Evaluation of a city-wide school-located influenza vaccination program in Oakland, California with respect to race and ethnicity: A matched cohort study

•We used a matched cohort design to study the differential impacts of SLIV by race and ethnicity.•Racial disparities in vaccine coverage and hospitalizations persisted in the presence of SLIV.•Vaccine hesitance remained a common reason for non-vaccination in school-aged children. Increasing influenz...

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Bibliographic Details
Published in:Vaccine 2022-01, Vol.40 (2), p.266-274
Main Authors: Nguyen, Anna T., Arnold, Benjamin F., Kennedy, Chris J., Mishra, Kunal, Pokpongkiat, Nolan N., Seth, Anmol, Djajadi, Stephanie, Holbrook, Kate, Pan, Erica, Kirley, Pam D., Libby, Tanya, Hubbard, Alan E., Reingold, Arthur, Colford, John M., Benjamin-Chung, Jade
Format: Article
Language:English
Subjects:
Aged
California - epidemiology
Caregivers
Charter schools
Child
Cohort analysis
Cohort Studies
Color
Cross-Sectional Studies
Cultural differences
Elementary schools
Enrollments
Ethnicity
Evaluation
Hispanic Americans
Hospitalization
Hospitalizations
Humans
Influenza
Influenza Vaccines
Influenza, Human - prevention & control
Institutionalization
Intervention
Laboratories
Minority & ethnic groups
Native North Americans
Older people
Pacific Islander people
Population
Race
School Health Services
School-located influenza vaccinations
Schools
Seasons
Socioeconomic factors
Students
Vaccination
Vaccination coverage
Vaccinations
Vaccine Efficacy
Vaccines
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Summary:•We used a matched cohort design to study the differential impacts of SLIV by race and ethnicity.•Racial disparities in vaccine coverage and hospitalizations persisted in the presence of SLIV.•Vaccine hesitance remained a common reason for non-vaccination in school-aged children. Increasing influenza vaccination coverage in school-aged children may substantially reduce community transmission. School-located influenza vaccinations (SLIV) aim to promote vaccinations by increasing accessibility, which may be especially beneficial to race/ethnicity groups that face high barriers to preventative care. Here, we evaluate the effectiveness of a city-wide SLIV program by race/ethnicity from 2014 to 2018. We used multivariate matching to pair schools in the intervention district in Oakland, CA with schools in a comparison district in West Contra Costa County, CA. We distributed cross-sectional surveys to measure caregiver-reported student vaccination status and estimated differences in vaccination coverage levels and reasons for non-vaccination between districts stratifying by race/ethnicity. We estimated difference-in-differences (DID) of laboratory confirmed influenza hospitalization incidence between districts stratified by race/ethnicity using surveillance data. Differences in influenza vaccination coverage in the intervention vs. comparison district were larger among White (2017–18: 21.0% difference [95% CI: 9.7%, 32.3%]) and Hispanic/Latino (13.4% [8.8%, 18.0%]) students than Asian/Pacific Islander (API) (8.9% [1.3%, 16.5%]), Black (5.9% [−2.2%, 14.0%]), and multiracial (6.3% [−1.8%, 14.3%)) students. Concerns about vaccine effectiveness or safety were more common among Black and multiracial caregivers. Logistical barriers were less common in the intervention vs. comparison district, with the largest difference among White students. In both districts, hospitalizations in 2017–18 were higher in Blacks (Intervention: 111.5 hospitalizations per 100,00; Comparison: 134.1 per 100,000) vs. other races/ethnicities. All-age influenza hospitalization incidence was lower in the intervention site vs. comparison site among White/API individuals in 2016–17 (DID −25.14 per 100,000 [95% CI: −40.14, −10.14]) and 2017–18 (−36.6 per 100,000 [−52.7, −20.5]) and Black older adults in 2017–18 (−282.2 per 100,000 (−508.4, −56.1]), but not in other groups. SLIV was associated with higher vaccination coverage and lower influenza hospitalization, but associations varied by race/ethnic
ISSN:0264-410X
1873-2518
DOI:10.1016/j.vaccine.2021.11.073