A school-based vaccination campaign with trivalent live attenuated intranasal vaccine (tLAIV) during the 2024–2025 influenza season in two schools of Palermo, Italy

A school-based vaccination campaign with trivalent live attenuated intranasal vaccine (tLAIV) during the 2024–2025 influenza season in two schools of Palermo, Italy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A school-based vaccination campaign with trivalent live attenuated intranasal vaccine (tLAIV) during the 2024–2025 influenza season in two schools of Palermo, Italy Claudio Costantino, Walter Mazzucco, Flavio Genna, Nicole Bonaccorso, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9335509/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 5 You are reading this latest preprint version Abstract Background: Influenza causes a substantial burden of disease in children and contributes to community transmission. In Italy, influenza vaccination coverage among children remains below national and international targets, despite the availability of intranasal trivalent live attenuated influenza vaccine (tLAIV) and regional strategies to promote uptake. School-based vaccination programmes may overcome organisational and access barriers. This study aimed to evaluate adherence to a school-based tLAIV campaign in two preschool and primary schools in Palermo during the 2024–2025 influenza season and to compare vaccination coverage with previous family paediatrician-based strategies and with overall coverage in the Local Health Authority (LHA). Methods: An observational study was conducted in two Palermo schools with different socioeconomic profiles. Children aged 3–11 were offered on-site influenza vaccination with tLAIV after parental consent. Adherence was defined as the proportion of vaccinated students, and vaccination coverage was estimated using regional registry and demographic data. Results: A total of 2,140 students aged 3–11 were included, with 415 vaccinated through the school-based programme (adherence 19.39%), varying between schools. Adherence was significantly higher than influenza vaccination coverage in the Palermo LHA in 2024–2025 and in the 2022–2023 paediatrician-led pilot campaign (p<0.001). High participation was observed in disadvantaged, multi-ethnic areas, with no safety issues reported. Conclusions: The school-based tLAIV programme in Palermo was feasible, well accepted, and associated with substantially higher pediatric influenza vaccination uptake compared with traditional delivery models. Integrating school-based vaccination with family paediatrician and LHA services may represent a key strategy to improve coverage, particularly in vulnerable communities, and to reduce influenza circulation among children and their contacts. Full Text Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Major revision 04 May, 2026 Reviewers agreed at journal 29 Apr, 2026 Reviewers invited by journal 17 Apr, 2026 Editor assigned by journal 13 Apr, 2026 First submitted to journal 06 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9335509","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":625032064,"identity":"d540da20-2d7b-4d68-90be-2f886b3b9ae8","order_by":0,"name":"Claudio Costantino","email":"","orcid":"","institution":"Università degli Studi di Palermo: Universita degli Studi di Palermo","correspondingAuthor":false,"prefix":"","firstName":"Claudio","middleName":"","lastName":"Costantino","suffix":""},{"id":625032065,"identity":"e85d52f1-fb54-4ab0-aa2e-f98a987c6777","order_by":1,"name":"Walter Mazzucco","email":"","orcid":"","institution":"University 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In Italy, influenza vaccination coverage among children remains below national and international targets, despite the availability of intranasal trivalent live attenuated influenza vaccine (tLAIV) and regional strategies to promote uptake. School-based vaccination programmes may overcome organisational and access barriers. This study aimed to evaluate adherence to a school-based tLAIV campaign in two preschool and primary schools in Palermo during the 2024–2025 influenza season and to compare vaccination coverage with previous family paediatrician-based strategies and with overall coverage in the Local Health Authority (LHA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e An observational study was conducted in two Palermo schools with different socioeconomic profiles. Children aged 3–11 were offered on-site influenza vaccination with tLAIV after parental consent. Adherence was defined as the proportion of vaccinated students, and vaccination coverage was estimated using regional registry and demographic data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 2,140 students aged 3–11 were included, with 415 vaccinated through the school-based programme (adherence 19.39%), varying between schools. Adherence was significantly higher than influenza vaccination coverage in the Palermo LHA in 2024–2025 and in the 2022–2023 paediatrician-led pilot campaign (p\u0026lt;0.001). High participation was observed in disadvantaged, multi-ethnic areas, with no safety issues reported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The school-based tLAIV programme in Palermo was feasible, well accepted, and associated with substantially higher pediatric influenza vaccination uptake compared with traditional delivery models. Integrating school-based vaccination with family paediatrician and LHA services may represent a key strategy to improve coverage, particularly in vulnerable communities, and to reduce influenza circulation among children and their contacts.\u003c/p\u003e","manuscriptTitle":"A school-based vaccination campaign with trivalent live attenuated intranasal vaccine (tLAIV) during the 2024–2025 influenza season in two schools of Palermo, Italy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-25 05:54:55","doi":"10.21203/rs.3.rs-9335509/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2026-05-04T08:18:30+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2026-04-29T16:00:48+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-17T14:03:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-14T03:24:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"Italian Journal of Pediatrics","date":"2026-04-06T11:44:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"italian-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"itjp","sideBox":"Learn more about [Italian Journal of Pediatrics](http://ijponline.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ITJP/default.aspx","title":"Italian Journal of Pediatrics","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a9964fbd-7470-494c-8ae7-24416a7a6eaa","owner":[],"postedDate":"April 25th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Major revision","date":"2026-05-04T08:18:30+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T12:19:06+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-25 05:54:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9335509","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9335509","identity":"rs-9335509","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}