Jeffrey C Kwong1, Jennifer A Pereira2, Susan Quach2, Rosana Pellizzari3, Edwina Dusome3, Margaret L Russell4, Jemila S Hamid5, Yael Feinberg2, Anne-Luise Winter2, Jonathan B Gubbay6, Brittany Sirtonski2, Deanna Moher2, Doug Sider2, Michael Finkelstein7, Mark Loeb8. 1. Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada. Electronic address: jeff.kwong@utoronto.ca. 2. Public Health Ontario, Toronto, ON, Canada. 3. Peterborough County-City Health Unit, Peterborough, ON, Canada. 4. Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. 5. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. 6. Public Health Ontario, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada. 7. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Toronto Public Health, Toronto, ON, Canada. 8. Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
Abstract
BACKGROUND:School-based influenza immunization can effectively address accessibility barriers, but injected inactivated influenza vaccines (IIV) may not be acceptable to some children and parents in school settings. OBJECTIVES: To better understand the feasibility of offering intranasal live attenuated influenza vaccines (LAIV) through schools, we assessed uptake, stakeholder acceptability, and cost of school-based delivery of LAIV compared to IIV. METHODS: We piloted an open-label cluster randomized trial involving 10 elementary schools in Peterborough, Ontario during the 2013-2014 influenza vaccination campaign. Schools were randomized to having students receive IIV or LAIV at publicly-funded school-based clinics organized by the local public health department. We measured the percentage of students vaccinated with at least one dose of influenza vaccine at school. Stakeholder acceptability was evaluated through a questionnaire of parents and interviews of public health department personnel and school principals. We compared the costs per dose of vaccine administered, including staff time and costs of vaccines and supplies. RESULTS: Single-dose influenza vaccine uptake was higher for the five schools offering LAIV than for the five offering IIV (19.3% vs. 12.2%, p=0.02). Interviews with nine school principals and five public health department personnel suggested that the clinics ran smoothly with little disruption to school routines, and that LAIV was associated with increased efficiency and calmer children. All interviewees cited unfamiliarity with LAIV and the study recruitment package length as potential reasons for low uptake. The cost per vaccine dose administered was $38.67 for IIV and $43.50 for LAIV. CONCLUSIONS: Use of LAIV in school-based clinics was associated with increased vaccine uptake and the perception among immunizing staff of reduced child anxiety, but also slightly higher vaccine administration costs, compared to IIV. However, uptake was low for both groups. More effective strategies to promote influenza vaccines and to obtain parent consent may improve vaccine uptake. TRIAL REGISTRATION: ClinicalTrials.gov NCT01995851. FUNDING: Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network.
RCT Entities:
BACKGROUND: School-based influenza immunization can effectively address accessibility barriers, but injected inactivated influenza vaccines (IIV) may not be acceptable to some children and parents in school settings. OBJECTIVES: To better understand the feasibility of offering intranasal live attenuated influenza vaccines (LAIV) through schools, we assessed uptake, stakeholder acceptability, and cost of school-based delivery of LAIV compared to IIV. METHODS: We piloted an open-label cluster randomized trial involving 10 elementary schools in Peterborough, Ontario during the 2013-2014 influenza vaccination campaign. Schools were randomized to having students receive IIV or LAIV at publicly-funded school-based clinics organized by the local public health department. We measured the percentage of students vaccinated with at least one dose of influenza vaccine at school. Stakeholder acceptability was evaluated through a questionnaire of parents and interviews of public health department personnel and school principals. We compared the costs per dose of vaccine administered, including staff time and costs of vaccines and supplies. RESULTS: Single-dose influenza vaccine uptake was higher for the five schools offering LAIV than for the five offering IIV (19.3% vs. 12.2%, p=0.02). Interviews with nine school principals and five public health department personnel suggested that the clinics ran smoothly with little disruption to school routines, and that LAIV was associated with increased efficiency and calmer children. All interviewees cited unfamiliarity with LAIV and the study recruitment package length as potential reasons for low uptake. The cost per vaccine dose administered was $38.67 for IIV and $43.50 for LAIV. CONCLUSIONS: Use of LAIV in school-based clinics was associated with increased vaccine uptake and the perception among immunizing staff of reduced childanxiety, but also slightly higher vaccine administration costs, compared to IIV. However, uptake was low for both groups. More effective strategies to promote influenza vaccines and to obtain parent consent may improve vaccine uptake. TRIAL REGISTRATION: ClinicalTrials.gov NCT01995851. FUNDING: Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network.
Authors: Laetitia Gerlier; Mark Lamotte; Sofia Dos Santos Mendes; Oliver Damm; Markus Schwehm; Martin Eichner Journal: Paediatr Drugs Date: 2016-08 Impact factor: 3.022