Preventing Influenza--The Case for Immunizing Children at School
Faced with the fact that current recommendations for vaccinating high-risk people such as the elderly against the flu don't seem to be reducing the incidence of seasonal influenza in the United States, U.S. policymakers are considering whether flu shots should be recommended for school-age children 5 to18 years old.
There is logic in such an idea, the journal Health Affairs said January 23, since school-age children are more likely than adults to contract influenza and spread it to high-risk populations, including the adults in their own households. But in the most recent flu season for which data are available—the 2004-05 season—only 10 percent of healthy children were immunized against flu.
That brings up the possibility that school-based immunizations might offer "an efficient and feasible approach to increase the coverage of school-age children, which would be expected to reduce the spread of influenza and decrease the burden of seasonal flu on households and communities." But whether school-based immunizations would be economically warranted is not clear, with some analyses indicating that immunizing healthy school-age children isn’t cost-effective.
To try to find out more about this relatively untested idea, researchers who acknowledge they were funded by the vaccine maker Medimmune looked at the effects when more than 15,000 schoolchildren were offered nasal live attenuated influenza immunizations at school.
They found, first, that there was a statistically significant reduction of flu-like symptoms in the vaccine-offering schools, less health care resource use, and fewer absences from school and work. Those advantages are important, but that still leaves the question of whether the immunizations were economically warranted, the researchers said.
Some of the factors in the trial:
• In the intervention schools, 47 percent of children received the intranasal influenza vaccine and 56 percent of those got a second dose;
• The average vaccination cost per household in the intervention schools was $41.66, much more than the average $5.56 families spent for flu shots in non-participating schools. But when expenditures by families for over-the-counter medications, herbal supplements, and emergency care and hospitalizations were included, costs somewhat evened out between intervention and control schools and were higher for families in the non-immunizing schools.
While admitting that there were flaws in the research model, including that all the medical data was self-reported, the researchers concluded that school-based influenza immunization with the nasal vaccine used in the trial "is cost-effective over the season," meaning the several weeks of the year in which influenza incidence is at its peak.
And as to effects other than money, the researchers admitted they did not attempt to value the long-term educational and achievement consequences when student are absent from school with influenza. They did note, however, that in school districts where funding is based on average daily attendance, there are real financial benefits for schools from higher attendance. They estimate that during the peak week of influenza incidence, schools that offer vaccine may lose an average of $784 as the result of student absences, while schools without vaccine are likely to lose an average of $1,395.
The study also looked at the time it takes to immunize a student at school as compared with providers' offices. What the researchers refer to as "mass vaccination" can run to as high as 30 per hour, they note, once staff are trained, while the average time for office-based vaccine administration is about 10 to 15 minutes of professional time per dose.
"Our findings suggest that school-based immunization programs are cost-neutral after the peak week alone and cost-saving over an influenza season." And if economic benefits of immunization to the household are included, the researchers concluded, "The clinical and economic benefits of expanding immunization to school-age children deserve further consideration."
The article "Benefits and Costs of Immunization Children Against Influenza at School" appears in the January 23, 2008, issue of Health Affairs, a publication of project HOPE.
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