A Retrospective Review of

New Mexico’s School Kids Influenza Immunization Project

(SKIIP) Rebecca Trujillo, MSN, BSN, RN

School Health Advocate

New Mexico Department of Health

Objectives

• Identify history of vaccination clinics

• Understand the health burden of Influenza

• Identify history of New Mexico’s SKIIP

• Understand and list challenges and successes

• Describe implications for Public Health Nurses and School Nurses

Review of Public Health Systems

• 30 percent of states (n=14) have a centralized or largely centralized governance

• Centralized states have an average of 28 state-run local health departments (ASTHO,2012)

• New Mexico Centralized Public Health

• 4 Public Health Regions

• 54 Public Health Offices

• 33 counties (NMDOH, n.d.)

New Mexico at a Glance Turquoise Northwest Region Purple Northeast Region Green Southeast Region Pink Southwest Region (NMDOH,2014)

History of School Located Vaccination Clinics

• 1855 - Massachusetts passed first compulsory rule

• 1860 - NY gave authority for children to be excluded

• 1875 - NY vaccinated 17,505 children with small pox

• 1901 - NM passed mandatory small pox vaccinations for children

• 1955 - 15,000 public schools in 44 states were vaccinating for Polio

• 1960 - Sabin oral vaccine used school buildings for adults & children

• 1960-1970 - measles outbreaks forces mass vaccination in the US

• 1979 - 50 states were enforcing school immunization laws (Mazyck, 2010)

Influenza Pandemic 1918-1919

• Spanish Flu (La Gripe) 1918

• Worst acute viral killer in history?

• It hopscotched across the world effecting one fifth of the worlds population est.

• All public gatherings were canceled (Unseen Enemies, 2013)

• Highest mortality rate among 20-40 year olds

• Infected 28% of all Americans

• An estimated 675,000 Americans died

• Effect so severe decreased average life span in US by 10yrs. (Stanford University n.d.)

Emergency Hospital during 1918 pandemic

(Stanford University n.d.)

Popular School Rhythm 1918

“I had a l bird, Its name was Enza I opened the window, And in flu-enza”

(NMDOH,n.d.)

Review of US Current Influenza History

Cost of influenza- hospitalization & ED

• 3 influenza season

• Children <5

• Lab confirmed

• Average direct hospitalization $5402 = $44-163 million

• average ED visit $512 = $62-$279 million (Fairbrother et al, 2010)

Average hospitalization & deaths

• Approximately 200,000 yearly Hospitalizations

• 36,000 deaths associated each year in US (Williams et all, 2012)

History of Influenza Recommendations

•2007-2008 ACIP recommendations expanded

(CDC, 2007)

•2008 -2009 Drastic change in ACIP

recommendations (CDC,2008)

•2009 -2010 New recommendations put into effect

Pilot Project-School Influenza Pilot Project (SIPP)

• New recommendation for all children to receive influenza vaccine (CDC,2008)

• Brainchild of Dr. Lance Chilton to give vaccine in schools (Pentler, 2015)

• 2008-2009 SIPP: School Influenza Pilot Project

• 76 schools in 11 counties

• ~11,000 children immunized

• Averaged 35%

• ~75% LAIV, 25% injectible

• 30,000 doses allocated from DOH (June, 2011)

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2008-2009 (June,2011)

2nd Year – School Influenza Immunization Project 2009-2010

(SIIP) • 2009-2010 SIIP: School Influenza Immunization Project

• 145 schools in 40 cities 18 counties

• ~55,000 children immunized

• Averaged 45%

• 75% LAIV, 25% injectible

• Vaccine ordered based on returned consents

• 60,000 doses allocated from DOH

• Received La Tierra Sagrada Society grant

• H1 N1 happened (June, 2011)

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2009-2010 (June, 2011)

3rd Year – 2010-2011 SIIP

• 2010-2011 SIIP: School Influenza Immunization Project

• 312 schools in 59 cities in 25 counties (June, 2011)

• 40,000 children immunized (NMIC, 2014)

• Averaged 35%

• Only offered FluMist

• Vaccine ordered on flat 45% estimate

• 60,000 doses allocated from DOH

• Graduated VFC schools ordered on their own (June, 2011)

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2010-2011 (June, 2011)

2011-2012 - 4th Yr. School Kids Influenza Immunization Project

(SKIIP)

• 2011-2012 SKIIP: School Kids Influenza Immunization Project

• 300 schools in 59 cities, 25 counties

• 60,000 doses provided by NMDOH/VFC

• Orders will be placed based on 35% estimate

• Schools can choose to offer only FluMist or both

• Approximately 38,600 doses administered (June,2011)

2012-2013 – 5th Year SKIIP

• 2012-2013 SKIIP: School Kids Influenza Immunization Project

• 350 schools in 59 cities, 25 counties

• 60,000 doses allocated by NMDOH/VFC

• Orders figured on 30% estimate

• Schools can choose to offer only FluMist or both

• Approximately 44,050 administered (NMIC, 2014)

2013-2014 – 6th Year SKIIP

• 2013-2014 SKIIP: School Kids Influenza Immunization Project

• 450 schools in 59 cities, 25 counties

• 60,000 doses allocated by NMDOH/VFC

• Orders figured on 30% estimate

• Schools can choose to offer only FluMist or both

• Approximately 52,000 administered (NMIC, 2014)

2014-2015 – Current Year (7th) SKIIP

• 2014-2015 SKIIP: School Kids Influenza Immunization Project

• SKIIP training a requirement

• 480 schools in 59 cities, 25 counties

• 60,000 doses allocated by NMDOH/VFC

• Orders figured on 30% estimate

• Schools can choose to offer only FluMist or both Final totals not available. (NMIC, 2014)

• Current estimate of 48,000 (Pentler, 2015)

2014-2015 (NMIC, 2014)

Year 2008 2009 2010 2011 2012 2013 2014

No. of Schools 76 145 300 ~300 350 450 480

No. Doses Administered

11,000

55,000

40,000

38,600

44,050

52,000

??

(NMIC, 2014)

Lessons Learned Challenges

• Program grew so fast – training needed

• Consent printing costly for school districts

• Distribution of forms to all districts • Manpower an issue – think outside

the box • Making sure vaccine isn’t wasted • Waiting on CDC to issue Influenza VIS

(June, 2013) • Resistance from some PHN • Resistance from some school nurses • Med error reporting (Pentler, 2015)

Successes

• School participation increase 53%

• Vaccine usage increased by 70%

• 2014 NM received award 60% influenza coverage children (Pentler, 2015)

• PHN getting on board

• SN getting on board

• Valuable partnerships

• Emergency preparedness

• Decrease influenza in communities

• Schools becoming VFC providers

Relationships Developed

• Public Health Nurses

• Public Health Immunization Program

• School Nurses

• School Staff

• Parent volunteers

• NMIC

• NM Schools of Nursing

• NM Schools of Pharmacology

• NM Medical Reserve Corps (June, 2013)

SKIIP Implications for School Nurses

• Infection control measures which affects population health

• School aged children are disproportionately affected by influenza

• Research indicates school located influenza clinics decrease absenteeism School funding may be dependent on average daily attendance

• Role of school nurse changing to role of immunization provider (Keck, 2013)

• School nurses vital role in reducing health-related barriers to learning and promoting healthy school environments

• School nurses actively involved in public health functions (Wilson, 2013)

SKIIP Implications for Public Health Nurses

• Infection control measures which affects population health

• Public health efforts are to reduce morbidity and mortality due to infectious disease

• Public Nurses routinely interact with schools to provide compensatory vaccinations (Wilson, 2013)

References Association of State and Territorial Health Officials. (2012). ASTHO Profile of state public health, volume 3.

CDC. (2007, July 13). Prevention and Control of Influenza. MMWR Recommendations and Reports, 56 (RR06), pp. 1-54.

CDC. (2008, July 17). Prevention and Control of Influenza. MMWR Recommendations and Reports, 57 (Early Release), pp. 1-60.

CDC. (2013, February). Advisory Committee on Immunization Practices (ACIP). Retrieved from Centers for Disease Control and Prevention:

http://www.cdc.gov/vaccines/acip/about.html

Fairbrother, G. C.-S. (12 July 2010). High costs of influenza: Direct medical costs of influenza disease in young children. Vaccine, 4913-4919.

June, M. &. (August, 2011). SKIIP 2011-2012. UNM. Albuquerque: New Mexico Immunization Coalition. Retrieved March 15, 2015

June, M. (2013). Executive Summary, School Kids Influenza Immunization Project (SKIIP) 2013. NMIC.

Keck, P. (2013). School-located influenza vaccination and absenteeism among elementary school students in a Hispanic community. The

Journal of School Nursing, 29(4) 271-283.

References Cont. Mazyck, D. (2010, August). School-located vaccination clinics: Then and now. Journal of School Nursing, 26, 3s-6s.

doi:10,1177/1059840510369231

New Mexico Department of Health. (n.d.). New Mexico Department Health. Retrieved from New Mexico Department Health:

http://nmhealth.org/

New Mexico Immunization Coalition. (2014). Update on SKIIP: School Kids Influenza Immunization Project 2014-2015 flu season. NMIC.

Pentler, A. (2015, March 26). Executive Director, NMIC. (R. Trujillo, Interviewer)

Stanford University. (n.d.). The Influenza Pandemic of 1918. Retrieved from stanford.edu: http://virus.stanford.edu/uda/

Unseen Enemies: The History of Pandemic Disease (2013). [Motion Picture].

Williams, V. R. (2012). Elementary school-located influenza vaccine programs: Key stakeholder experiences from initiation to

continuation. The Journal of School Nursing, 28(4), 256-267.

Wilson, D. (2013). Implementing and sustaining school-located influenza vaccination programs: Perspectives from five diverse school

districts. The Journal of School Nursing, 29 (4) 303-314.