School-based H1N1 vaccination clinics at each K-12 school

The Rhode Island Department of Health held school-based H1N1 vaccination clinics at each of its K-12 schools for registered students throughout November 2009. A separate clinic was held for pre-registered students who reside in Rhode Island but attend school out of state. Clinics took place both during the day and in the evening.

An H1N1 Vaccine Information Statement, vaccine consent form, and accompanying letter were sent to parents in mid-October announcing a clinic. Children receiving vaccine were required to have a signed and dated consent form. An online schedule allowed parents to search for their child's school-based clinic by city, date, or school name. The school clinic schedule was developed using a randomized, computer-generated process.

Communications to medical providers, school staff and parents were routinely sent or posted online. Messages included situational updates, reminders, and warnings. Warnings addressed issues such as: only children who attend the school can receive vaccine; video and photographs are prohibited; a child with a fever of 100.4 F or higher cannot be vaccinated; clinic schedules could change due to vaccine availability; and children who miss the school clinic may have to wait months for vaccination. Superintendents or principals also contacted parents with details about their child's clinic.

School staff, parents and members of the Rhode Island Medical Reserve Corps (MRC) volunteered.

In the first 10 days of the 28-day H1N1 school-based vaccination program, 38,537 school-aged children had received the H1N1 vaccine. Approximately 76% of enrolled students received the vaccine in school clinics during that time.

Event organizers suggest colleagues consider the following:

DAYTIME CLINICS:

* Arrange for a substitute school nurse to handle routine student health issues separate from the clinic.

* Obtain the day's absenteeism list for the clinic registration table to prevent organizers from searching for absent students who returned consent forms in advance.

* Use stickers/stamps to identify students registered to receive vaccine.

* Keep emergency medical equipment out of sight of waiting students.

* Provide regular planning updates to event staff, including school staff answering parents' calls about clinic plans and policies.

* Recruit as many parent volunteers as possible.

* Identify a few staff members who are available to troubleshoot issues as they arise.


EVENING CLINICS:

* Stagger vaccinations by the child's last name (such as having children whose last names begin with the letters A though G get vaccinated between 4 and 5:30 p.m.).

* Arrange for adequate security in the registration and vaccine administration areas, as well as outside the school (where they may help address traffic flow).

* Have clear signage both outside and inside the school to direct parents to specific areas.

* Have enrollment rosters available at registration tables. Have sufficient staff to register students.

* Use sticker/stamps to identify students who are registered for their vaccinations to distinguish them from siblings or other children who do not attend the school.

* Shield children who are awaiting vaccination from children who are receiving their shots.

* Establish a separate area to vaccinate hysterical children.

* Finally, provide an activity to keep children occupied during their 15-minute observation periods.

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