ISHN Comment: Further comparative research on the impacts of school-based vaccinations during and after the Covid pandemic are urgently needed.
Read more in the article.
An article in the January 2022 collection of BMC Public Health explores the value added by doing vaccinations in school sites. Other research has shown that school-based programs have a broader reach, better coverage, help to familiari8ze young people with health care services and can be linked directly with classroom instruction as well as individual education and school activities. This article explores the feasibility of school-base vaccinations in a small pilot study. "Vaccination rates for measles, mumps, and rubella (MMR) and diphtheria, tetanus, pertussis, and polio (Tdap-IPV) are not optimal among German adolescents. Education in combination with easy access to vaccination may be a promising approach to improve vaccination rates. The present paper describes a pilot study of a planned cluster randomized controlled trial (cRCT) in which we aim to improve MMR and Tdap-IPV vaccination rates together with knowledge and self-efficacy in a school setting." The findings of the pilot study indicated good feasibility. Of the total sample, 437 students (50.9%) brought their vaccination cards to school, 68 students received Tdap-IPV vaccinations, and 11 received MMR vaccinations. Out of six knowledge questions, on average, the students had more correct answers before and after the class and positive changes to self-efficacy .
ISHN Comment: Further comparative research on the impacts of school-based vaccinations during and after the Covid pandemic are urgently needed. Read more in the article.
1 Comment
The Covid pandemic has underlined the need to a public or societal concern for the health of others. Many in the USA, like other countries, consider health to be a personal responsibility, de-emphasizing the other side of the equation, whereby public authorities are able to provide supports in times of need, especially during health crises like Covid. An article in Issue #1, 2022 of Preventive Medicine documents the fragile state and erosion of public support for social safety nets during the pandemic, even as a new President assumed power. "We surveyed a nationally representative cohort of 1222 U.S. adults in April 2020 and November 2020 to evaluate changes in public opinion about 11 social safety net policies and the role of government over the course of the pandemic. ....The share of respondents believing in a strong role of government also declined from 33% in April to 26% in November 2020".
ISHN Comment: One of the poorly understood goals of an effective health & life skills education program is to promote a concern for the health of others. In the US, that specific goal has been part of the National Standards for Health Education for many years. Yet, progress towards that goal is rarely reported. There are other societal underpinnings to health education that could be used in a comparison study. For example, in Africa, one could examine the impact of the "ubuntu" concept (which emphasizes the connection between individuals and the village. Or an indigenous perspective, one that views health as a set of relationships with the land and with our ancestors could be considered. Eastern world views, such as that which has emerged in Bhutan, which measures "happiness" in relation to economic and social progress should al;so be on the list. This discussion should be a part of any review of the failure of health education in many jurisdictions to have an impact on the fundamental values which should guide our responses to health and other crises. Go to the Preventive Medicine Journal article. The Lancet has published a report on a large cross-sectional survey of school health monitoring in 17 provinces in China. The study used data from 2428 schools from 17 provinces in China in 2018. Data were collected using a questionnaire administered by the Ministry of Education through its monitoring system, and included infectious diseases (e.g., reporting system for student infectious diseases), non-communicable diseases (e.g., regular student health examinations), and school physical environments (e.g., monitoring of classroom light, microclimate and drinking water). "Findings: Overall, the coverage rate of full school health monitoring systems was 16·6%. The coverage rates of school health monitoring systems for infectious diseases, non-communicable diseases, and school physical environments were 71·2%, 68·5%, and 24·9%, respectively. Coverage was higher in schools from urban rather than rural areas, in schools from areas with greater wealth, and in senior secondary schools rather than junior secondary and primary schools. Overall, the coverage of school health services monitoring was higher in urban areas, in wealthier areas, and in senior secondary schools."
The monitoring of infectious diseases is likely higher than most other countries. "The proportion of schools with all infectious disease monitoring systems was 71·2%. Overall, infectious disease monitoring systems were established in more than 90·0% of schools. The exception was in the use of student enrolment inoculation cards, which were adopted by only 76·4% of schools. The use of enrolment inoculation cards requiring an inspection system varied by school type, being highest in primary schools (96·4%), followed by junior secondary schools (47·3%) and senior secondary schools (25·6%)." Further "Since the SARS outbreak in 2003, the Chinese government has invested heavily in infectious disease control and prevention, with demonstrated improvements in disease surveillance. This may explain why we found few differences in the coverage of infectious disease prevention and monitoring systems between urban and rural locations, regional SES groups, and primary and secondary schools, which is consistent with the widespread implementation of school-based monitoring systems around infectious diseases. Among the components of infectious disease monitoring in schools, the one exception to high coverage was around a system to review student enrolment inoculation cards (a certificate inspection system) which was evident in only 76·4% of schools, well lower than for other components." . ISHN Comments: This Chinese example of SH monitoring is likely among the best in the world and underlines the need to better surveillance policies and practices. The relative "problems" with tracking student vaccination rates would be likely be seen as a success in most other countries. The discussion of monitoring and reporting (See the ISHN and FRESH Partner (pp 38-39) summaries on Monitoring, Reporting, Evaluating & Improving) should be linked directly to improvement planning and policy-making. Countries could learn more from each other on implementing better MREI practices which have been underlined by the recent Covid pandemic. Read the Lancet article here An article in Issue #20, 2018 of Vaccine joins several others in reporting that school-based vaccination programs are able to reach more more children at lower cost. " Influenza vaccination rates among children are low and novel strategies are needed to raise coverage. We measured the impact of school-located influenza vaccination (SLIV) on coverage, examined whether SLIV substitutes for practice-based influenza vaccination (“substitution”), and estimated whether a second year of experience with SLIV increases its impact. 42 schools (38,078 children) participated over 2 years. Overall vaccination rates were 5 and 7 percentage points higher among SLIV- school children versus control-school children in suburban (aOR 1.36, 95% CI 1.25–1.49 in Years 1–2 SLIV vs. Year 1 control schools) and urban schools (aOR 1.22, 95% CI 1.10–1.36), respectively, adjusting for prior year’s vaccination and other covariates." Read more...
(This item is among the 5-10 highlights posted for ISHN members each week from the ISHN Member information service. Click on the web link to join this service and to support ISHN) (An item from the ISHN Member information service) A register-based study of 90,000 girls and their parents in Norway was used to examine the demographic, socioeconomic and behavioural correlates of HPV vaccination of preadolescent girls in a publicly funded, school-based vaccination programme. "Data for all Norwegian girls born 1997–1999, eligible for routine school-based HPV vaccination in 2009–2011 (n = 90,842), and their registered mother and father, were merged from national registries. Correlates of girl vaccination status were analysed by unadjusted and multivariable logistic regression. In total, 78.2% of the girls received the first dose of the HPV vaccine, 74.6% received three doses, and 94.8% received the MMR vaccine. Correlates associated with initiation of HPV vaccination included parental age, income and education, maternal occupational status and cervical screening attendance, and girl receipt of the MMR vaccine. Rates of completion of HPV vaccination among initiators were high, and disparities in completion were negligible. " The authors conclude that "Routine school-based vaccination generally provides equitable delivery, yet some disparities exist. Information campaigns designed to reach the sub-groups with relatively low vaccine uptake could reduce disparities." The Norwegian vaccination programme is administered by the municipality health services, who are obliged by law to provide the included vaccines to all children. HPV vaccination was included in the programme in 2009. The vaccine is usually given by the school nurse during school hours. Among other vaccines, the childhood immunisation programme also offers vaccination against MMR (measles, mumps and rubella combined) in the sixth grade. Vaccination is optional, and the vaccine and their parents/guardians have to consent to vaccination. Written consent is not required, but is encouraged for vaccination of school children." Read More>>
(An item from the ISHN Member information service) "The weekly epidemiological record of the World Health Organisation 15th May 20151 states that ‘the cases of Middle East Respiratory Syndrome (MERS) recently exported to other countries have not resulted in sustained onward transmission to persons in close contact with these cases on aircraft or in the respective countries outside the Middle East.’ This situation has changed rapidly and remarkably. Five days after the publication of this report, the first case of a MERS-coronavirus (MERS-CoV) infection in Seoul, South Korea was reported...". This first sentence in an article in the July 2015 Issue of International Journal of Infectious Diseases got our attention. It is noteworthy that South Korea closed 2700 schools quickly during the outbreak. In discussions with Toronto public health and school officials after the SARS outbreak, we learned that closure of schools was difficult due to poor communications and unclear definitions of decision-making roles. The authors of the MERS article conclude that " Moving forward, it is critical that global efforts are focussed urgently on the basic science and on clinical and public health research so that the exact mode of transmission to and between humans, and new drugs and other therapeutic interventions and vaccines can be developed6, 7. Two coronaviruses, SARS-CoV and now MERS-CoV, which cause severe respiratory disease with high mortality rates emerged within the past two decades10, reinforcing the need for clinically efficacious antivirals targeting coronaviruses. Lessons learnt from the recent Ebola Virus Disease could also be applied to MERS11. Whilst MERS does not yet constitute an International Public Health Emergency the Korean outbreak is an extraordinary event." Read more>>
(From the ISHN Member information service) An article in December 2014 Issue of BMC Public Health examined the potential impact of several non-pharmaceutical strategies for responding to influenza outbreaks. These included school closures, work place closures, travel restrictions, voluntary and obligatory quarantines and more. The most effective non-pharma response to such outbreaks was closing any school quickly when infections reached a certain level. The authors conclude that "Our methodology was able to design effective NPI strategies, which were able to contain outbreaks by reducing infection attack rates (IAR) to below 10% in low and medium virus transmissibility scenarios with 33% and 50% IAR, respectively. The level of reduction in the high transmissibility scenario (with 65% IAR) was also significant. As noted in the published literature, we also found school closure to be the single most effective intervention among all NPIs". Read more>>
(From the ISHN Member information service) An article in Issue #49, 2014 of Vaccines reports on a WHO led study on the growing trend among parents around the world. "Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite the availability of vaccination services. Different factors influence vaccine hesitancy and these are context-specific, varying across time and place and with different vaccines. Factors such as complacency, convenience and confidence are involved. Acceptance of vaccines may be decreasing and several explanations for this trend have been proposed." The WHO Strategic Advisory Group of Experts (SAGE) has developed an explanatory model that was tested and found useful in explaining the results of this interview-based study in Immunization Managers in several countries. "Even if there had been reports of vaccine hesitancy in their country, 11 of the 13 IMs considered that vaccine hesitancy was not common and that it did not have a significant impact on vaccine uptake in the routine immunization programmes. IMs from two countries indicated that mass immunization campaigns, rather than routine immunization programmes, were affected by vaccine hesitancy. Factors concerning convenience and ease of access were perceived to be important by nine of the IM's Convenience was a factor for sub-populations which did not use the health services provided and for hard-to-reach populations. However, two IMs stated that vaccine hesitancy was an important issue in their country." When IMs were asked about the percentage of non-vaccinated and under-vaccinated individuals in their country due to lack of confidence in vaccination, only six provided estimates ranging from less than 1% to 20%. Four IMs reported issues of complacency in their countries." Religious beliefs were often a causal factor in vaccine hesitancy (cited by nine IMs).Risk perceptions were identified by seven IMs as causal factors. This included concerns regarding vaccine safety, lack of perceived benefits of vaccination and lack of understanding of the burden of vaccine-preventable diseases. The new, basic understanding of vaccine hesitancy from this first study, which shows an apparent lack of urgency among Immunization Managers, runs counter to the many news stories of returning diseases such as measles in high income countries as well as renewed concerns about infectious diseases in low resource countries. Schools are a convenient site for vaccinations as well as a strong connection for educating parents. School policies about vaccination requirements are also key. More attention and action are warranted. Read more>>
(From the ISHN Member information service) An article in Issue #5, 2015 of Vaccine provides an update on the number of countries currently using schools to deliver vaccinations to their populations. The article covers only the delivery of the vaccines and does not discuss the other roles that schools can play in informing parents, educating students, and responding to outbreaks but it underlines the need for a global discussion of the school's role in immunization, development and in national policies/committees." Every year since 1998, UNICEF and WHO collect data through the “WHO-UNICEF Joint Reporting Form (JRF)”, which is completed by Ministries of Health in all Member States [5]. Since 2009, the data includes data on whether a school-based approach is used in a country, what vaccines are being given at what grade and to what age groups, the sex of the children targeted, as well as some additional questions. Countries are asked whether “routine immunization is given to school-aged children using the school as a venue” and should include only “doses that are given as part of the national immunization schedule”, i.e. excluding campaigns". "Of the 195 countries and territories that had been requested to complete the JRF report in 2013 (reporting 2012 data), 189 submitted a JRF form, of which 174 included information on whether a school-based approach was used in their country as of 2012. Of these, 95 answered positively, while 79 said no school-based approach was being used for immunization services". "64% of high income or higher middle income countries reported the existence of a school-based immunization program, against 28% of lower and lower middle income countries". "Most countries provided more than one antigen using a school-based approach, often using combination vaccines. Only 13 countries just gave one antigen, while at the other extreme 3 countries gave 10 different antigens." Read more>>
The report notes that "Vaccines and immunization have created a healthier world. Progress is being made towards polio eradication. Measles and neonatal tetanus deaths are on the decline and new vaccines are being
introduced into the national programmes of low -and middle-income countries with associated reductions in morbidity and mortality. Still, national governments, development partners and international agencies must invest more to meet the Decade of Vaccines’ goals of disease eradication or elimination and to reduce mortality and morbidity from vaccine-preventable diseases. However, the report also notes that :
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