School-Based H1N1 Vaccination in New York City

Background: New York City (NYC) was the epicenter of the novel H1N1 influenza outbreak in the spring of 2009. School-age children were disproportionately affected, with an estimated 22% of children 5 to 17 years of age reporting influenza-like illness in a citywide telephone survey. In fall 2009, NYC instituted a school- and community-based H1N1 vaccination program to reduce the burden of illness and decrease community transmission.

Setting: NYC, a large urban area of 8.3 million people.

Population: 1.4 million school-age children (K through grade 12) in all public and private schools.

Project Description: H1N1 vaccine was offered at over 1,200 elementary schools, both public and non-public, and at 58 weekend clinics over five weekends for middle and upper school students. Regular school nurses vaccinated children in small elementary schools (<400 students). Contract nurses provided additional support in mid-size elementary schools (400-600 students). Nine-person vaccination teams served large elementary schools (>600 students). Parents were informed of the effort through school communications, the news media and official city websites.

Results/Lessons Learned:

Of 572,624 eligible students, consents were received for 150,469 (26.3%); as of 1/28/10, a total of 120,233 first doses and 75,489 second doses of H1N1 vaccine were administered in schools. Student turn-out at weekend clinics was low. Both programs required a large amount of staff time, mobilizing approximately 600 full-time and 3,500 weekend staff from DOHMH, 19 other City agencies and volunteer groups in addition to regular Immunization, Emergency Management, Office of School Health, and DOE personnel. Increased participation in schools was associated with active involvement by parent coordinators and principals. Successful operations required investment in the infrastructure for vaccine storage and handling and training. Working closely with partner agencies and labor unions to staff and support both programs was critical. In addition, providing multiple methods to obtain suggestions from staff working in the field was critical to ongoing improvement, as well as to staff and client satisfaction. Citywide flu vaccination is feasible, though its cost-effectiveness as a strategy must be determined.