Annual influenza epidemics result in substantial mortality and morbidity among adults and children with more than $10 billion in direct medical costs. Although national guidelines recommend annual influenza vaccination of all school-aged children, less than half of these children are vaccinated. The major barrier is the short time window for vaccination: primary care practices are simply unable to vaccinate all of their pediatric patients within a few months. An alternative setting for child influenza vaccination is school-located influenza vaccinations (SLIV), yet <5% of children receive vaccine in schools. Three barriers impede SLIV: an ineffective paper-based parent consent system, ineffective parent reminders, and lack of experience with SLIV among adolescents. The goal of this project is to address these 3 barriers and to optimize influenza vaccination rates via SLIV. We will adapt two dissemination/implementation conceptual models (the Chronic Care Model and RE- AIM). We will work closely with schools, primary care practices, and local and state public health leaders, and with two national partners - CDC's National Center for Immunization and Respiratory Diseases (NCIRD) and the National Association of School Nurses (NASN). We propose a technical aim, a scientific aim, and a dissemination aim. The technical aim (Aim 1, Yr 1) is to develop, pilot, and evaluate a web-based consent and parent reminder system, using an innovative web-based informatics system. We will perform formative studies of parents, school staff, and providers, to create a useful system. The scientific aim (Aim 2, Yrs 2-4) is to perform effectiveness testing of SLIV, using web-based consent + reminders. We will randomize schools to SLIV vs. control in 3 successive annual RCTs, with increasing number of schools, and measure vaccination rates, school absences, and SLIV processes and costs. In Yr 2 we will include 5 schools districts (all elementary;26 study, 28 control schools, n=25,078). In Yr 3 we will expand to 8 school districts and also middle/high schools (n=59,556 children);in Year 4 to 12 districts (n=79,713 children). The dissemination aim (Aim 3, Yrs 4-5) is to spread SLIV throughout Monroe County and diffuse SLIV best practices and technological innovations nationally. We will offer SLIV to all county schools (182 schools, n=112,034), and work with national partners to disseminate the consent/reminder system and a training program for SLIV across the US. This project addresses AHRQ priority area Prevention/Care Management, includes a focus on priority populations (adolescents, urban), and is a major redesign of primary care.

Public Health Relevance

This demonstration and dissemination project addresses the problem of low influenza vaccination rates among school-aged children and subsequent morbidity to children and, through spread of infection, to adults. We will implement and evaluate a county-wide school-located influenza vaccination system in which children will receive influenza vaccination in their schools. To accomplish this, we will develop, pilot, and evaluate a web- based parent consent and parent reminder system that will simplify receipt of consent and improve participation. We will then test the effectiveness of school-located influenza vaccinations through a series of randomized clinical trials, spreading the program to an enlarging number of schools. Finally, we will disseminate the program across the county and develop, with national collaborators, a model program that can be used nationally.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
Project #
Application #
Study Section
Health Systems Research (HSR)
Program Officer
Ricciardi, Richard
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Rochester
Schools of Dentistry
United States
Zip Code
Humiston, Sharon G; Poehling, Katherine A; Szilagyi, Peter G (2014) School-located influenza vaccination: can collaborative efforts go the distance? Acad Pediatr 14:219-20