Story from the Field

Process of School-located Clinics:We send a packet home to each child with four items: a Dear parent letter?(http://www.cdc.gov/h1n1flu/vaccination/slv/ltr-parents-clinics.htm) based on the CDC template from the health officer (myself) and the school superintendent, vaccine info sheets for both types (http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-inact-h1n1.pdf, http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-laiv-h1n1.pdf), and a consent form. We are using the standard CDC consent form for both vaccines (http://www.cdc.gov/h1n1flu/vaccination/slv/word/h1n1-combination-consent-form.doc). We've added a #7 to section 2B to provide an option for type of vaccine with disclaimer for availability and eligibility. On the evening that the forms go home with the child, the parents are notified through an automated phone call known as the WARN (Wide Area Rapid Notification) system to make them aware that the child is coming home with the packet. Parents are directed to review, sign, and return the consent form in the next three days, otherwise there is follow up. A second automated phone call is made the night prior notifying the parents that their child will be receiving their vaccination the next day. The school nurses are responsible for reviewing the consent forms and conducting medical screenings prior to the clinic day, including contacting parents if needed. On the day of the clinic, parent volunteers guide the children from classroom to vaccination area and then to recovery area and assist with maintaining children in line. For the younger children, we place name tags on them to identify them, as well as a colored sticker (dot on name tag) that identifies those that are going to be getting the LAIV vs. the inactivated vaccine. We separate them into two lines based on these criteria as well. This has significantly increased the efficiency at the clinics. Parents are allowed to bring other young siblings as well as themselves if they are pregnant and school staff oversees this process.

Roles: One of the most important aspects of school clinics was to determine the delegation of roles and responsibilities of each agency. Once this was decided, it was much easier to plan and assign roles and train staff and volunteers. This includes the school nurses, as well as health department staff. Training: There was very short time to train school nurses and volunteers. We accomplished this by meeting with all of the school nursing staff and providing training so that they could take responsibility for medical screening. We also developed a training DVD for vaccinators, which we will be submitting to the NACCHO toolkit.

Flow of clinics: Keeping a steady flow of kids to vaccinate becomes a challenge with different reasons at each school. We've seen that it's important to have some person pay attention and maybe delegated just for this purpose and to rectify problems as soon as they arise. Nutrition and Rest: This was important for both for the staff as well as for children in observation area for 15 minutes after being vaccinated. We worked around this by calling each school ahead of time to make sure the cafeteria would be providing lunch for the staff as well as snacks. Also working around lunchtime at schools needs to be pre-planned.

Daycares: We had initially planned to spend certain evenings at schools to take care of daycares but the numbers weren't worth the daily stays. We ended up accepting daycares and home-school children into separate Saturday clinics that we hold at high schools around the county.

Issue of unknown pregnancy in teenagers: This has probably been one of the most contentious issues in the team process between us and the schools officials. Initially school officials preferred that either all adolescent girls get the inactivated vaccine or all high school and middle school students get the inactivated vaccine, in which case LAIV would have been wasted. We knew there would be some backfire in the community for doing this. We negotiated with the school personnel to avoid tampering with consent forms. The plan we have today in place is that all high school children will be getting the inactivated vaccine. The middle schools will be going ahead as planned.

We were deliberate in mixing public and private schools, as well as city and county schools. School staff will be vaccinated by school nurses. The health department staff will be entering all data into WVSIIS.

We've also come across some legal issues. We've received some FOIA (Freedom of Information) requests asking us for documentation why we've scheduled a certain school and not other schools. It was very important that we had delegated responsibilities and we were able to defer those questions to school officials saying that school officials were the ones that decided and we basically followed their lead as to which school went first, second, and so on.

Lastly, the venue for the second vaccine dose for 9 and under, while yet to be decided, we are thinking about having a rapid action team going into each school and taking care of that.

H1N1 Parent/Guardian Letters and Consent Forms for School-located Vaccination http://www.naccho.org/toolbox/tool.cfm?id=1867

H1N1 Volunteer Training--Vaccine Safety PowerPoint
http://www.naccho.org/toolbox/tool.cfm?id=1866