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 program.

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 program:

1. 79.26% returned consent forms
2. 23.7% chose not to participate (most because already immunized)
3. 94.7% received at least one dose
4. 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 tracking.

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 schools (.90).

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 avoided.

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 here.