title: Targeted vaccination in healthy school children - Can primary school vaccination alone control influenza?
abstract: BACKGROUND
  The UK commenced an extension to the seasonal influenza vaccination policy in autumn 2014 that will eventually see all healthy children between the ages of 2-16 years offered annual influenza vaccination. Models suggest that the new policy will be both highly effective at reducing the burden of influenza as well as cost-effective. We explore whether targeting vaccination at either primary or secondary schools would be more effective and/or cost-effective than the current strategy.
  
  
  METHODS
  An age-structured deterministic transmission dynamic SEIR-type mathematical model was used to simulate a national influenza outbreak in England. Costs including GP consultations, hospitalisations due to influenza and vaccinations were compared to potential gains in quality-adjusted life years achieved through vaccinating healthy children. Costs and benefits of the new JCVI vaccination policy were estimated over a single season, and compared to the hypothesised new policies of targeted and heterogeneous vaccination.
  
  
  CONCLUSIONS
  All potential vaccination policies were highly cost-effective. Influenza transmission can be eliminated for a particular season by vaccinating both primary and secondary school children, but not by vaccinating only one group. The most cost-effective policy overall is heterogeneous vaccination coverage with 48% uptake in primary schools and 34% in secondary schools. The Joint Committee on Vaccination and Immunisation can consider a modification to their policy of offering seasonal influenza vaccinations to all healthy children of ages 2-16 years.
authors: Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: dominic.thorrington@lshtm.ac.uk.
authors: Dominic
authors: D
authors: Thorrington
authors: Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK.
authors: Mark
authors: M
authors: Jit
authors: Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK.
authors: Ken
authors: K
authors: Eames
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000706:statistics & numerical data; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000517:prevention & control*; D008875:Middle Aged; D008962:Models, Theoretical; D011159:Population Surveillance; D012574:Schools; D006113:United Kingdom / Q000453:epidemiology; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Cost-effectiveness analysis; Influenza; Mathematical model; QALYs; Schools; Vaccination