School-located vaccination for adolescents: Past, present, and future and implications for HPV vaccine delivery

Abstract

Adolescents were first specifically targeted for school-located vaccination (SLV) in the 1990s when hepatitis B catch-up vaccination was recommended for all adolescents. SLV affords the opportunity to access adolescents at a time when their activities have developmental import and the patients have the capacity to decline repeatedly missing school and extracurricular events to get vaccinated. As noted above, SLV has been primarily reserved for brief catch-up interventions among youth, with routine vaccination recommendations quickly defaulting to the primary care provider. Now in 2016, with relatively disappointing adolescent immunization rates for the routinely recommended human papillomavirus (HPV) vaccine, the SLV option is one that could potentially help increase vaccination rates for a particularly effective, life-saving, 3-dose vaccination series. This article will serve as a brief review of the successful use of SLV in other countries, lessons learned when SLV was employed to immunize adolescents against hepatitis B in the United States in the late 1990s and early 2000s, and the current hopes and challenges for the future of adolescent SLV programming in the United States. Overall, the shift to the use of SLV to administer routinely recommend vaccine for adolescents will require careful planning to implement known strategies for accessing youth and in addition to new strategies designed to assure appropriate reimbursement for cost-effect SLV services. While not the best option for all adolescents, SLV provides an important opportunity to immunize youth with limited access to healthcare services in the community at large.

Can School-Located Vaccination Have a Major Impact on Human Papillomavirus Vaccination Rates in the United States?

“…Published studies have also reported some school districts requiring separate consent forms for each adolescent vaccine, requiring parents to be in attendance for all immunizations, and only allowing certain schools to participate, with students and parents needing to travel to other schools to participate. [23][24][25][26] Each of these factors might pose significant barriers to the success of SLV programs.…”

Childhood and Adolescent Vaccination in Alternative Settings

“…19 In other countries, SLV is widely used to administer a broad range of vaccinations, including HPV vaccine. 20,21 SLV efforts face certain challenges including potential disruption to the school day as well as the need to receive buy-in from educational authorities, obtain parental consent, verify insurance status, purchase vaccine for non-VFC eligible students, use outside individuals to administer vaccinations, and notify PCPs that their patients were vaccinated in school. 19,22,23 School-based health centers (SBHCs) often provide health care services to youth who have financial, cultural, or geographic barriers to receiving care elsewhere.…”

Cost-effectiveness of Interventions to Increase HPV Vaccine Uptake

“…In US school-located vaccination models, parents provide consent for their children to be vaccinated by trained community vaccinators at school. 38,39 Because school-located health clinics are uncommon in the United States, we consider the model of holding mass vaccination days, which would potentially reach those ages 11 to 13 who attend a public school (87%). 40 The costs for schoollocated vaccination include time and resources to create information materials, obtain permission from parents, schedule the event, administer the vaccination, and process insurance claims for privately insured adolescents.…”