School-located influenza vaccination decreases laboratory-confirmed influenza and improves school attendance

Clin Infect Dis. 2014 Aug 1;59(3):325-32. doi: 10.1093/cid/ciu340. Epub 2014 May 14.


Background: School-located influenza vaccination (SLV) programs can efficiently immunize large numbers of school-aged children. We evaluated the impact of SLV on laboratory-confirmed influenza and absenteeism.

Methods: Active surveillance for influenza-like illness (ILI) was conducted on 4455 children in 4 SLV intervention and 4 control elementary schools (grades K-6) matched for sociodemographic characteristics during the 2010-2011 influenza season in Los Angeles County, California. Combined nose/throat swabs were collected from febrile children with ILI at presentation to the school nurse or during absenteeism.

Results: In SLV schools, 26.9%-46.6% of enrolled students received at least 1 dose of either inactivated or live attenuated influenza vaccine compared with 0.8%-4.3% in control schools. Polymerase chain reaction for respiratory viruses (PCR) was performed on 1021 specimens obtained from 898 children. Specimens were positive for influenza in 217 (21.3%), including 2009 H1N1 (30.9%), H3 (9.2%), and B (59.9%). Children attending SLV schools, regardless of vaccination status, were 30.8% (95% confidence interval, 10.1%-46.8%) less likely to acquire influenza compared with children at control schools. Unvaccinated children were indirectly protected in the school with nearly 50% vaccination coverage compared with control schools (influenza rate, 27.1 vs 60.0 per 1000 children; P = .023). Unvaccinated children missed more school days than vaccinated children (4.3 vs 2.8 days per 100 school days; P < .001).

Conclusions: Vaccination of at least a quarter of the school population resulted in decreased influenza rates and improved school attendance. Herd immunity for unvaccinated children may occur in schools with vaccination coverage approaching 50%.

Keywords: herd immunity; influenza; influenza vaccine; school-located influenza vaccination.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absenteeism
  • Adolescent
  • California / epidemiology
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Influenza A Virus, H1N1 Subtype / immunology*
  • Influenza A virus / immunology*
  • Influenza Vaccines / administration & dosage*
  • Influenza, Human / epidemiology*
  • Influenza, Human / prevention & control
  • Male
  • Schools
  • Students / statistics & numerical data
  • Vaccination*
  • Vaccines, Attenuated


  • Influenza Vaccines
  • Vaccines, Attenuated