In 1996, the
Mid America Immunization Coalition started coordinating a metropolitan
effort to provide hepatitis B immunizations to adolescents in a
school-based program. Personnel from up to 23 school districts and six
health departments joined volunteers from 13 agencies to implement the
Consent forms were developed for the
program and included a request for reasons for refusal for those not
wanting to participate. Consent forms were sent home with the students
and incentives were often used to encourage the return of the forms.
Health departments coordinated the
immunization days with school personnel. Immunization data for students
in Missouri were entered into the state immunization registry.
A total of 46,749 students from 141 public
and 54 private schools in Kansas and Missouri were offered vaccinations
at school. The population was 70% Caucasian and 30% minority from rural,
suburban, and urban schools in 23 districts.
Here are a few statistics from the
- 79.26% returned consent forms
- 23.7% chose not to participate (most
because already immunized)
- 94.7% received at least one dose
- 80.9% completed series
Several studies were conducted to evaluate
the program. Some of the results are provided below.
Keys to success - Good organization from a
centralized agency; adequate time for preparation; anything to enhance
obtaining consent; providing an educational opportunity; enlisting school
support (especially the principal); and any effort to improve student
Other findings - Larger schools had
decreased participation & completion rates. Schools providing educational
interventions had high participation & completion rates. Schools with a
large population of commercially insured students had low participation
rates (65%), but high completion rates (85%). Schools with a high number
of Medicaid eligible students had high participation rates (97%), but low
completion rates (67%). Income - high and low participate less. Race -
non-white have lower participation rates. Location of school - urban
schools had significantly lower participation rate (.58) than suburban
Cost issues - Yearly program costs $81,972
- $142,485. Vaccine costs $247,051 - $304,276. Total administration
cost/dose $3.28 - $5.06. Typical private office costs $15.00/dose.
Typical health department costs $5.62. $53 million of future costs
The program ended in 2003 when the birth
cohort who received hepatitis B vaccine as infants reached 6th grade and
school-based hepatitis B vaccinations were no longer needed.
For a camera-ready copy of the evaluation
of the Kansas City program, click