SKIPP - School Kids Influenza Prevention Program

SKIPP aims to prevent influenza illness (flu) in school-aged children by offering flu vaccination in participating schools in Monroe County and to create a model to disseminate nationally for school-located influenza vaccination (SLIV). The program includes web-based consent and parent reminder systems to enhance enrollment, developed with input from parents and school officials.

Background

Seasonal influenza disease results in significant illness in the U.S. each year, resulting in over 200,000 hospitalizations, more than 20,000 deaths, and direct medical costs of $10.4 billion. Although most of these deaths occur in persons who are elderly or have chronic disease, children and adolescents can experience significant illness.

Because of this, and the safety of the vaccine, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) expanded its recommendation for annual influenza vaccination of children for all children 6 months to 18 years of age.

Despite these recommendations, fewer than 50% of children and adolescents in the U.S. currently receive influenza vaccination. These rates are by far the lowest coverage for any recommended childhood vaccination. And there are also disparities in vaccination rates, with lower rates among adolescents, low-income children, and minorities. A major public health priority is to improve pediatric influenza vaccination rates and thereby reduce illness, hospitalizations and deaths from influenza disease.

One major reason for the low vaccination rates is the challenge of getting all the children recommended to receive influenza vaccination into primary care offices in a short timeframe. For many years, experts in the field have discussed alternative settings for vaccinating children and among the most promising is the school setting. Using school-located influenza vaccination (SLIV) clinics, which are daytime vaccine “clinics” held on school grounds to vaccinate children attending that school, has been shown to increase immunization rates for those children.

There have been a number of successful pilot SLIV projects, including one at the University of Rochester. We are now building on those projects with a grant from the Agency for Healthcare Research and Quality (AHRQ). We are developing a model that enhances the way SLIV clinics are conducted, through an improved consent system for parents to enroll their children (with an online option), and a better system for communication to parents (such as email reminders to families to complete the forms). We will test the model through iterative randomized controlled trials to compare flu vaccination rates in schools with and schools without the SLIV clinics.

Purpose

To use randomized-controlled trials (RCTs) to determine whether school-located influenza vaccination (SLIV) clinics can improve influenza vaccination coverage among Monroe County school children. Schools are randomized to one of two groups: 1) those offering SLIV clinics to children in the school and 2) the control group, where SLIV is not offered. After developing an effective model, we will develop a toolkit and work to disseminate the model to other communities throughout the U.S.

Study Aims

• Develop, pilot, and evaluate a web-based consent + parent reminder system. Use interviews with parents, school personnel and health care providers to craft the reminder messages and to design the consent system.

• Perform effectiveness testing of our enhanced SLIV model through RCTs. We will randomize schools to the SLIV group or the control group (with more schools added each year, eventually including all schools in Monroe County) and measure vaccination rates and the cost of providing vaccination in schools.
• Disseminate web-based consent/reminder system and a training program for SLIV, and measure use.