Factors associated with uptake of the Influenza A(H1N1)pdm09 monovalent pandemic vaccine in K-12 Public Schools, Maine 2009-2010.

CONTEXT AND OBJECTIVE: Maine implemented a statewide pre-K through 12-school vaccination program during the 2009-2010 H1N1 influenza pandemic. The main objective of this study was to determine which school, nurse, consent form, and clinic factors were associated with school-level vaccination rates for the first dose of the 2009 H1N1 pandemic vaccine. METHODS: In April 2010, school nurses or contacts were e-mailed electronic surveys. Generalized linear mixed regression was used to predict adjusted vaccination rates using random effects to account for correlations within school districts. Elementary and secondary (middle and high) schools were analyzed separately. RESULTS: Of 645 schools invited to participate, 82% (n = 531) completed the survey. After excluding schools that were ineligible or could not provide outcome data, data for 256 elementary and 124 secondary public schools were analyzed and included in the multivariable analyses. The overall, unadjusted, vaccination rate was 51% for elementary schools and 45% for secondary schools. Elementary schools that had 50 or fewer students per grade, had availability of additional nursing staff, which did not require parental presence at the H1N1 clinic or disseminated consent forms by mail and backpack (compared with backpack only) had statistically significant (P < .05) higher (adjusted) vaccination rates. For secondary schools, the vaccination rate for schools with the lowest proportion of students receiving subsidized lunch (ie, highest socioeconomic status) was 58% compared with 37% (P < .001) for schools with the highest proportion receiving subsidized lunch. CONCLUSIONS: Several factors were independently associated with vaccination rates. For elementary schools, planners should consider strategies such as providing additional nursing staff and disseminating consent forms via multiple methods. The impact of additional factors, including communication approaches and parent and student attitudes, needs to be investigated, especially for secondary schools.

Lessons from a project to create performance measures for public health.

This paper uses a specific example to illustrate complications that arise in formulating and implementing performance measures. The context of this demonstration is a Centers for Disease Control and Prevention (CDC)-funded project to explore the feasibility of performance measures developed at the national level for local sexually transmitted disease (STD) prevention and control programs. Grantees provided local data and reported on their experience in eliciting the data and using the results for program development. The experience of this project suggests that measures can be made operationally feasible and programmatically useful only if terminologies are subjected to extensive definition and clarification activities. These activities must include development of common language, mapping of workflows, and clarification of spheres of influence. Finally, performance measures must be used with some caution, as they often unintentionally capture extraneous program elements.

Instituting a case management system for the lead-poisoned child: the Maine experience.

This article details the origin and implementation of a state-level case management system for children with elevated blood lead levels. This includes a thorough accounting of the methods utilized to create the system. The article closes with data derived from the case management reporting system showing the system's effectiveness and with a description of how this design parallels the case management recommendations by the Centers for Disease Control and Prevention made at a later date. The article offers suggestions for designers of such systems. In general, the authors advise building on existing systems, creating written protocols for both case managers and health care personnel, developing a support system for case managers, tracking activities through data, and giving recognition to field personnel.