Uptake and impact of a new live attenuated influenza vaccine programme in England: early results of a pilot in primary school-age children, 2013/14 influenza season

Pebody, Richard; Green, H K; Andrews, Nicholas; Zhao, Hailan; Boddington, Nicola L.; Bawa, Zharain; Durnall, H.; Singh, Naveena; Sunderland, Anne; Letley, Louise; Ellis, Joanna; Elliot, Alex J; Donati, Matthew; Smith, Gillian; Lusignan, Simon de; Zambon, Maria

doi:10.2807/ese.19.22.20823-en

Cited by 11 publications

(32 citation statements)

References 6 publications

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“…Indirect effects were strongest among individuals aged 65 years or older – the age group most vulnerable to influenza hospitalization and mortality. The magnitude of indirect effects we observed is similar to those of other SLIV interventions [21,22,32–34] and of interventions vaccinating children at any location [62]. In addition, our results are highly consistent with mathematical models, which project that an increase from 40 to 60% coverage in children aged 6 months to 18 years would reduce influenza hospitalization among adults over 19 years by 33-36% [15].…”

Section: Discussionsupporting

confidence: 85%

“…Prior studies reported that SLIV programs increased influenza vaccination [17–26] and decreased school absence [17–20,27–29] and student illnesses [17,20], and some studies report that their economic benefits likely outweigh the cost of program delivery [30,31]. There is some evidence that SLIV programs can produce community-wide indirect effects among pre-school aged children and adults; however, other studies have produced conflicting results [21,22,32–34]. Many prior SLIV evaluations did not use randomization or multivariate matching to select a comparison group and are subject to confounding [18,19,21,22,27–29,32–34]; those that have used more rigorous designs did not measure health outcomes [24–26,35,36] or enrolled small numbers of schools [17,20].…”

Section: Introductionmentioning

confidence: 99%

“…There is some evidence that SLIV programs can produce community-wide indirect effects among pre-school aged children and adults; however, other studies have produced conflicting results [21,22,32–34]. Many prior SLIV evaluations did not use randomization or multivariate matching to select a comparison group and are subject to confounding [18,19,21,22,27–29,32–34]; those that have used more rigorous designs did not measure health outcomes [24–26,35,36] or enrolled small numbers of schools [17,20]. No prior studies have rigorously measured the impacts of large-scale SLIV interventions on student and community-wide health outcomes over multiple years.…”

Section: Introductionmentioning

confidence: 99%

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Impact of a city-wide school-located influenza vaccination program over four years on vaccination coverage, school absences, and laboratory-confirmed influenza: a prospective matched cohort study

Benjamin‐Chung¹,

Arnold

Kennedy³

et al. 2019

Preprint

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Background: It is estimated that vaccinating 50-70% of school-aged children for influenza can produce population-wide indirect effects. We evaluated a city-wide, school-located influenza vaccination (SLIV) intervention that aimed to increase influenza vaccination coverage. The intervention was implemented in over 95 pre-schools and elementary schools in northern California from 2014 to 2018. Using a matched prospective cohort design, we estimated intervention impacts on student influenza vaccination coverage, school absenteeism, and community-wide indirect effects on laboratory-confirmed influenza hospitalizations. Methods and Findings: We used a multivariate matching algorithm to identify a nearby comparison school district with similar pre-intervention characteristics and matched schools in each district. To measure student influenza vaccination, we conducted cross-sectional surveys of student caregivers in 22 school pairs (2016 survey N = 6,070; 2017 survey N = 6,507). We estimated the incidence of laboratory-confirmed influenza hospitalization from 2011-2018 using surveillance data from school district zip codes. We analyzed student absenteeism data from 2011-2018 from each district (N = 42,487,816 student-days). To account for pre-intervention differences between districts, we estimated difference-in-differences (DID) in influenza hospitalization incidence and absenteeism rates using generalized linear and log-linear models with a population offset for incidence outcomes. The number of students vaccinated by the SLIV intervention ranged from 7,502 to 10,106 (22-28% of eligible students) each year. During the intervention, influenza vaccination coverage among elementary students was 53-66% in the comparison district. Coverage was similar between the intervention and comparison districts in 2014-15 and 2015-16 and was significantly higher in the intervention site in 2016-17 (7% 95% CI 4, 11) and 2017-18 (11% 95% CI 7, 15). During seasons when vaccination coverage was higher among intervention schools and the vaccine was moderately effective, there was evidence of statistically significant indirect effects: adjusting for pre-intervention differences between districts, the reduction in influenza hospitalizations in the intervention site was 76 (95% CI 20, 133) in 2016-17 and 165 (95% CI 86, 243) in 2017-18 among non-elementary school aged individuals and 327 (5, 659) in 2016-17 and 715 (236, 1195) in 2017-18 among adults 65 years or older. The reduction in illness-related school absences during influenza season was 3,538 (95% CI 709, 6,366) in 2016-17 and 8,249 (95% CI 3,213, 13,285) in 2017-18. Limitations of this study include the use of an observational design, which may be subject to unmeasured confounding, and caregiver-reported vaccination status, which is subject to poor recall and low response rates. Conclusion: A city-wide SLIV intervention in a large, diverse urban population decreased the incidence of laboratory-confirmed influenza hospitalization in all age groups and decreased illness-specific school absence rates among students during seasons when the vaccine was moderately effective, suggesting that the intervention produced indirect effects. Our findings suggest that in populations with moderately high background levels of influenza vaccination coverage, SLIV programs can further increase coverage and reduce influenza across communities.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of a city-wide school-located influenza vaccination program over four years on vaccination coverage, school absences, and laboratory-confirmed influenza: a prospective matched cohort study

Benjamin‐Chung¹,

Arnold

Kennedy³

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…Therefore, vaccination can also reduce transmission and provide indirect protection to vulnerable populations [24]. Vaccination of school children provides direct protection for the recipients and indirect (herd) protection for the community [25][26][27][28], and vaccinating HCWs reduces influenza transmission to vulnerable patients [29][30][31]. Indeed, quantification of the direct and indirect effects of influenza vaccination suggest that for complications such as death due to influenza, which occur much more frequently in unvaccinated elderly populations, indirect benefits can surpass direct ones by a factor of at least 20 [32].…”

Section: Introductionmentioning

confidence: 99%

Influenza vaccine uptake among at-risk adults (aged 16–64 years) in the UK: a retrospective database analysis

et al. 2021

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Background In the UK, annual influenza vaccination is currently recommended for adults aged 16–64 years who are in a clinical at-risk group. Despite recommendations, rates of vaccine uptake in the UK have historically been low and below national and international targets. This study aims to analyse vaccine uptake among adults in clinical at-risk groups from the 2015–2016 influenza season to the present. Methods A retrospective analysis of influenza vaccine coverage in the UK was conducted using data extracted from publicly available sources. Clinically at-risk individuals (as defined by Public Health England), including pregnant women, aged 16–64 years, were included in this study. Results Influenza vaccination coverage rates across the UK in adults aged 16–64 years in a clinical at-risk group have been consistently low over the past 5 years, with only 48.0, 42.4, 44.1 and 52.4% of eligible patients in England, Scotland, Wales and Northern Ireland receiving their annual influenza vaccination during the 2018–2019 influenza season. Influenza vaccine coverage was lowest in patients with morbid obesity and highest in patients with diabetes in 2018–2019. Coverage rates were below current national ambitions of ≥75% in all clinical risk groups. In these clinical at-risk groups, influenza vaccine coverage decreased between 2015 and 2019, and there was considerable regional variation. Conclusions Uptake of the influenza vaccine by adults aged 16–64 years in a clinical at-risk group was substantially below the national ambitions. As a result, many individuals in the UK remain at high risk of developing severe influenza or complications. Given that people who are vulnerable to COVID-19 are also at increased risk of complications from influenza, during the 2020–2021 season, there is a heightened need for healthcare professionals across the UK to address suboptimal vaccine uptake, particularly in at-risk patients. Healthcare professionals and policymakers should consider measures targeted at increasing access to and awareness of the clinical benefits of the influenza vaccine.

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“…Of course, we do not consider economical due to the CBR to be more than 1.0. According to the criteria of the public investment analysis proposed by the US government's Office of Management and Budget (OMB), it is recognized that the minimum cost benefit ratio is 1.26 or more considering the excess burden due to tax distortion 11 . However, in other studies, the 1.0 standard is applied, so we will judge it based on the equity level.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Chemoprophylaxis of Malaria Treatment

Kim¹

2018

J Infectiology

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Background: This study will analyze the existing studies and provide the basis for immunity and immune duration that can be obtained by prophylactic chemotherapy.Methods: Based on the data of the patients who take preventive chemotherapy (taking group) and those who do not (non-taking group), cost benefit analysis is conducted considering the direct and indirect benefits obtained by taking malaria treatment. Results:The results of economic evaluation of preventive use of malaria chemoprophylaxis that higher malaria incidence rates of non-taking groups showed a (+) positive value for the NPV, a CBR of greater than 1 (1.34), so economically viable vaccine with a high benefit per cost. Conclusion:Chemoprophylaxis could be cost-effective if the incidence of non-taking group in the risk area is maintained above 50%. Therefore, it will be possible to block the incidence of malaria in the future through analysis of the trend of incidence of malaria, and to inform the effect of the chemoprophylaxis method through educational and public relations activities.

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Uptake and impact of a new live attenuated influenza vaccine programme in England: early results of a pilot in primary school-age children, 2013/14 influenza season

Abstract: Binary file ES_Abstracts_Final_ECDC.txt matches

Cited by 11 publications

References 6 publications

Impact of a city-wide school-located influenza vaccination program over four years on vaccination coverage, school absences, and laboratory-confirmed influenza: a prospective matched cohort study

Impact of a city-wide school-located influenza vaccination program over four years on vaccination coverage, school absences, and laboratory-confirmed influenza: a prospective matched cohort study

Influenza vaccine uptake among at-risk adults (aged 16–64 years) in the UK: a retrospective database analysis

Cost-Effectiveness Analysis of Chemoprophylaxis of Malaria Treatment

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