school-based flu clinic

Last year when H1N1 was the buzz, my district tested the waters by suggesting in school clinics. The other nurses in district and i opposed the idea stating that we would not inject any vaccine into a child without a parent or guardian physically present. We felt that even if there was a waiver, that we would not want to have to physically restrain any child resistant to getting vaccinated - and realistically, very few children would be cooperative for a vaccine without a parent present.

I give immunizations in the school without parents present as long as I have the signed consent from the parent. But I work for the Health Dept. and we have signed protocols including anaphylaxis protocols with epinephrine available for reactions. I have never had a reaction bad enough for epi (knock on wood) but would not feel comfortable doing the immunizations without the protocol and epi present. I work in a middle school so getting the kids to sit still for shots is not usually a problem.

There was an entire issue of the Journal of School Nursing on this issue August 2010: http://jsn.sagepub.com/content/26/4_suppl.toc

School nurse commitment to immunizations and flu vaccines underscores the value of the nurses' role in prevention of communicable diseases. School nurses' public health role is often overlooked, but supporting school located vaccine clinics exemplifies that school nurse do more than bandaids.

I am trying to find the stats to quote, but I heard a CDC official present in November that children attending schools with school located vaccine clinics had much higher H1N1 flu vaccing rates than schools that did not hold clinics.

The important part of achieving the outcomes is that the clinic be held at the school. It is not important who employs the nurse who gives the injection. It varies widely from state to state based on ratios, infrastructure, state and local health department strength. Sometimes it is the school nurse, other times the public health department nurse and other times a nurse or other health professional working for an agency that administers vaccines.

Maine promising practices: Promising Practices Evaluation of H1N1 Vaccination Clinics Highlights Leadership Role of School Nurses (ME)

Hull, H. F. & Ambrose , C. F. (2011). The impact of school-located influenza vaccination programs on student absenteeism: A review of the U.S. literature, Journal of School Nursing, 27: 34-42.

I had not seen the FEB , 2011 issue of the Journal of School Nursing - another article about school located flu vaccinations: Six studies compared absenteeism for students in SLIV schools and control schools; all found absenteeism

decreased in SLIV schools. Three studies compared absenteeism for vaccinated and unvaccinated students in SLIV

schools; all found that absenteeism was reduced for vaccinated students. Benefits were also reported to extend

beyond the vaccinated children; one study found that absenteeism was significantly reduced among high school students

when elementary school students were vaccinated. The available evidence indicates that SLIV programs

reduce student absenteeism during the influenza season. Additional research into sustainable funding sources and

the comprehensive effects of SLIV programs on students, families, staff, and the community is warranted.

For the table of contents to the entire issue: http://jsn.sagepub.com/content/27/1.toc?etoc

Our health department held school based flu clinics at the schools in our district and the school nurses helped. We mostly sent out and collected consents, answered questions from parents and then on the day of, we mostly organized the flow, made sure each student who recieved the vaccine had a consent, etc rather than admininstering the vaccine, though we did some of that as well. Our health department offered the nasal mist to students and the injection for those who the mist was contraindicated such as Asthma students, all for free. Injections were not given if the child was truly fighting it and students were certainly comforted by me, a teacher, a para, whoever they were comfortable with during and after, even a couple of parents showed up to hold their children. I don't remember exact numbers but I'd guess 90% got the mist and the rest the injection. As I mentioned this was a free service and my school (K-5, about 400 kids) had a good 40% participation rate. I thought everything went very smoothly. My own girls who are in school there got their flu vaccines at school instead of the pedi. We had a day about a 1 week later for make-ups for students who were absent and 1 month later for those that needed boosters. All in all I felt it was very positive for our school/community.