Vaccines and Schools: Estimating the Impact of School-Based Infectious Disease Mitigation Programs in the Southeastern United States Restricted; Files Only
Harton, Paige (Fall 2025)
Abstract
Children and adolescents who attend school can serve as spreaders of infectious diseases, within the schools they attend and the communities in which they live. Adverse outcomes of disease transmission among school-aged children and adolescents include illness-related absenteeism and secondary transmission to vulnerable populations. However, there are school-based disease mitigation measures that can be implemented to combat school-based transmission.
This dissertation estimated the impact of COVID-19 vaccination among school-aged children and adolescents using data from a school-based weekly SARS-CoV-2 testing program within a large urban school district during the 2021-2022 school year.
Aim 1: Using a target-trial emulation framework, we estimated COVID-19 vaccine effectiveness (VE) against any infection, among a matched cohort of students participating in a weekly opt-in SARS-CoV-2 testing program. VE was modest among students aged 5-11 years approximately 60 days after vaccination, and this protection waned over the course of the school year.
Aim 2: We used pooled logistic regression to estimate the indirect and total effects of COVID-19 vaccination among students aged 5-11 years in this large urban school district. This analysis found limited significant indirect protection from COVID-19 vaccination among unvaccinated students attending schools with at least 60% grade-level vaccination coverage.
Aim 3: In this analysis, we used negative binomial regression to estimate associations of COVID-19 vaccination on all-cause school absenteeism. Across most subpopulations, including 1) the previously defined matched cohort, 2) students enrolled in the opt-in testing program, and 3) all students, this analysis found that vaccinated students were less likely to miss school than unvaccinated students for any reason.
Conclusion: The results of this dissertation demonstrated how routine testing data may be used to assess associations of vaccination on important metrics such as infection and school absenteeism. These analyses provide information for public health officials and school administrators as they continue to make informed decisions regarding vaccine policies within school settings. Given the importance of reducing SARS-CoV-2 infection and transmission among school-aged children to prevent transmission to other vulnerable populations and limit school absenteeism due to illness, this dissertation may have lasting public health impact for future outbreaks or epidemics of vaccine-preventable diseases.
Table of Contents
Chapter 1 – Introduction. 1
Chapter 2 - Estimating COVID-19 Vaccine Effectiveness among Children and Adolescents using Data from a School-based Weekly COVID-19 Testing Program.. 18
Abstract 18
Introduction. 19
Methods. 21
Results. 26
Discussion. 31
Conclusion. 35
Funding. 36
CRediT authorship contribution statement 36
Declaration of competing interest 36
Acknowledgements. 36
Data Availability. 37
Tables. 38
Figures. 42
Supplement 45
Chapter 3 – Estimating Indirect Effects of COVID-19 Vaccination against Reported SARS-CoV-2 Infection among Children aged 5 – 11 years Attending a Large Urban School District 81
Introduction. 81
Methods. 83
Results. 88
Discussion. 91
Tables. 96
Figures. 102
Supplement 103
Chapter 4 – Assessing Associations of COVID-19 Vaccination with Reported School Absences in a Large Urban School District During the 2021-2022 School Year. 131
Introduction. 131
Methods. 132
Results. 137
Discussion. 140
Tables. 144
Figures. 149
Supplement 151
Chapter 5 – Summary of Results and Conclusions. 172
Chapter 6 – References. 177
About this Dissertation
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File download under embargo until 12 January 2027 | 2025-11-21 13:01:32 -0500 | File download under embargo until 12 January 2027 |
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