title: School-located influenza vaccination reduces community risk for influenza and influenza-like illness emergency care visits.
abstract: BACKGROUND
  School-located influenza vaccination (SLIV) programs can substantially enhance the sub-optimal coverage achieved under existing delivery strategies. Randomized SLIV trials have shown these programs reduce laboratory-confirmed influenza among both vaccinated and unvaccinated children. This work explores the effectiveness of a SLIV program in reducing the community risk of influenza and influenza-like illness (ILI) associated emergency care visits.
  
  
  METHODS
  For the 2011/12 and 2012/13 influenza seasons, we estimated age-group specific attack rates (AR) for ILI from routine surveillance and census data. Age-group specific SLIV program effectiveness was estimated as one minus the AR ratio for Alachua County versus two comparison regions: the 12 county region surrounding Alachua County, and all non-Alachua counties in Florida.
  
  
  RESULTS
  Vaccination of ∼50% of 5-17 year-olds in Alachua reduced their risk of ILI-associated visits, compared to the rest of Florida, by 79% (95% confidence interval: 70, 85) in 2011/12 and 71% (63, 77) in 2012/13. The greatest indirect effectiveness was observed among 0-4 year-olds, reducing AR by 89% (84, 93) in 2011/12 and 84% (79, 88) in 2012/13. Among all non-school age residents, the estimated indirect effectiveness was 60% (54, 65) and 36% (31, 41) for 2011/12 and 2012/13. The overall effectiveness among all age-groups was 65% (61, 70) and 46% (42, 50) for 2011/12 and 2012/13.
  
  
  CONCLUSIONS
  Wider implementation of SLIV programs can significantly reduce the influenza-associated public health burden in communities.
authors.affiliation: Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America; Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America; Clinical Translational Science Institute, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Cuc H
authors.initials: CH
authors.lastname: Tran
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America; Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America; Department of Epidemiology, College of Medicine, University of Florida, Gainesville, Florida, United States of America; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Sugimoto
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America; Department of Biology, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida, United States of America; Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America.
authors.forename: Juliet R C
authors.initials: JR
authors.lastname: Pulliam
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America; Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Ryan
authors.affiliation: Florida Department of Health in Alachua County, Gainesville, Florida, United States of America.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Myers
authors.affiliation: College of Nursing, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Joan B
authors.initials: JB
authors.lastname: Castleman
authors.affiliation: College of Pharmacy, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Randell
authors.initials: R
authors.lastname: Doty
authors.affiliation: Alachua County Public Schools, Gainesville, Florida, United States of America.
authors.forename: Jackie
authors.initials: J
authors.lastname: Johnson
authors.affiliation: Partnership for Strong Families, Gainesville, Florida, United States of America.
authors.forename: Jim
authors.initials: J
authors.lastname: Stringfellow
authors.affiliation: Florida Department of Health in Alachua County, Gainesville, Florida, United States of America.
authors.forename: Nadia
authors.initials: N
authors.lastname: Kovacevich
authors.affiliation: Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America; Department of Epidemiology, College of Medicine, University of Florida, Gainesville, Florida, United States of America; Florida Department of Health in Alachua County, Gainesville, Florida, United States of America.
authors.forename: Joe
authors.initials: J
authors.lastname: Brew
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Lai Ling
authors.initials: LL
authors.lastname: Cheung
authors.affiliation: Florida Department of Health in Alachua County, Gainesville, Florida, United States of America.
authors.forename: Brad
authors.initials: B
authors.lastname: Caron
authors.affiliation: University of Florida Health Integrated Data Repository, UF Health, Gainesville, Florida, United States of America.
authors.forename: Gloria
authors.initials: G
authors.lastname: Lipori
authors.affiliation: Clinical Translational Science Institute, University of Florida, Gainesville, Florida, United States of America; Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Harle
authors.affiliation: Florida Department of Health, Tallahassee, Florida, United States of America.
authors.forename: Charles
authors.initials: C
authors.lastname: Alexander
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America; Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America; Department of Biostatistics, Colleges of Medicine, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America; Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America; Department of Biostatistics, Colleges of Medicine, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Ira M
authors.initials: IM
authors.lastname: Longini
authors.affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America; Department of Biostatistics, University of Washington, Seattle, Washington, United States of America.
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Halloran
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America; Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America.
authors.forename: J Glenn
authors.initials: JG
authors.lastname: Morris
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America; Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida, United States of America; Department of Pathology, College of Medicine, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Parker A
authors.initials: PA
authors.lastname: Small
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D017589:Immunization Programs / Q000379:methods*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012306:Risk; D012574:Schools / Q000706:statistics & numerical data*; D014611:Vaccination / Q000706:statistics & numerical data*