In School Influenza Vaccination Decreases Absenteeism Presented by Carolyn Cook RN MSN MultiCare Health System

Project Overview Free Flumist Vaccine was offered to LHJ’s through the Washington State DOH in August 2007 Purpose was to collect data on acceptability of LAIV in children Tacoma Pierce County Health Department chose to use vaccine for school based clinics partnering with the Mary Bridge Mobile Immunization Clinic

Project Goals Introduce children and families to the benefits of annual influenza vaccination Deliver vaccine to a high-needs, low-resource population Track influenza-like illness and absenteeism in a highly vaccinated school population over the 2007-2008 influenza season Determine the utility of intranasal flu vaccine in a school-based clinic setting Gain an understanding of parent / child acceptance of the nasal spray vs. flu vaccination by injection

Choosing Schools Target schools had high percentage of free/reduced lunch and minority students because low income and minority children are underimmunized for influenza. The schools chosen had 95% free/reduced lunch Tillicum Elementary 279 students ages 3-12 Lakeview Elementary 390 students ages 3-12

Racial/Ethnic Breakdown Tillicum Elementary AI/AN 4.3% Asian/PI 5.7% Black 21.9% Hispanic 17.9% White 44.4% Economically Disadvantaged 90.9% Lakeview Elementary AI/AN 1.0% Asian/PI 18.7% Black 18.0% Hispanic 32.8% White 24.9% Economically Disadvantaged 88.7%

PROCESS Meet with school nurses, principals, and teachers to gain support Cover letter, screening forms and VIS’s in Spanish and English were sent home with each child Posters and fliers were placed at high traffic sites within the schools Forms were collected at school and passed on to the TPCHD All forms were screened and parents contacted if needed prior to clinic dates (children with contraindications to LAIV were offered TIV)

STAFFING/PROCEDURE Two HD nurses, the MBMIC nurse, a volunteer RN, and two senior baccalaureate nursing students gave the demonstrations and vaccines. All pre approved students in a classroom were brought to the vaccine site by two parent volunteers. Children were given a demo, then vaccine and returned to their classroom. The MBMIC nurse went to special needs classrooms and gave shots there. A form was sent home to the parent of each child documenting vaccines given and if they needed to return for a second dose. All doses were documented in Child Profile, the WA State vaccine registry.

Immunizations Provided Tillicum (initial clinic) 113 Tillicum (second clinic) 63 Tillicum (under 9 needing second dose) 56/75 Age breakdown 2 3-5 6 7-10 11-12 Clinic 1 1 28 15 61 6 Clinic 2 0 19 14 28 0

Immunizations Provided Lakeview (initial clinic) 133 Lakeview (second clinic) 82 Lakeview (children under 9 needing a 2nd dose) 58/76 Age Breakdown 3-5 6 7-10 11-12 Clinic 1 18 31 72 5 Clinic 2 8 21 45 2

Absenteeism Tracking Absenteeism data was collected weekly from November 2007 through May 2008 Data consisted of daily enrollment and absences Data was collected from intervention schools and six control school matched for demographics and population We tried to refine data to include only those absent with flu like symptoms but this was not feasible to collect

ANALYSIS/CONCLUSIONS Average daily absenteeism was placed on an Excel spreadsheet and intervention/control schools were compared Peak influenza season (01/07/08-03/14/08) data were analyzed using a paired t-test A total of 40 date pairs (only dates with complete data for all schools were used) were entered in SAS 9.1 The mean difference was -1.768% showing that the intervention schools had a lower rate of absenteeism A p-value of < .0001 demonstrates a statistically significant difference.

Remember, a positive difference means absenteeism was higher in the control schools than the intervention schools. CDC Sentinel Provider ILI Activity for the Pacific Region (Washington, Oregon, California, Alaska, Hawaii) http://www.cdc.gov/flu/weekly/regions2007-2008/data/senreg9t.htm

Lessons Learned You CAN do it. Look for your local resources and opportunities. Work with other enthusiastic people. Talk about your research and findings in your community- people may be more willing to hear information when the data is from the school down the street. Use what you have learned to promote projects in your communities.

Limitations The 2007-2008 influenza vaccine was a poor match for the circulating virus. We were unable to collect data on the cause of absenteeism. Absenteeism data was collected slightly differently between the two school districts. Influenza vaccination rates at the control schools was unavailable.

Future During the 2008-2009 influenza season we provided influenza vaccine in four schools (over 600 doses) and collected data from those schools and eight control schools. More schools in our county are open to (and some are requesting) influenza clinics in their schools. The ability to do school clinics quickly is dependent on a supply of LAIV which may not continue to be available.

PARTICIPANTS Denise Stinson RN MN TPCHD Jill Smith RN MN TPCHD Jim Marshall MPH TPCHD Rose Alexander PLU RN Student Heather Brook PLU RN Student The staff and students of Tillicum and Lakeview Elementary Schools