Evaluation of a city-wide school-located influenza vaccination program in Oakland, California with respect to race and ethnicity: a matched cohort study

Abstract Objectives To evaluate the effectiveness of city-wide school-located influenza vaccination by race/ethnicity from 2014-2018. Methods We used multivariate matching to pair schools in the intervention district in Oakland, CA with schools in West Contra Costa County, CA, a comparison district. We estimated difference-in-differences (DIDs) in caregiver-reported influenza vaccination coverage and laboratory-confirmed influenza hospitalization incidence. Results Differences in influenza vaccination coverage in the intervention vs. comparison site were larger among White and Latino students than Asian/Pacific Islander (API), Black, and multiracial students. Concerns about vaccine effectiveness or safety were more common among Black and multiracial caregivers; logistical barriers to vaccination were more common among White, API, and Latinos. In both sites, hospitalization in 2017-18 was higher in Blacks vs. other races/ethnicities. All-age influenza hospitalization incidence was lower in the intervention site vs. comparison site among White/API individuals in 2016-17 and 2017-18 and Black older adults in 2017-18, but not in other groups. Conclusions SLIV was associated with higher vaccination coverage and lower influenza hospitalization, but associations varied by race/ethnicity. SLIV alone may be insufficient to ensure equitable health outcomes for influenza.