Seasonal influenza vaccine opportunities for schools

INFORMATIONAL LETTER: 107
POLICY CODE: JLCB

TO: Superintendents of Schools, Private Schools, Special Purpose Private Schools, and School Nurses
FROM: Commissioner Susan A. Gendron, Department of Education and Dora Anne Mills, MD MPH, Director, Maine CDC/DHHS
DATE: June 8, 2009
RE: Seasonal influenza vaccine opportunities for schools

SUMMARY: The purpose of this letter is to provide you with information on an opportunity for schools to offer seasonal influenza vaccine this fall to their students.

There are two overarching reasons why Maine DOE and Maine CDC are teaming up to provide this opportunity:

The U.S. CDC now recommends that all children, 6 months through 18 years of age, receive annual vaccination against seasonal influenza. There are several reasons for this recommendation, including:

Children are increasingly recognized at higher risk for complications from influenza than previously thought;
School-aged children have the highest rates of infection with seasonal influenza; and
School-aged children are the major transmitters of influenza in a community, including to those at higher risk for complications.

In many communities it will be very challenging for all children to be vaccinated at their local health care provider offices this fall, and many retail vaccine clinics (such as supermarkets and pharmacies) do not vaccinate either minors or elementary school-aged children.

Additionally, H1N1 at this point in time appears to be affecting children and young adults disproportionately. Although seasonal influenza vaccine will not protect specifically against H1N1, it will help improve the overall health of a child during this coming influenza season when both seasonal and H1N1 influenza strains may be circulating. We also anticipate a vaccine against H1N1 may be available later in the year.

As a result of these two major factors, we expect there will be an increase in the number of parents who will want their children vaccinated against seasonal influenza. Therefore, with some federal American Recovery and Reinvestment Act funds (“Stimulus Funds”) the Maine CDC in the Department of Health and Human Services (DHHS), in partnership with the Maine Department of Education (DOE), is offering seasonal influenza vaccine for interested school districts for use in the fall of 2009.

We believe this is an opportunity for schools to work with local health care providers to assure a healthier school environment, especially during what could be a challenging influenza season with two strains of virus circulating. To facilitate those contacts, Maine CDC is also reaching out to local health care providers to make them aware of this opportunity.

Thank you ahead of time for your consideration. We believe the vigilance of our schools and your leadership in addressing H1N1 is at least partially responsible for Maine’s lower rate of infection than our neighboring states. This opportunity to bring seasonal influenza to students is another strategy in an ongoing comprehensive approach to address H1N1 as well as the overall health of our schools and communities during influenza season.

Questions:

What can Maine CDC provide?

Influenza vaccine to the requesting school or school district. (In order to maintain the required cold temperature for the vaccine, it would have to be delivered to a Maine CDC Immunization Program local vaccine provider.);
Educational materials for students and parents as well as parental permission forms;
Funds to purchase materials such as gauzes, band-aid strips, alcohol pads, gloves, disposal boxes, and epinephrine;
Standing order for school nurses to vaccinate students;
Any necessary training for staff;
Assistance from Maine CDC’s Public Health Nurses, as their resources permit.

What do interested schools need to provide? Schools, either alone or in conjunction with local health care providers would have to ensure:

An existing Maine CDC Immunization Program vaccine provider, or someone who is able to become an Immunization Program vaccine provider, has adequate space to receive and store vaccine shipments;
The ability to maintain cold chain (recommended storage temperatures) during transportation of the vaccine and at the site of the clinic;
Adequate nursing staff to administer vaccine at the school/school district;
Sites to dispose sharps and biohazards during and after the clinics.

School physician presence at the vaccinating site would be very helpful, but not a necessary requirement. This presence could assure medical questions or issues of concern could be addressed.

What timelines are expected? Since Maine CDC needs to order vaccine very soon, we need to know if a school will be participating before June 30th. If a school district or school decides to move forward with this, please notify Nancy Dube, School Nurse Consultant, for Maine Department of Education and she will inform Maine CDC. Include names of the schools and total number of students in the schools.

We also strongly encourage school-based vaccine clinics to be held as early as possible after vaccine is available, such as in September or October. Part of the reason is because H1N1 vaccine may be available by mid-late fall, so it may be easiest on the school and health care system to offer these sequentially, with some time in between.

Will the vaccine be thimerosal-free? Yes.

Who else can be vaccinated at these clinics? Schools and their participating community partners have the option of offering this seasonal influenza vaccine to other children in the community, such as preschool children, home-schooled children, and students from other schools. Since the vaccine provided will be a pediatric (thimerosal-free) and therefore more expensive vaccine than adult seasonal influenza vaccine, we ask that this state-supplied vaccine be limited to the pediatric population. We can provide materials on where adults can locate clinics. If non-school district children will be offered vaccine, then this should be incorporated into the estimates of needed vaccine.

If a school district is interested, what is the next step? We recommend a school district reach out to local health care providers such as hospitals, health care practices, health centers or local public health departments, in order to assure adequate capacity for putting on such vaccine clinics. Then, if the interest and commitment is present, please contact Nancy Dube at 624-6688 or nancy.dube@maine.gov before June 30th. There is a memorandum of understanding that will need to be signed by the superintendent along with some estimates of vaccine need. These forms will be provided once the department has been contacted.

How do we become a Maine Immunization Program vaccine provider? Please check the following link for the forms and information to become a Maine Immunization Program vaccine provider: www.maine.gov/dhhs/boh/mip/materials.html .
Note that a new provider should submit two weeks’ refrigerator and freezer temperature logs for validation before vaccine will be shipped to the site. If you are using a new vaccine provider, please leave at least a two-week time window for the requirements to be met.

Where can we learn more about school-based vaccination clinics?
U.S. CDC March 2009 Power Point on school-based influenza vaccine clinics can be viewed at:
www.ct.gov/dph/lib/dph/infectiousdiseases/immunization/pdf/schoolfluclinicmarch2009vogtslides.pdf . This recent presentation reviews the experiences in three areas of the country that conducted school-based influenza vaccine clinics in the fall of 2008.

Ransom, J. (2009). School-Located Influenza Vaccination Clinics: Local Health Department Perspectives. The Journal of School Nursing 25: 13S-17S. You will need a subscription to view the full article, however, school nurses, who are members of the National Association of School Nurses, have free access to this article.

US CDC Large Scale Vaccine Clinic Guidelines www.cdc.gov/flu/professionals/vaccination/vaxclinic.htm

Will H1N1 vaccine be offered to schools as well? We anticipate very likely reaching out to schools for H1N1 vaccine, but, at this point in time, specific plans with U.S. CDC are in very early stages.

Will seasonal influenza vaccine be offered to schools in future years? This depends on the availability of resources.

Can parents bring their children to their doctor’s offices for seasonal influenza vaccine even if it is offered through the schools? Over the past several years, Maine CDC has supplied some free seasonal influenza vaccine to health care providers. We will continue to provide this vaccine; however, local health care providers need to decide how many children they can vaccinate through their offices.

For further information, contact Nancy Dube, School Nurse Consultant, Department of Education (and Maine CDC) at 624-6688 or nancy.dube@maine.gov .