Factors Influencing Provision of School-Based Influenza Vaccination Clinics in King County, Washington

Background:
School-based influenza vaccination programs could supplement those offered by health care providers. We surveyed King County, Washington public and private schools on their practices regarding school-based influenza (“flu”) vaccine clinics (SBFC). Washington State's universal vaccine access policy provides free vaccine to all children under age 19 years.

Objectives:
To assess: a) provision of SBFC in King County, WA and b) to identify factors influencing whether schools offered SBFC during school year 2007-2008.

Methods:
In April 2008, school district administrators (N=19) and individual schools (N=671) were mailed an invitation to participate in an on-line survey. Respondents completed a standardized questionnaire regarding factors influencing their practices during 2007-08. Analysis was conducted with Excel 2003.

Results:
One hundred sixty-eight schools (25%) representing 18 districts (95%) participated in the survey. Thirty-six percent of schools offered SBFC; vaccine was offered to school staff at all SBFC and to students at 42% of SBFC. Students aged 11-14 years were most frequently eligible to receive vaccine (91%) whereas students six years and younger were least likely to be able to participate (23%). Eighty-six percent of SBFC were administered by commercial vaccinators or pharmacies; none participated in VFC. Reasons for offering SBFC included desire to reduce faculty absenteeism (79%) and student absenteeism (27%) and in response to staff and faculty requests (60%). Reported barriers include time constraints (28%) and cost of vaccination (15%), specifically that provision of vaccine on a fee-for-service basis excluded some students from participating.

Conclusions:
Most schools in King County do not offer SBFCs and the majority of those that provide SBFC don't offer vaccine to students. Barriers to offering SBFC include time required by school staff, cost of vaccination and inadequate reimbursement of commercial vaccinators. New approaches are needed for provision of immunization services at schools in universal access states.