Evaluation of a city-wide school-located influenza vaccination program in Oakland, California with respect to race and ethnicity: A matched cohort study.
Evaluation of a city-wide school-located influenza vaccination program in Oakland, California with respect to race and ethnicity: A matched cohort study.
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DOI：
10.1016/j.vaccine.2021.11.073
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发表时间：
2022-01-21
期刊：
影响因子：
5.5
通讯作者：
Benjamin-Chung J
中科院分区：
文献类型：
--
作者：
Nguyen AT;Arnold BF;Kennedy CJ;Mishra K;Pokpongkiat NN;Seth A;Djajadi S;Holbrook K;Pan E;Kirley PD;Libby T;Hubbard AE;Reingold A;Colford JM Jr;Benjamin-Chung J
增加学龄儿童的流感疫苗接种覆盖率可能会大大减少社区传播。学校流感疫苗接种（SLIV）旨在通过增加可及性来促进疫苗接种，这可能对面临预防性护理高障碍的种族/民族群体特别有益。在这里，我们评估了2014年至2018年按种族/民族划分的全市SLIV计划的有效性。我们使用多变量匹配配对学校在奥克兰，加利福尼亚州的干预区与学校在西康特拉科斯塔县，加利福尼亚州的比较区。我们进行了横断面调查，以衡量所有学生报告的疫苗接种状况，并估计了按种族/民族分层的地区之间疫苗接种覆盖率水平和未接种疫苗原因的差异。我们使用监测数据估计了按人种/种族分层的地区之间实验室确认的流感住院发病率的差异（DID）。干预区与比较区的流感疫苗接种覆盖率差异在白色人中更大（2017-18：21.0%差异[95%CI：9.7%，32.3%]）和西班牙裔/拉丁裔（13.4% [8.8%，18.0%]）的学生比亚洲/太平洋岛民（API）（8.9% [1.3%，16.5%]），黑人（5.9% [-2.2%，14.0%]），和多种族（6.3% [-1.8%，14.3%））的学生。对疫苗有效性或安全性的担忧在黑人和多种族照顾者中更为普遍。对数障碍在干预区与对照区不太常见，白色学生之间的差异最大。在这两个地区，2017-18年黑人的住院率高于其他种族/民族（干预：每10万人111.5次住院;比较：每10万人134.1次）。2016- 2017年，干预研究中心与对照研究中心相比，白色/API人群中所有年龄段的流感住院发生率较低（DID-25.14/100，000 [95% CI：−40.14，−10.14]）和2017-18年（每10万人中有−36.6 [−52.7，−20.5]），以及2017-18年的黑人老年人（每10万人中有−282.2（−508.4，−56.1]），但其他群体没有。SLIV与较高的疫苗接种覆盖率和较低的流感住院率相关，但相关性因种族/民族而异。单靠SLIV可能不足以确保公平的流感结局。
Increasing influenza vaccination coverage in school-aged children may substantially reduce community transmission. School-located influenza vaccinations (SLIV) aim to promote vaccinations by increasing accessibility, which may be especially beneficial to race/ethnicity groups that face high barriers to preventative care. Here, we evaluate the effectiveness of a city-wide SLIV program by race/ethnicity from 2014 to 2018. We used multivariate matching to pair schools in the intervention district in Oakland, CA with schools in a comparison district in West Contra Costa County, CA. We distributed cross-sectional surveys to measure caregiver-reported student vaccination status and estimated differences in vaccination coverage levels and reasons for non-vaccination between districts stratifying by race/ethnicity. We estimated difference-in-differences (DID) of laboratory confirmed influenza hospitalization incidence between districts stratified by race/ethnicity using surveillance data. Differences in influenza vaccination coverage in the intervention vs. comparison district were larger among White (2017–18: 21.0% difference [95% CI: 9.7%, 32.3%]) and Hispanic/Latino (13.4% [8.8%, 18.0%]) students than Asian/Pacific Islander (API) (8.9% [1.3%, 16.5%]), Black (5.9% [−2.2%, 14.0%]), and multiracial (6.3% [−1.8%, 14.3%)) students. Concerns about vaccine effectiveness or safety were more common among Black and multiracial caregivers. Logistical barriers were less common in the intervention vs. comparison district, with the largest difference among White students. In both districts, hospitalizations in 2017–18 were higher in Blacks (Intervention: 111.5 hospitalizations per 100,00; Comparison: 134.1 per 100,000) vs. other races/ethnicities. All-age influenza hospitalization incidence was lower in the intervention site vs. comparison site among White/API individuals in 2016–17 (DID −25.14 per 100,000 [95% CI: −40.14, −10.14]) and 2017–18 (−36.6 per 100,000 [−52.7, −20.5]) and Black older adults in 2017–18 (−282.2 per 100,000 (−508.4, −56.1]), but not in other groups. SLIV was associated with higher vaccination coverage and lower influenza hospitalization, but associations varied by race/ethnicity. SLIV alone may be insufficient to ensure equitable influenza outcomes.
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