School-Located Influenza Vaccination Toolkit
The flu is a contagious illness caused by the influenza virus. The best way to prevent the flu is by getting a flu vaccine each year. For children, the flu is more dangerous than the common cold and can lead to serious health complications as well as school absenteeism, which can result in reduced learning outcomes for those children affected. Annual influenza immunization is recommended for all individuals six months of age and older.

Multiple approaches, including school-located influenza vaccination (SLIV) programs, are necessary to ensure adequate influenza vaccination coverage among this expanded population.
Local health departments lead the efforts for organizing and implementing
SLIV programs. NACCHO supports these efforts and has compiled the following toolkit to provide background information on school-located influenza vaccination and assist LHDs. Visit NACCHO's Influenza webpage for more information about flu.
Due to COVID-19, community mitigation practices and social distancing are recommended. For more information regarding influenza vaccination in the time of COVID, please click the CDC button above.
SLIV programs can immunize large numbers of children, as well as teachers and school staff, in a short time period. SLIV programs can vaccinate with either the live or inactivated influenza vaccine (4). Private medical sectors as well as public health clinics have limited capacity and often are unable to vaccinate the expanded population to the degree that SLIV programs are. Some advantages of school-located vaccination are:
- Increased number of vaccinated children;
- Improved efficiency and cost-saving from a public health perspective;
- Increased access to students who are from minority groups, are economically disadvantaged, and/or are from families whose primary language is not English;
- Reduced absenteeism, for both vaccinated and unvaccinated students, and;
- Reduced absenteeism for staff and teachers.
The School-Located Influenza Vaccination Toolkit is a comprehensive collection of information, best practices, and lessons learned from health departments, as well as federal and national partners, working with schools to conduct school-located influenza vaccination (SLIV) clinics.
The resources included in this toolkit are organized in chapters by topic area: Planning, Relationships & Communications, Educational Materials, Implementation, and Evaluation. These chapters can be used as a part of the toolkit as a whole, or independently as needed. Most of the items listed in the individual chapters contain linked resources and other information to be considered during each of the stages of school-located influenza vaccination clinic planning, implementation, and evaluation.
LHDs can use this dynamic repository to build their own school-located influenza vaccination programs, connect with colleagues, and share what works and what does not. The toolkit does not have all the answers, and as more programs are conducted, we anticipate that it will continue to expand.
This SLIV toolkit is a "living" document that includes background literature, reference documents, and general immunization programs that are easily adapted to school-located influenza vaccination programs. Also included are checklists, work plans, consent forms, letters to parents, and assessment/evaluation tools. However, additional resources can be added at any time. If you have resources that would benefit the SLIV toolkit, please e-mail [email protected].
This section includes tools, information, and checklists necessary to plan a school-located influenza vaccination clinic including best practices, how to staff, how to fund, and how to supply.
Logistics—checklists and general information for successfully planning school-located vaccination clinics
- Influenza School-Located Vaccination (SLV): Information for Planners (CDC)
- Best Practices Checklist (National Adult and Influenza Immunization Summit)
- Immunization Event Planning Checklist (Immunity Community)
- Policy for School-located Influenza Vaccination Clinics (Alabama Department of Public Health)
- School-Located Vaccine Clinic (SLVC) Planning & Supply Guidelines (Maine Center for Disease Control and Prevention)
- Viability Issues
Timeline—examples of timelines and checklists for planning SLIV clinics
- School Nurse Six Month Planning Tool
- General Timeline
- Stop Flu at School Program Timeline (Hawaii)
- Timeline and Responsibilities (Sacramento County, CA)
Funding and Budgeting—sample budgets and general funding information for SLIV clinics
- Experiences In Billing and Reimbursement for School-Located Influenza Vaccination (2011 National Immunization Conf.)
- Funding the Clinic (see pp. 17-22)
- Stop Flu at School Program 2008-2009 Budget (Hawaii)
- Immunize Kansas Kids Costs (see pp. 12-18)
- Sample Cost Distribution of SLV Programs
Staffing—how to staff the clinic including utilizing volunteers
- Job Action Sheets (Immunity Community)
- Flu Clinic Process Information 2009 (Sacramento County – Department of Health and Human Services)
- School Flu Clinics Staffing Roster
- Staffing Grid
- Influenza Vaccinations for Healthcare Personnel Policy Statement (NACCHO)
- Letter to Gain Volunteers (Knox County)
- Volunteer Packet (Immunity Community)
Interpretation Services—resources to support communication with diverse language populations
Training—useful information for administering vaccines
- Administering IM and NAS
- Administration of Biological Products (Yukon Immunization Program)
- IAC Skills Checklist for Immunization
- Influenza Immunization Training Course (CDC)
- Vaccine Administration Resource Library
Supplies— how to select, store, and handle vaccines
- 2020 Vaccine Storage and Handling Toolkit (CDC)
- IAC Checklist for Supplies
- Supply Checklist for School-Located Influenza Vaccination Clinic (Knox County Health Department)
- Vaccine Selection
- School Staff - Guidance for Adult Vaccinations
Incident Management and Command—Overview of Incident Management System (IMS)/Incident Command System (ICS) and outlines of the various positions within the system.
- IMS
- ICS Chief Logistics
- ICS Chief Operations
- ICS Chief Finance
- ICS Incident Commander
- ICS Public Information
Options for Follow-up Clinics and Second Doses
- When is a Second Dose Needed
- Second Dose Postcard (Knox County Health Department)
- Letter to Parents for Children Requiring a Second Dose of Influenza Vaccine (Word document - will download to browser)
- Pandemic Vaccine Program
Information, letters, and other communications necessary to build important relationships with those connected to school-located immunization clinics, including school staff, parents, and other potential partners.
Partner Overview
Influenza Partner Organizations
Tools for Teachers, Principals, and Students
- General Info for Schools (Knox County Health Department 2008)
- How Schools Work and How to Work With Schools (National Association of State Boards of Education)
- Letter to School Principals (East Baton Rouge Parish School System/Health Care Centers in Schools)
- Letter to School Principals (Knox County Health Department)
- Master Cover Letter to Teachers (Sacramento County – Department of Health and Human Services)
- Talking Points for Working with Schools
- Working with Students as Marketers
Tools to Involve and Notify Parents and Parent Groups
- Communication Ideas for Parents
- 2008 FluMist Letter to Parents (Knox County Health Department)
- Flu Letter to Parents 2008 (Sacramento County – Department of Health and Human Services)
- Form Used to Notify Parent of Non-Vaccination (Knox County Health Department)
- Influenza Vaccination Informational Letter to Parents — Spanish (Anne Arundel County Health Department)
- Letter to Parents (Knox County Health Department)
- Letter to Parents Explaining Voluntary School-Based Influenza Vaccination Program (East Baton Rouge Parish School System/Health Care Centers in Schools)
- Letter to Parents for Children Requiring a Second Dose of Influenza Vaccine (Sacramento County – Department of Health and Human Services)
- Parent Packet (Garrett County Health Department)
- Template Letter to Parents/Guardians (CDC)
- Unable to Vaccinate Card template (Sacramento County Department of Health and Human Services)
- Unable to Vaccinate Letter template (Anne Arundel County Health Department)
Tools to Involve Providers
Tools to Involve Community Organizations
- Letter to School Groups (Knox County Health Department)
- Talking Points for Community Organizations and Coalitions
Flyers
- Keep Our School Healthy Flyer (California Department of Health)
- Nasal Influenza Vaccination Clinic Flyer (Anne Arundel County Department of Health)
- Stop Disease Flyer (California Department of Health)
Factsheets, FAQs, and information statements that may be used to educate parents, school groups, students, or other partners.
- Education Process
- FluMist FAQs
- Key Reasons to Get Vaccinated (CDC)
- Let's Fight the Flu Together (National Parent-Teacher Association)
- Making the Vaccine Decision: Addressing Common Concerns (CDC)
- Top 3 Reasons – English (HHS/CDC)
- Top 3 Reasons – Spanish (HHS/CDC)
- Vaccine Key Facts (CDC)
- Vaccine Information Statement, Inactivated (CDC)
- Vaccine Information Sheet, Inactivated —Spanish (IAC)
- Vaccine Information Statement, Live (CDC)
- Vaccine Information Sheet, Live—Spanish (IAC)
Information necessary for the day of implementation of school-located influenza immunizations
- Logistics
- Instructions for School Flu Clinics
- Day of Event Checklist (Immunity Community)
- Emergency Management
- Medical Management of Vaccine Reaction in Adults (Immunization Action Coalition)
- Medical Management of Vaccine Reaction in Children and Adolescents (Immunization Action Coalition)
- Managing Vaccines Onsite
- Cooler/Freezer Temperature Log and Wasted Vaccine Log (Immunity Community)
- Temperature Log
- See “Supplies” section under the Planning tab for more information on vaccine storage and handling
- Cooler/Freezer Temperature Log and Wasted Vaccine Log (Immunity Community)
- Physician Orders
- Standing Orders for Administering Vaccines to Adults (Immunization Action Coalition)
- Standing Orders for Administering Vaccines to Children and Adolescents (Immunization Action Coalition)
Information needed for steps to take after the completion of school-located influenza immunizations
- After Action Report
- Post Event Checklist
- 2010-2011 H1N1 Final After Action Report (Texas Department of State Health Services)
- 2009 H1N1 After Action Report (Maine Center for Disease Control and Prevention)
- Sample After Action Report Format (Immunity Community)
- Standard Format for After Action Report Development (CDC/Homeland Security Exercise and Evaluation Program)
- Feedback
- School Feedback Form for LHD (Sacramento County – Department of Health and Human Services)
- Feedback Form for Nurses Participating in School-Located Influenza Immunization Clinics (New Mexico Department of Health)
- Template for Public Feedback and Evaluation Form (Immunity Community)
- Template for Offsite Clinic Staff and Volunteer Evaluation (Immunity Community)
- Documenting Vaccination Rates
- Sample Documentation of Vaccination Results (Knox County Health Department)
- Tracking Costs
- For more information, see “Funding and Budgeting” in the Planning tab of the toolkit
Below are templates and examples of consent forms for SLIV programs:
- Ideas for Increasing Return on Consent Forms
- Anne Arundel County Department of Health FluMist® Program Consent Form
- Anne Arundel County Department of Health FluMist Program Consent Form – Spanish
- CDC Template for Annual Influenza Vaccine Consent Form-FLU SHOT
- CDC Template for Annual Influenza Vaccine Consent Form-NASAL SPRAY
- CDC Template for Annual Influenza Vaccine Consent Form-FLU SHOT and NASAL SPRAY
- East Baton Rouge Parish School System/Healthcare Centers in Schools FluMist Consent Form
- Kanawa-Charleston H1N1 Consent Form
- Knox County Consent Form
- New Mexico Consent Form
- Sacramento County Consent Form
- Sacramento County Consent Form – Spanish
- South Dakota Consent Form
- State of Hawaii Consent Form Packet
- State of Hawaii Consent Form Packet— Spanish
- State of Hawaii Consent Form Packet— Chinese
- State of Hawaii Consent Form Packet— Tagalog
- State of Hawaii Consent Form Packet— Korean
- Tooele County Consent Form
- Tooele County Consent Form — Spanish
- 2011 Stop Flu at School Summary Report (Hawaii State Department of Health)
- 2016-2017 School-Based Flu Vaccination Program Report (Columbia/Boone County Department of Public Health and Human Services)
- 2019–2020 Influenza Season Vaccine Label Examples (CDC)
- Feasibility of a School-Based Influenza Vaccination Program in Kansas (Immunize Kansas Kids)
- How to Maintain a Successful Flu Vaccination Program (Medical Economics)
- Immunization Program Manual (Yukon Government Department of Health and Social Services)
- Immunization Manual (British Columbia Centre for Disease Control)
- Influenza Implementation Guidance (American Academy of Pediatrics)
- Mass Vaccination Clinics(Wisconsin Department of Health)
- Pandemic Flu Action Kit (New York State Department of Health)
- Process Evaluation of an Intervention to Increase Provision of Adolescent Vaccines at School Health Centers (Golden et. al. Health Education & Behavior 2014)
- Recommendations for Mass Immunization Events During Pandemic Conditions (DoD/Military Health System)
- Resources for Hosting a Vaccination Clinic (CDC)
- School-located Vaccination Position Statement (National Association of School Nurses)
- ''The Flu Project'' Pilot Presentation Delivered at the 2009 NACCHO Annual Conference (Health Care Centers in Schools)
- Tools to Assist Satellite, Temporary, and Off-Site Vaccination Clinics (National Adult and Influenza Immunization Summit)
- Effler, P., Chu, C., He, H., Gaynor, K., Sakamoto, S., & Nagao, M. et al. (2010). Statewide School-located Influenza Vaccination Program for Children 5–13 Years of Age, Hawaii, USA. Emerging Infectious Diseases, 16(2), 244-250. doi: 10.3201/eid1602.091375
- Hull, H., & Ambrose, C. (2011). Current experience with school-located influenza vaccination programs in the United States. Human Vaccines, 7(2), 153-160. doi: 10.4161/hv.7.2.13668
- Szilagyi, P., Schaffer, S., Rand, C., Vincelli, P., Eagan, A., & Goldstein, N. et al. (2016). School-Located Influenza Vaccinations: A Randomized Trial. Pediatrics, 138(5), e20161746. doi: 10.1542/peds.2016-1746
- Additional Articles
- Flu Prevention Toolkit for Schools and Childcare Centers (County of Los Angeles Public Health)
- Guide to Human Papillomavirus (HPV) Resources for Local Health Departments (NACCHO)
- Keep Flu Out of School E-ToolKit (NASN)
- Mobile Immunizations Toolkit (Immunity Community)
- Model Practice Awards Database (NACCHO)
- Opioid Overdose Epidemic Toolkit for Local Health Departments (NACCHO)
- Pandemic Model Plan (Adapted from Tacoma-Pierce County Health Department)
- Pandemic Toolkit (Adapted from Tacoma-Pierce County Health Department)
- Stories from the Field Database (NACCHO)
- The Local Health Department Department Guide for Hosting a Mass Vaccination Clinic (Indiana State Department of Health)
Community Health Program
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