Implementation of school-based vaccination in French middle schools: Efficient or not?

Despite various vaccination campaigns coordinated by French authorities, vaccine coverage (VC) in France remains low, especially for human papillomavirus (HPV). The Agence Regionale de Santé established a mandate for vaccination centres in Normandy to develop a school-based vaccination program in public middle schools. The aim of this study was to analyse the efficiency of this program after four academic years (2019-2023).

Authorization from the parents was required to update each of the following recommended vaccinations for their children (aged 11-13-years-old): diphtheria-tetanus-poliomyelitis-pertussis; hepatitis B virus (HBV); measles, mumps and rubella; meningococcal C; and HPV vaccines. Adolescents for whom at least one vaccine has been accepted were seen by the doctor and were vaccinated if needed. Global VC was defined as being vaccinated for all French mandatory and recommended vaccines. The objective of this study was to compare the proportions of global VC pre and post implementation of the school vaccination program during the period study.

During the study period, 199 schools were visited. Among the 18,476 students, 33.6 % (n = 6217) of the students' parents accepted at least one vaccine, and 4464 students were vaccinated (81.9 %, 4464/5450). Global preintervention VC was 10.7 % (n = 585), which increased to 65.7 % (n = 3585) after the vaccine intervention (p < 0.0001). VC increased from 64.8 % in preintervention to 87.5 % in postintervention (p < 0.0001) for the meningococcal C vaccine, from 67.6 % to 85.6 % (p < 0.0001) for the HBV vaccine and from 14.6 % (n = 675/4614) to 79.9 % (n = 3685/4614) (p < 0.0001) for the HPV vaccine. In multivariate analysis, the post-COVID-19 period (2021-2022) was significantly associated with not being up to date for at least one vaccine (OR: 1.4 [1.2-1.9]).

Our study determined that school vaccination program effectively improved VC for all recommended vaccines and should not be restricted to certain vaccines, such as HPV.