Influenza Vaccine Delivery to Adolescents: two multicomponent interventions

描述（由申请人提供）： 迫切需要更好地控制目前的流感负担。尽管有针对最有可能发生并发症的人的疫苗和疫苗接种战略，但每年仍有约36 000人死亡，200 000多人住院。 这项建议涉及国家决策者目前正在考虑的一项新的控制战略的两种可能的提供系统，以便每年为所有在校儿童接种疫苗。具体来说，我们将确定在学校接种青少年疫苗是否与他们通常的医疗保健来源（即，医生办公室或卫生部诊所）导致更高的免疫覆盖率。对青少年的关注特别重要，因为许多人没有进行建议的预防保健访问，确定接触他们进行疫苗接种的最佳方式与为这一年龄组推荐的一些新疫苗有关。 我们将进行一项三臂对照试验，采用系统复制设计，比较格鲁吉亚东南部三个种族多样化的农村县，特别是沃伦、林肯和詹金斯县的流感疫苗接种率。在林肯县和沃伦县，我们将实施两个周期的多成分干预措施，旨在鼓励父母和青少年接种疫苗，并分发免费疫苗券。在沃伦县（N=437名初中和高中学生），我们还将在学校开展疫苗接种诊所。 相比之下，在林肯县（N = 783），我们将要求父母带着他们的孩子，沿着凭证，到他们通常的护理来源，那里将提供疫苗，免费。 提供者也将报销疫苗管理的医疗保险费，每剂17.05美元。 詹金斯（N = 869）将作为对照县，我们将不实施干预。 作为次要结果，我们将评估其他推荐的预防性卫生服务的提供情况，以确定与基于学校的干预和控制条件相比，将青少年带到他们通常的医疗保健来源进行疫苗接种（基于提供者的干预）是否可以改善预防性卫生保健的整体提供。 其他结果将包括两种干预措施对疫苗接受介质的影响。 这项研究的结果可能具有重要的卫生政策意义，为如何最好地实施青少年通用流感疫苗接种策略的建议奠定了基础。

DESCRIPTION (provided by applicant): There is a critical need to better control the current burden of influenza. Despite the availability of vaccines and vaccination strategies targeted to those most at risk of complications from the disease, approximately 36,000 deaths and more than 200,000 hospitalizations occur annually. This proposal addresses two potential delivery systems for a new control strategy currently under consideration by national policy makers for annual vaccination of all school children. Specifically, we will determine whether vaccinating adolescents at school as compared to their usual source of medical care (i.e., doctor's office or health department clinic) leads to higher immunization coverage. The focus on adolescents is particularly important because many do not make the recommended preventive care visits, and determining the best means of reaching them for vaccination has relevance for a number of new vaccines recommended for this age group. We will conduct a three- armed controlled trial using a systematic replication design to compare influenza vaccination rates in three racially diverse rural counties of southeast Georgia, specifically, Warren, Lincoln and Jenkins counties. In Lincoln and Warren counties we will implement two cycles of the multicomponent interventions designed to motivate parents and adolescents to be vaccinated and distribute vouchers for free vaccine. In Warren County (N=437 middle- and high-school students), we also will conduct vaccination clinics in the school. In contrast, in Lincoln County (N = 783), we will ask parents to take their child, along with the voucher, to their usual source of care where vaccine will be provided, free. Providers will also be reimbursed for vaccine administration at the Medicare fee, $17.05 per dose. Jenkins (N = 869) will serve as a control county where we will implement no intervention. As a secondary outcome we will assess the delivery of other recommended preventive health services to determine whether bringing adolescents to their usual source of medical care for vaccination (provider-based intervention) can improve the overall delivery of preventive healthcare compared to the school-based intervention and the control condition. Other outcomes will include the effect of the two interventions on mediators of vaccine acceptance. Findings from this study could have important health policy implications, laying the foundation for recommendations on how best to implement a universal influenza vaccination strategy of adolescents.