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。尽管有针对该疾病并发症风险最高的人的疫苗和疫苗接种战略，但每年仍有大约36000人死亡，200 000多人住院。这项提案涉及国家政策制定者目前正在考虑的为所有学龄儿童每年接种疫苗的新控制战略的两种可能的交付系统。具体地说，我们将确定与青少年通常的医疗保健来源(即医生办公室或卫生部门诊所)相比，在学校为青少年接种疫苗是否会导致更高的免疫覆盖率。将重点放在青少年身上尤其重要，因为许多人没有进行建议的预防保健访问，而确定接触他们接种疫苗的最佳手段与为这一年龄段推荐的一些新疫苗有关。我们将使用系统的复制设计进行一项三臂对照试验，比较佐治亚州东南部三个不同种族的农村县的流感疫苗接种率，特别是沃伦县、林肯县和詹金斯县。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，旨在激励父母和青少年接种疫苗并分发免费疫苗代金券。在沃伦县(N=437名初中生和高中生)，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)，我们将要求父母将他们的孩子连同代金券一起带到他们通常的护理来源，那里将免费提供疫苗。提供者还将获得疫苗管理的补偿，按联邦医疗保险费计算，每剂17.05美元。詹金斯(N=869)将作为控制县，在那里我们将不实施干预。作为次要结果，我们将评估其他推荐的预防保健服务的提供情况，以确定将青少年带到他们通常的医疗保健来源接种疫苗(基于提供者的干预)是否可以比以学校为基础的干预和控制条件改善预防性保健的整体提供。其他结果将包括这两种干预措施对疫苗接受度介体的影响。这项研究的发现可能具有重要的卫生政策影响，为如何最好地实施青少年普遍流感疫苗接种战略的建议奠定基础。

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.