1. “Stop Flu at School” Implementing a Statewide School-located Influenza Vaccination Program Hawaii Department of Health

2.  Prevent childhood illness  Indirectly decrease community transmission  ACIP Recommendations  Prepare for possible mass vaccinations of school children in the event of an influenza pandemic

3.  Planning/Proposal  Collaborating Partners  Logistics  Budget/Expenditures  Media/Communications

4.  Feasibility of providing choice of TIV or LAIV  3 elementary schools  Overall vaccination rate: 35%

5.  Grades K – 8  All Hawaii public and private schools invited to participate  Voluntary written consent of parent/guardian required  Offered TIV and LAIV  Two clinics held for schools with children aged less than 9 years in first year (2007- 08); only 1 clinic in subsequent years

6.  95% participation rate for all public and private K-8 schools  50% influenza vaccination uptake for Hawaii school children grades K-8 in participating schools

7. Formation of an Executive Advisory Committee Neighbor Island District Health Offices  Hawai`i Department of Education  Hawai`i Association of Independent Schools  Hawai`i Catholic Schools  Hawai`i Pacific University, School of Nursing  Kauai Community College, School of Nursing  Maui Community College, School of Nursing  University of Hawai`i at Manoa, School of Nursing  American Academy of Pediatrics – Hawai`i Chapter  American Academy of Family Physicians - Hawai`i Chapter  Hawai`i Medical Services Association  Hawai`i County Fire Department  Kaiser Foundation Health Plan  Kahu Malama  MedImmune, Inc.  Medical Reserve Corps – Oahu, Maui, Hawaii, and Kauai counties  Sanofi Pasteur  U.S. Military’s Joint Public Health Emergency Working Group  West Kauai Lions Club  Etc.

8.  School, student, and vaccine projections  Staffing projections  IT support  Budget analysis  Timelines  Printed materials and communications Feasible?

9. JanFebMarAprMayJunJulAugSepOctNovDecJan* Order Vaccines Staffing Arranged Consents Due/Review SchoolsScheduled Clinics Consents Sent SchoolsAsked Promotion *2007-08 only

10. Subsequent years Separate (color-coded) consent forms for LAIV and TIV 2007-2008 (Printed in triplicate)

11. 2007 (1 st year) 2008Vaccine$1,858,995$1,289,441 Staffing$266,345$233,884 Other † $782,134$311,911 TOTAL$2,907,474$1,835,236 * Note that expenditure figures for 2009 still being finalized. † Medical Supplies, Print Materials, Data Entry, Staff, Curriculum & Training, Public Relations, Courier, Promotion & Incentives

12.  Develop Public Service Announcements (PSA)  TV commercials  Radio spots  Newspaper advertisements  Flyers  Morning show interviews (TV and radio)  Governor’s announcement  Call centers  Public inquiries  Physician inquiries and reporting of adverse events  Translation services  Coordinate media events at school clinics

13. 200720082009* Participating Schools340/377 (90%)337/379 (89%)342/375 (91%) Student enrollment146,777142,603152,623 Students Vaccinated TIV38,23136,98144,188 LAIV24,92225,37526,581 TOTAL63,153 (43%)62,355 (43.7%)70,769 (46.4%) Total Faculty/Staff21,62521,10222,471 Faculty/Staff Vaccinated TIV8,31889889,400 LAIV988533648 TOTAL9,306 (43%)9,521 (45.1%)10,048 (44.7%) *Preliminary Data

14.  Consent Form  Separate TIV and LAIV  Simplify  2 nd dose clinics for children under age 9 years  45% of all clinics were 2 nd dose clinics  Diminishing returns  Staffing  Student nurses  Medical Reserve Corp  Contract nurses

15.  Established relationships with partners  Existing forms and procedures  Existing supplies  Staffing sources  Parental/community support

16.  H1N1 clinics followed seasonal clinics, beginning November 2009  Limited staff available to run additional clinics  Uncertainty regarding timing of availability of 2009 Influenza A H1N1 vaccine  Short lead-time  School furlough days

17.  School-based influenza vaccination clinics are feasible  Provide infrastructure for pandemic preparation  Require extensive planning  Close collaboration with partners, especially schools  Funding – constant challenge  Once established, public expectation (and support) for clinics to continue  Assessment of impact

18. Thank You www.stopfluatschool.com