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American Journal of Epidemiology Advance Access originally published online on August 13, 2009
American Journal of Epidemiology 2009 170(6):679-686; doi:10.1093/aje/kwp237
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American Journal of Epidemiology © 2009 The Authors
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

PRACTICE OF EPIDEMIOLOGY

Strategies for Pandemic and Seasonal Influenza Vaccination of Schoolchildren in the United States

Nicole E. Basta, Dennis L. Chao, M. Elizabeth Halloran, Laura Matrajt and Ira M. Longini, Jr

Correspondence to Dr. Ira M. Longini, Jr., Program in Biostatistics and Biomathematics, Vaccine and Infectious Disease Institute, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA 98109 (e-mail: longini{at}scharp.org).

Received for publication March 19, 2009. Accepted for publication July 9, 2009.

Vaccinating school-aged children against influenza can reduce age-specific and population-level illness attack rates. Using a stochastic simulation model of influenza transmission, the authors assessed strategies for vaccinating children in the United States, varying the vaccine type, coverage level, and reproductive number R (average number of secondary cases produced by a typical primary case). Results indicated that vaccinating children can substantially reduce population-level illness attack rates over a wide range of scenarios. The greatest absolute reduction in influenza illness cases per season occurred at R values ranging from 1.2 to 1.6 for a given vaccine coverage level. The indirect, total, and overall effects of vaccinating children were strong when transmission intensity was low to intermediate. The indirect effects declined rapidly as transmission intensity increased. In a mild influenza season (R = 1.1), approximately 19 million influenza cases could be prevented by vaccinating 70% of children. At most, nearly 100 million cases of influenza illness could be prevented, depending on the proportion of children vaccinated and the transmission intensity. Given the current worldwide threat of novel influenza A (H1N1), with an estimated R of 1.4–1.6, health officials should consider strategies for vaccinating children against novel influenza A (H1N1) as well as seasonal influenza.

communicable disease control; influenza, human; influenza vaccines; mass immunization

Abbreviations: LAIV, trivalent live, attenuated influenza vaccine; R, average number of secondary cases produced by a typical primary case in a population with a certain level of preexisting partial immunity; TIV, trivalent inactivated influenza vaccine; VEI, vaccine efficacy for infectiousness; VEP, vaccine efficacy for illness given infection; VES, vaccine efficacy for susceptibility; VESP, vaccine efficacy for infection-confirmed symptomatic illness


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