Missouri School Located Influenza Vaccination

Stakeholder Meeting Summary - November 19, 2010

At the conclusion of the 2010 Missouri Immunization Conference, participants gathered to discuss methods to create sustainable school located vaccination opportunities.  More than 50 individuals participated, including state and local health department staff, school officials, pharmaceutical representatives and immunization advocates.

The meeting was opened by the chairman of the Missouri Advisory Committee on Childhood Immunizations, Robert Steele, M.D. of St. John’s Children’s Hospital in Springfield.

Value of School-Based Clinics

Robert Belshe, M.D. of the St. Louis University Center for Vaccine Development highlighted the science of influenza and the value of school-based vaccination clinics.

• During the last decade there has been an explosion in our knowledge of influenza and the development of vaccines.
• The Burden of Influenza Pyramid.  The top represents deaths from influenza that occur mainly in the elderly.  The base represents the vectors of the disease.  New recommendations simplify who should be vaccinated and focus on the base of the pyramid.
• 2004 University of Maryland School-Based Vaccination Study - Thirty-nine percent of the students at a Maryland elementary school were vaccinated in school and then outcomes were compared to two schools where children were not offered in-school vaccinations. Compared to the two non-participating schools, families at the participating schools indicated a 72 percent drop in adult workdays lost, and a 46 percent drop in school days lost by all children in the family. There was also a 67 percent reduction in medical visits for adults, and a 60 percent decline for children. The use of medications went down in these families as well, with 56 percent less use of non-prescription drugs, a 59 percent drop in herbal/natural remedies and a 59 percent decrease in prescription drugs. http://www.umm.edu/news/releases/flumist_study.htm

 

Best Practices

Jean Grabeel, BSN, M.Ed., Springfield Public Schools

• Springfield has a student population of 24,000 students and 53 school nurses.
• Vaccination in schools has been a practice for almost 20 years.  The thought being to go where the kids are.
• A partnership was developed with Greene County, Cox Mobile Care, & Jordan Valley Community Health Center.
• The original plan in 2009 was to expand flu vaccination efforts to 12 schools.  H1N1 resulted in a change of plans that expanded the efforts to all schools in the district.
• 10,010 influenza vaccines were given by 3 vaccinators 9,000 doses were given to students with the remainder going to employees.
• There was an emphasis on not letting staffing become a barrier.  Springfield chose to not push the responsibility of vaccinating to the school nurses.
• The planning considerations included vaccine storage as well as parent letters, VIS and Consent form printing and distribution. 
• A dedicated phone line was used for scheduling.  With over 1,000 calls, this became overwhelming and difficult from which to retrieve accurate information.
• $3,000 was used to copy an adequate supply of forms.  The forms were also available online.
• Media helped to promote school programs.
• The school district’s “alert system” was used to get calls to all parents.
• Mo. State University nursing students helped with the vaccination efforts primarily with logistics.
• Students who were vaccinated had fewer medical absences than those who didn’t get vaccinated.
• Continued education is needed for OB/GYNs and other specialists who are not familiar with all vaccine presentations and created barriers in some instances.

 

Charlotte Sims-Higgins, VFC Coordinator, Mo. Bureau of Immunizations

• VFC vaccine can be used in School programs, but proper screening must occur.
• Proper storage and handling procedures must be followed.
• Children who are not eligible to receive VFC vaccine must receive doses purchased privately.
• Planning must occur early enough to place a preorder during the spring timeframe.  An order will then be placed in the fall.
• DO NOT schedule clinics until vaccine has been received.  Flu vaccine shipping can be unpredictable.

 

Questions, Answers and Comments

Q.        How was the Springfield Public Schools influenza program funded? 
A.        The American Recovery and Reinvestment Act of 2009.

Q.        How were notes from concerned obstetricians handled?
A.        Employees were allowed to take a sick or personal day if they were concerned about exposure. Greene County Health Dept communicated with community physicians including obstetricians regarding vaccine safety.

Q.        Why was school vaccination more common and different in the 1970s?
A.        American culture was different i.e., the diseases were more feared and legal concerns were not what they are today.

There are 522 public school districts in Missouri with a total of 1214 school districts when private schools are included.

There are many different ways for vaccinating to occur:

• St. Louis County - School Nurses were vaccinators
• Cole County - Parochial school had 50% uptake when Cole County Health Dept administered vaccine.  The school nurse distributed and collected consents.

There is a need to educate teachers and answer their questions about vaccines and vaccination efforts.

Is there a way to survey how the vaccination efforts were handled throughout the state in different programs?

School-Based Vaccination Campaign Ideas and Barriers

The group broke into three workgroups.  Dr. Steele asked them to describe the characteristics of an ideal school located influenza vaccination program.

Group 1

• Formation of a vaccination campaign committee should occur to include representatives from the school board, LPHA, school nurses, community champions, local health care provider liaison, local insurance representatives, mass vaccinators who can provide vaccine and bill multiple insurers, mobile unit coordinator
• The committee’s role would be that of the “champion” for a community wide program that would include the ability to vaccinate parents.
• There would need to be 3-5 models to allow for differences in different communities.

 

Group 2

• Collaboration
• Present during school registration to get the word out early and gauge interest.
• Streamlined paperwork
• Mobile van to provide vaccinations
• State funds available to provide vaccine for all children
• Funds to vaccinate all state residents
• Adequate staffing
• Partnerships between schools, LPHAs, media, and insurance companies
• Get insurance companies to provide vaccines for programs
• A specific team paid to lead the project
• Mo. Health Foundation to provide funding for supplies DHSS provide storage and distribution
• Universal Billing paperwork
• Early school board approval to ensure proper funding
• DSSE approval and support
• Flu vaccine mandate for school attendance
• Require 3rd party insurance to pay for flu vaccine
• All LPHAs become FQHCs

 

Group 3

• Identify and align target audience/timeline (dosing during school or after school)
• Stabilize vaccine supply
• Pre-screening done prior to vaccination day
• No additional cost to school (i.e. substitute nurses)
• No restrictions- everyone can be vaccinated
• Revenue stream- easy billing for vaccine
• No written consent required
• No liability concern
• Immunize the entire family and school staff
• Offer other vaccines during flu clinic.
• Identify and provide parent messaging to reduce questions and answers
• Community wide program
• Vaccine Mandate

 

Solutions to Barriers

Group 1

• All vaccine free
• Community wide program
• Vaccination regardless of insurance status
• POSITIVE community wide communication
• School clinics, weekend clinics and transportation to clinics
• Attach consent forms with grade cards or in pre-school packet
• Create an annual plan for the flu vaccination program that begins as the previous school year ends

 

Group 2

• Conduct a community assessment
• Gain insurer collaboration to get a universal billing form
• Public Service Announcements to educate parents
• Early planning: present at registration, school board mtg, and PTA meetings
• Create a fine for not getting a flu vaccine
• Incentives- Mascot involvement (Truman, Fred Bird, etc)
• Conduct funding analysis to approach legislature to provide funding
• Get NEA involved
• Consider Storage needs.
• Require LPHAs to bill private insurers

 

Group 3

• Physically gather all players together
• Gain agreement from schools to have full access both during and after school hours
• Determine ability to even out vaccine distribution/availability
• Agree as a community to share vaccine
• Early planning by Jan of previous flu season to make plans with school board, school admin, parents and staff
• Exempt influenza vaccine from VFC and federally fund universal immunization or have a state mandate that creates universal flu vaccination funding
• Contract out the billing for flu
• Wrap the consent in with pre-screening
• Message to parents through the local media, news, and PSAs
• Gain support of community leaders- community communication is more effective than statewide messaging
• Utilize social network sites and text messaging

For more information visit www.teachflualesson.com.