vaccines, and vaccines with new, expanded recommendations (such as the annual immunization for seasonal influenza) where background rates are likely to be very low and improvements in coverage are needed.

Task Force Finding & Rationale Statement

About the Interventions

• Organized child care centers include day care, nursery or preschool settings, and federal Head Start programs for children 5 years of age and younger.
• Despite important differences between schools and organized child care centers, both can provide immunization services to large groups of children (and their caregivers) in common locations over regular periods of time.
• Vaccination programs are often collaborations with local health departments, private healthcare providers, or community healthcare services.
• Most states have laws establishing vaccination requirements for school and organized child care center attendance.

Results From the Systematic Reviews

The Task Force finding is based on evidence from two Community Guide systematic reviews published in 2000 (Vaccination Programs in Schools and Vaccination Programs in Childcare Centers; search period 1980-2001) combined with more recent evidence (search period 1997-2009).

Learn more about the original reviews and Task Force findings in the Vaccinations to Prevent Diseases section of our publications page.

Twenty-nine studies qualified for this review.

• Vaccination rates: median increase of 47 percentage points (interquartile interval [IQI]: 14 to 61 percentage points; 14 studies with 17 study arms)
• Improvements in vaccination rates were also observed in studies using different measures (5 studies).
• Rates of disease: 11 studies evaluated morbidity and mortality outcomes of immunization programs in schools (8 studies) and child care centers (3 studies).
  • School vaccination programs showed reductions in the incidence rates of measles and hepatitis B (3 studies).
  • There were changes in a variety of disease outcomes related to the provision of seasonal influenza vaccines (8 studies).
    • Influenza vaccination programs in U.S. schools showed mixed results for self-reported influenza-like illness and rates of absenteeism (4 studies).
    • Of three studies of influenza vaccination programs in day care centers, two showed reductions in rates of acute otitis media (middle ear infection), and one showed reductions in influenza-like illness in the homes of vaccinated children.
    • An increase in mortality rates among younger children following the elimination of a national vaccination requirement and immunization program for school-age children was observed in Japan (1 study).

Economic Review

Ten studies qualified for the review.

• Overall, they suggest that vaccination programs in schools can be less expensive compared to immunizations provided in healthcare settings due to lower vaccine costs and the averted loss of parental income associated with children's clinic visits.
• Only one study evaluated an influenza vaccination program in a child care center.
• More studies are needed to determine the economic costs and benefits of vaccination programs in child care centers.

The effectiveness and economic review findings are based on systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to vaccinations to prevent diseases.

Publications

The findings and results of this systematic review have not been published. Read other Community Guide publications about Vaccinations to Prevent Diseases in our library, including articles about the previous review. You may also subscribe to be notified as new materials on this topic become available.

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Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Universally recommended vaccinations: vaccination programs in schools & organized child care centers. www.thecommunityguide.org/vaccines/universally/schools_childcare.html. Last updated: MM/DD/YYYY.

Review completed: June 2009