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BACKGROUND	School-based influenza immunization can effectively address accessibility barriers , but injected inactivated influenza vaccines ( IIV ) may not be acceptable to some children and parents in school settings .
OBJECTIVE	To better understand the feasibility of offering intranasal live attenuated influenza vaccines ( LAIV ) through schools , we assessed uptake , stakeholder acceptability , and cost of school-based delivery of LAIV compared to IIV .
METHODS	We piloted an open-label cluster randomized trial involving 10 elementary schools in Peterborough , Ontario during the 2013-2014 influenza vaccination campaign .
METHODS	Schools were randomized to having students receive IIV or LAIV at publicly-funded school-based clinics organized by the local public health department .
METHODS	We measured the percentage of students vaccinated with at least one dose of influenza vaccine at school .
METHODS	Stakeholder acceptability was evaluated through a questionnaire of parents and interviews of public health department personnel and school principals .
METHODS	We compared the costs per dose of vaccine administered , including staff time and costs of vaccines and supplies .
RESULTS	Single-dose influenza vaccine uptake was higher for the five schools offering LAIV than for the five offering IIV ( 19.3 % vs. 12.2 % , p = 0.02 ) .
RESULTS	Interviews with nine school principals and five public health department personnel suggested that the clinics ran smoothly with little disruption to school routines , and that LAIV was associated with increased efficiency and calmer children .
RESULTS	All interviewees cited unfamiliarity with LAIV and the study recruitment package length as potential reasons for low uptake .
RESULTS	The cost per vaccine dose administered was $ 38.67 for IIV and $ 43.50 for LAIV .
CONCLUSIONS	Use of LAIV in school-based clinics was associated with increased vaccine uptake and the perception among immunizing staff of reduced child anxiety , but also slightly higher vaccine administration costs , compared to IIV .
CONCLUSIONS	However , uptake was low for both groups .
CONCLUSIONS	More effective strategies to promote influenza vaccines and to obtain parent consent may improve vaccine uptake .
BACKGROUND	ClinicalTrials.gov NCT01995851 .
BACKGROUND	Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network .

