Effectiveness and cost of immunization recall at school-based health centers

Pediatrics. 2012 Jun;129(6):e1446-52. doi: 10.1542/peds.2011-2921. Epub 2012 May 7.


Background and objective: Effectiveness of recall for immunizations has not been examined in the setting of school-based health centers (SBHCs). We assessed (1) immunization rates achieved with recall among sixth-grade girls (demonstration study); (2) effectiveness of recall among sixth-grade boys (randomized controlled trial [RCT]); and (3) cost of conducting recall in SBHCs.

Methods: During October 2008 through March 2009, in 4 Denver public SBHCs, we conducted (1) a demonstration study among 265 girls needing ≥ 1 recommended adolescent vaccine and (2) an RCT among 264 boys needing vaccines, with half randomized to recall and half receiving usual care. Immunization rates for recommended adolescent vaccines were assessed 6 months after recall. First dose costs were assessed by direct observation and examining invoices.

Results: At the end of the demonstration study, 77% of girls had received ≥ 1 vaccine and 45% had received all needed adolescent vaccines. Rates of receipt among those needing each of the vaccines were 68% (160/236) for tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, 57% (142/248) for quadrivalent meningococcal conjugate vaccine, and 59% (149/253) for the first human papillomavirus vaccine. At the end of the RCT, 66% of recalled boys had received ≥ 1 vaccine and 59% had received all study vaccines, compared with 45% and 36%, respectively, of the control group (P < .001). Cost of conducting recall ranged from $1.12 to $6.87 per recalled child immunized.

Conclusions: SBHC-based recall was effective in improving immunization rates for all adolescent vaccines, with effects sizes exceeding those achieved with younger children in practice settings.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Child
  • Cost-Benefit Analysis
  • Diphtheria-Tetanus-acellular Pertussis Vaccines / economics
  • Diphtheria-Tetanus-acellular Pertussis Vaccines / therapeutic use
  • Female
  • Humans
  • Immunization / economics*
  • Immunization / trends
  • Male
  • Meningococcal Vaccines / economics
  • Meningococcal Vaccines / therapeutic use
  • Papillomavirus Vaccines / economics
  • Papillomavirus Vaccines / therapeutic use
  • Patient Participation / economics*
  • Patient Participation / trends
  • School Health Services / economics*
  • School Health Services / trends
  • Tetanus Toxoid / economics
  • Tetanus Toxoid / therapeutic use
  • Treatment Outcome


  • Diphtheria-Tetanus-acellular Pertussis Vaccines
  • Meningococcal Vaccines
  • Papillomavirus Vaccines
  • Tetanus Toxoid