1. School-located Vaccination (SLV) Clinics September 22, 2009

2. SLV Clinic Considerations Update on H1N1 status Defining a SLV Clinic Benefits/Challenges Leadership Roles Key Partners Planning Principles Multiple Models Human Resource Needs Clinic Lay-out and specifications Other considerations

3. Defining a SLV Clinic Vaccination that is: Administered on school grounds Targets enrolled students and potentially others Held before, during, and/or after school hours Typically involves collaboration between public health departments and public and private schools/school districts

4. Benefits of SLV Clinics Large numbers of children are found in schools Schools are conveniently located throughout communities Communities are generally familiar with and trust schools School facilities can generally accommodate mass vaccination clinics (e.g., the availability of gymnasiums and auditoriums, ample parking in some locations) School nurses, if present, may be available to assist in vaccination activities and may be familiar with the health of individual students

5. Benefits of SLV Clinics School staff have access to parental contact information, which could facilitate communications (e.g., for announcing clinic dates, obtaining parental consent for vaccination) Others prioritized for vaccination besides enrolled students may request vaccination at vaccination events

6. Challenges Clinics could disrupt educational activities Locating adequate staff to prepare for and conduct the clinic may be difficult Immunization activities may need to be tailored to each school or school district, complicating planning efforts Handling and transporting the vaccine to many and varied locations requires considerable planning, equipment, and training

7. Leadership Roles Local Health Department School District H1N1 Lead Designee Vaccine Administrator for H1N1 School site Administrator/Nurse

8. Other KEY Partners School-based Health Centers Institutional Education facilities serving incarcerated youth Private schools Parochial schools Home schooled children/parents

9. Planning Principles Novel H1N1 Flu Vaccination is voluntary and vaccines will only be administered following receipt of informed consent from the individual or their legal guardian. Children/staff at high risk of complications of H1N1 flu should be encouraged to access vaccine through available avenues in the community, as soon as it is available, as opposed to waiting for school-located clinics to be organized.

10. Planning Principles County school systems can assist in the identification of priority school populations to target within the planned strategies and consideration factors. Programming has been developed through WVEIS to assist public school systems in pulling existing system information needed to assist county vaccination planning teams in making these decisions. Please access this tool at https://wveis.k12.wv.us/nclb/private/nclbdata09/h1n1p. cfm?cn=099. https://wveis.k12.wv.us/nclb/private/nclbdata09/h1n1p. cfm?cn=099

11. Planning Principles Decisions about holding school-located vaccination efforts are local decisions. –It is assumed that every county will consider, in conjunction with their LHD, providing vaccine through the school setting; however, it is not assumed that such will be implemented in every county. –If a school-located program of vaccination is implemented in a county, it does not imply that a clinic must be held in every school/with every school community in a jurisdiction. Again, a variety of factors go into these decisions.

12. Planning Principles School-located vaccination programs will be undertaken in partnership with an existing healthcare sector partner familiar with administering pediatric immunizations. All health professionals who administer vaccines will be licensed to do so and experienced. Standard medical records will be maintained by the health provider assisting the school with vaccination. Although adverse events are expected to be rare, providers working with school settings to administer vaccine should be available to assist in management of any identified vaccine adverse events that arise.

13. Planning Principles Consideration may be given to including individuals other than students through school-located vaccine efforts (e.g., staff, parents, family members, etc.); however, expansions beyond students should not exceed vaccine target groups being promoted on a community wide basis at the time the school-located effort is being undertaken.

14. Multiple Models Use of the school as a communication channel – sharing information on flu and H1N1 vaccine, linking individuals in the school community to where vaccine is available in their community, promoting vaccine, etc. Working with a variety of community partners (LHD, primary care center, hospital, commercial vaccination provider, or others) to provide medical direction and staffing of vaccination clinics held specifically for the school population. Such clinics can be undertaken with a variety of community based partners.

15. Multiple Models In addition, there are a variety of models by which this can be done: –Holding a vaccination clinic during school hours with parents present. – Holding a vaccination clinic during school hours with parents sending an informed consent in advance. –Holding a vaccination clinic after school hours with parents present. –Working through a school based health center to provide ongoing vaccine services in the school setting. –Working with a local provider willing to accept school based referrals of children and staff at high risk of complications from influenza and supporting delivery of the same. –Combined strategies are also feasible in various school settings (e.g., an initial large scale clinic followed by provision of ongoing vaccines through the school based health center, etc.).

16. Identify Human Resource Needs (will vary with size of clinic) Screeners Greeters/educators Escort for students to and from the classroom Forms completion/ contraindication assessment staff Medical evaluator Vaccination assistants Vaccinators Data collectors Support staff Clinic flow controllers Security EMS Liability 1.PREP Act provides coverage for licensed professionals. 2.If working as volunteer with LHD, covered under LHD liability coverage. 3.Though likely 1 and 2 are sufficient/provide good coverage, could also utilize W.Va. Code §15-5-11 to provide immunity to volunteers during governmental request for response.

17. Clinic Layout and Specifications Considerations: Time of day for clinic and type of vaccination (intranasal and/or injection) Private area for over-clothed students to discreetly bare their arms and possible need to use other anatomical sites for smaller children with minimal deltoid (upper arm) muscle mass Safety issues if during school day especially if clinic is open to the community

18. Clinic Layout and Specifications Cont. Include contact information for pre and post clinic questions from students, staff and parents Onsite adverse reaction and comfort measures planned and communicated prior to clinic Onsite data entry into WVSIIS

19. Clinic Layout and Specifications Cont. Protocol of waiving vaccination for noncompliance or students who refuse without parent/guardian present Prioritizing the population…H1N1 tool located on NCLB Private Data site…prioritizes students with chronic medical conditions, 3 and 4 year old students and allowance for pregnant staff/student population per school

20. Other Considerations Developing Memorandum of understanding (MOU) between school and LHD/vaccine administrator to define roles and responsibilities, if needed. Role of school nurse On-site clinic coordinator Sending and reviewing vaccination consents in advance Knowledge of student medical diagnoses and specialized health care needs Vaccine administration (PREP Act, LHD volunteer & W.Va. Code §15-5-11 provides immunity as volunteer during governmental request for response)

21. Other Considerations Cont. Coverage of administration fee for uninsured population if using a private sector vaccine administrator Volunteers including school personnel, students (LPN/RN, HOS, vo-tech business, medical), retired staff, parents, community, etc.

22. Consents The CDC SLV Information and Planning Document has sample consents for SLV clinics Template consents located at http://www.cdc.gov/h1n1flu/vaccination/slv/wor d/h1n1-im-consent-form.doc and http://www.cdc.gov/h1n1flu/vaccination/slv/wor d/h1n1-combination-consent-form.doc http://www.cdc.gov/h1n1flu/vaccination/slv/wor d/h1n1-im-consent-form.doc http://www.cdc.gov/h1n1flu/vaccination/slv/wor d/h1n1-combination-consent-form.doc

23. RESOURCES CDC School-Located Vaccination Planning Materials and Templates at http://www.cdc.gov/h1n1flu/vaccination/slv/ http://www.cdc.gov/h1n1flu/vaccination/slv/ Guidance for School-located H1N1 Vaccination Planning at http://wvde.state.wv.us/osshp/main/documents/GuidanceforSchool- locatedH1N1VaccinationPlanning.pdf West Virginia Department of Health and Human Resources at http://www.wvidep.org/Home/HotTopicSwineInfluenza/tabid/1856/Default. aspx http://www.wvidep.org/Home/HotTopicSwineInfluenza/tabid/1856/Default. aspx West Virginia Department of Education-Office of Healthy Schools website http://wvde.state.wv.us/osshp/main/PandemicFlu.htmlhttp://wvde.state.wv.us/osshp/main/PandemicFlu.html

24. Contact Information Office of Threat Preparedness (304)558-3600 WVDE – Office of Healthy Schools (304)558-8830 mpurkey@access.k12.wv.usmpurkey@access.k12.wv.us or rjking@access.k12.wv.usrjking@access.k12.wv.us