Vaccination Programs: Schools and Organized Child Care Centers

Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) 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 CPSTF recommendation is based on findings from 27 studies in which vaccination programs in schools or child care centers:

Provided vaccinations on site
Were administered by a range of providers including school health personnel, health department staff, and other vaccination providers
Were delivered in a variety of different school and organized child care settings
Delivered one or more of a range of vaccines recommended for children and adolescents
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.

The full CPSTF Finding and Rationale Statement and supporting documents for Vaccination Programs: Schools and Organized Child Care Centers are available in The Community Guide Collection on CDC Stacks.

Intervention

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:

Immunization education and promotion
Assessment and tracking of vaccination status
Referral of under-immunized school or child care center attendees to vaccination providers
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.

About The Systematic Review

The CPSTF 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).

Study Characteristics

No content is available for this section.

Summary of Results

Twenty-nine studies qualified for this review.

Vaccination rates: median increase of 47 percentage points (interquartile interval 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.

School vaccination programs showed reductions in incidence rates of measles and hepatitis B (3 studies)
Changes in disease outcomes related to seasonal influenza vaccines varied (8 studies)
- Influenza vaccination programs in U.S. schools showed mixed results for self-reported influenza-like illness and absenteeism (4 studies)
- Two of three studies in day care centers showed reductions in acute otitis media; one showed reductions in influenza-like illness in homes of vaccinated children
- An increase in mortality rates among younger children followed elimination of a national vaccination requirement and immunization program for school-age children in Japan (1 study)

Summary of Economic Evidence

Ten studies qualified for the review.

Overall, they suggest vaccination programs in schools can be less expensive compared to immunizations in healthcare settings due to lower vaccine costs and 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 economic costs and benefits in child care centers.

Applicability

No content is available for this section.

Evidence Gaps

More research of vaccination interventions in child care centers is needed to provide additional information on implementation, impact, and economics of vaccination interventions in these settings.
Additional research is suggested on ways to sustain vaccination programs in schools and child care centers by addressing challenges with staffing and financing these interventions.
Future research also should examine how programs can be best coordinated with vaccination providers in the community, local health departments, and immunization information systems while adhering to the requirements of the Family Education Rights and Privacy Act (FERPA).

Implementation Considerations and Resources

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 where background rates are likely to be very low and improvements in coverage are needed.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.