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Vaccination Programs: Schools and Organized Child Care Centers

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What the Task Force Found

About The Systematic Review

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). The review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing appropriate vaccination.

Context

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Summary of Results

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)

Summary of Economic Evidence

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.

 

Applicability

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Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified 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).

Study Characteristics

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Publications