Despite years of effort, immunization rates have not reached desired levels in the United States. On-time vaccination throughout childhood is essential because it helps provide immunity before children are exposed to potentially life-threatening diseases. Vaccines are tested to ensure that they are safe and effective for children to receive at the recommended ages. According to Federal health data, New York is among the 10 states with the lowest vaccination rates. School-based health centers (SBHCs) improve adolescent vaccination rates, while simultaneously saving health care dollars for society. Below are resources for SBHCs and Parents/Caregivers to consider when vaccinating their children.
Immunization Laws & Vaccination Schedules
New York State Recommended Vaccine Schedule
CDC Recommended Vaccine Schedule
New York State Immunization Laws & Regulations
Resources for SBHC and Staff
- School Nurse Immunization Toolkit: The New York State Association of County Health Officials (NYSACHO), in collaboration with the New York State Department of Health (NYSDOH), is pleased to provide this toolkit for use by school nurses to promote immunization among school children.
- Resources for Vaccine Providers: The Campaign to ImmuNYze all New Yorkers is an initiative of the County Health Officials of New York (NYSACHO) bringing together patients, parents, providers and campaign partners to heighten awareness of vaccines and the need to immunize throughout life – from infancy through senior years.
- Communicating with Families: Learn about vaccine-hesitant parents, common concerns, vaccine information statements, and view risk communication videos
- CDC’s Tips on Talking to Parents about Vaccines and Vaccine-preventable Diseases Fact Sheets: Many parents have questions about their children’s vaccines, and answering their questions can help parents feel confident in choosing to immunize their child according to the CDC’s recommended immunization schedule. The materials below are intended to help health care professionals start or continue conversations with parents.
- Summary of Recommendations for Child/Teen Immunization (Age birth through 18 years): This document was adapted from the vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP) and also Best Practices Guidance of the ACIP.
- Medical Management of Vaccine Reactions in Children and Teens In a Community Setting: Administering any medication, including vaccines,has the potential to cause an adverse reaction. To minimize the likelihood of an adverse event, screen patients for vaccine contraindications and precautions prior to vaccination (see “Screening Checklist for Contraindications to Vaccines for Children and Teens”. When adverse reactions do occur, this resource helps you to be prepared.
- Vaccinations in Refugee Children: New York State and New York City Recommendations and Guidelines
Resources for Parents & Caregivers
- The Importance of Childhood Vaccinations and Resource Page for parents
- CDC: Why Vaccinate and If You Choose Not to Vaccinate Your Child, Understand the Risks and Responsibilities
- Track Your Child’s Immunizations and Development Milestones: This worksheet will help you to record your child’s immunizations, developmental milestones, and growth at each well-child visit.
- The New York State Vaccines for Children (NYS VFC) Program is a federally-funded program that provides vaccines at no cost to eligible children. The vaccines are distributed to private physicians’ offices and public health clinics enrolled as VFC providers. VFC providers administer the vaccines to VFC-eligible children. VFC providers may also obtain other publicly-funded vaccines to serve children eligible under other criteria.
- Consequences of Undervaccination — Measles Outbreak, New York City, 2018–2019: Recent measles outbreaks in states with high overall MMR coverage, such as New York, highlight the need for assessing vaccination coverage at the local level
Literature on SBHCs and Immunizations
For a full database on published literature related to School-based health centers and Immunizations visit the SBHC Literature Database built by the National School-Based Health Alliance. Below are some papers we believe highlight the important role of SBHCs in providing students with vital vaccines.
Efficacy of LAIV-T on Absentee Rates in a School-Based Health Center Sample
Objective: To determine the effectiveness of the intranasal LAIV-T in decreasing school absenteeism in a school-based vaccination initiative and to compare the acceptability of LAIV-T versus TIV among adolescents.
Finding: LAIV-T was associated with a reduction in nonsuspension absences and was well
accepted by students. Administration of LAIV-T may be a convenient and effective method to
mass-immunize students in a school setting and help establish herd immunity within the community.
Process Evaluation of an Intervention to Increase Provision of Adolescent Vaccines at School Health Centers
Objective: A process evaluation of an intervention to increase school-based health center-located vaccination to better understand the feasibility and challenges of such interventions among school-based health centers (SBHCs) in four traditional high schools in one district in central North Carolina.
Finding: This low-resource intervention successfully obtained consent for at least one vaccine from 10% of parents whose children were enrolled in an SBHC. Parents indicated the intervention materials were clear and persuasive and provided reminders about adolescent vaccination and information about the SBHC vaccination program. Most parents who consented opted to provide global consent, using the all recommended vaccine checkbox, rather than identifying specific vaccines. However, this study identified two topics that require more explanation in vaccination program material: vaccination costs and male HPV vaccination.
Addressing Adolescent Immunization Disparities: A Retrospective Analysis of School-Based Health Center Immunization Delivery
Objective: A comparison of completion rates for adolescent immunization series administered at SBHCs to completion rates for series administered at CHCs within a single integrated delivery system among patients aged 12-18 years in Denver, Colorado.
Finding: In this analysis SBHCs were found to be superior to CHCs as a setting for completion of adolescent immunization series, even after adjusting for significant demographic differences. Children and adolescents seen in SBHCs were more likely to be up to date for hepatitis B, Tdap, varicella, measles/mumps/ rubella, HPV for patients aged 16 to 18 years, and the HPV/Tdap/MCV4 immunization series for female patients aged 16 to18 years. SBHC users were more likely to complete series that required multiple doses (hepatitis B, Tdap, varicella, and HPV), with the exception of hepatitis A. CHC users were more likely to be up to date for tetanus/diphtheria vaccinations. There were no differences by site of care for hepatitis A or MCV4 vaccinations.
Effectiveness and Cost of Immunization Recall at School-Based Health Centers
Objective: Effectiveness of recall for immunizations has not been examined in the setting of school-based health centers (SBHCs). We assessed (1) immunization rates achieved with recall among sixth-grade girls (demonstration study); (2) effectiveness of recall among sixth-grade boys (randomized controlled trial [RCT]); and (3) cost of conducting recall in SBHCs.
Finding: At the end of the demonstration study, 77% of girls had received ≥1 vaccine and 45% had received all needed adolescent vaccines. Rates of receipt among those needing each of the vaccines were 68% (160/236) for tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, 57% (142/248) for quadrivalent meningococcal conjugate vaccine, and 59% (149/253) for the first human papillomavirus vaccine. At the end of the RCT, 66% of recalled boys had received ≥1 vaccine and 59% had received all study vaccines, compared with 45% and 36%, respectively, of the control group (P < .001). Cost of conducting recall ranged from $1.12 to $6.87 per recalled child immunized.
Improving HPV Vaccine Delivery at School-Based Health Centers
Objective: To identify characteristics associated with human papillomavirus (HPV) vaccination rates, describe barriers and facilitators to vaccine uptake and the potential role for clinician-to-clinician Assessment, Feedback, Incentives, and eXchange (AFIX) visits in school-based health centers (SBHCs).
Finding: Baseline initiation and completion rates were 76% and 43% for high schools, and 81% and 45% for middle schools. SBHCs that allowed adolescent self-consent or did not require separate vaccine consent had higher baseline rates, but was not statistically significant. Barriers to series completion included challenges with scheduling and appointment compliance. At follow-up, high school SBHCs increased HPV vaccine initiation by 2.9 percentage points (p < 0.01) and series completion by 2.7 percentage points (p < 0.05). There was no statistically significant increase at middle school SBHCs. Most
SBHCs (88%) chose reminder/recall systems as a QI strategy. Fewer than half (42%) implemented their QI strategy.
Acceptability of School-Based Health Centers for Human Papillomavirus Vaccination Visits: A Mixed-Methods Study
Objective: To study facilitators, barriers, and overall acceptability of HPV vaccination visits at SBHCs from the perspective of students and parents.
Finding: Parents who had used SBHCs previously were more willing to use an SBHC for HPV vaccinations than those who had not used an SBHC. Facilitators were convenience and ease of access, barriers were concerns about fragmented care and records and negative perceptions of SBHCs.
