Clinical Infectious Diseases (CID)
Volume 59 Issue 3 August 1, 2014
http://cid.oxfordjournals.org/content/current

Editorial Commentary: School-Located Influenza Vaccination: Why Worth the Effort?
Manjusha J. Gaglani1,2
Author Affiliations
1Scott & White Memorial Hospital and Clinic
2Pediatric Infectious Diseases, Texas A&M Health Science Center, Temple
Extract
Influenza viruses cause annual wintertime toll of morbidity and mortality in both hemispheres. The burden of influenza is not evenly borne by everyone; the highest rates of infection are in schoolchildren, and the highest rates of hospitalization and death are in the elderly aged ≥65 years [1]. Influenza vaccines are safe but are only moderately effective in preventing medically attended real-time polymerase chain reaction (RT-PCR)-confirmed influenza. Vaccine effectiveness can be diminished by virus mismatch, increased exposure in crowded environments and immunosenescence with advancing age. Despite maintaining the highest immunization uptake of approximately 65%, effectiveness can be marginal in the elderly, with highest morbidity and mortality seen during seasons when A(H3N2) viruses are predominant.
Daycares and schools provide the ideal environment for spreading influenza, and increased school absences are early indicators of community outbreaks; hospitalizations and deaths increase after the peak activity. After gradually expanding the recommendations to immunize children ages 6–23 months with high hospitalization rates, then children 2–5 years with high outpatient-visit rates, the Centers for Disease Control and Prevention Advisory Committee for Immunization Practices (CDC ACIP) recommended children 5–17 years receive annual influenza immunization beginning 2008–2009 [1]. These were further expanded to include people ages 18–49 years after the 2009 A (H1N1) pandemic so that universal annual influenza vaccines for persons ages ≥6 months is now recommended.
School-located influenza vaccination (SLIV) offers the best option for achieving high-immunization coverage in a short period of time. With SLIV, immunization of approximately 50% (25%–75%) schoolchildren is possible, the highest proportions being elementary schoolchildren. With clinic-based vaccination, uptake of trivalent inactivated influenza vaccine (IIV-3) has generally been higher than …