School “Flu” Clinics
2013-2014
Arkansas Department of Health
Northwest Region
Nursing
• Non ADH and ADH Non-Clinical
– Attend orientation
• Non-ADH nurses
– Provide current Arkansas Nursing
License
– Picture ID
– Sign Volunteer Indemnity form
– Sign HIPPA form
Goals and Objectives
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Provide protection against influenza
Decrease Illness
Decrease Absentees
Decrease Spread of Disease
Community Immunity
Herd Immunity
Cocoon Effect
Indications for Flu
Vaccine
• Any person who wishes to reduce the
likelihood of becoming ill or transmitting
influenza
• Inactivated influenza vaccine can be given
to anyone 6 months of age or older,
including breastfeeding and pregnant
women
• LAIV vaccine can be given to healthy,
nonpregnant persons 2 through 49 years of
age
Recommendations
• All persons aged ≥ 6 months, unless
medically contraindicated
• Persons at higher risk for influenzarelated complications
Recommendations
• Adults and children who are
immunosuppressed
• Adults and children who have any
condition that can compromise
respiratory function or the handling of
respiratory secretions or that can
increase the risk for aspiration
• Residents of nursing homes/chronic-care
facilities
When vaccine supplies are limited,
vaccination efforts should focus on
delivering vaccination to the following
persons
• Children aged 6 months through 4 years (59 months)
• Persons aged ≥ 50 years
• Adults and children who have chronic pulmonary (including
asthma), cardiovascular (except hypertension), renal,
hepatic, neurologic, hematologic, or metabolic disorders
(including diabetes mellitus)
• Persons who have immunosuppression (including
immunosuppression caused by medications or by HIV
infection)
• Women who are or will be pregnant during the influenza
season
• Children and adolescents (aged 6 months through 18
years) who are receiving long-term aspirin therapy
Continue
• Residents of nursing homes and other long-term
care facilities
• American Indians/Alaskan Natives
• Persons who are morbidly obese (body-mass index
≥ 40)
• Health-care personnel
• Household contacts and caregivers of children
aged < 5 years and adults aged ≥ 50 years, with
particular emphasis on vaccinating contacts of
children aged < 6 months
• Household contacts and caregivers of persons
with medical conditions that put them at higher
risk for severe complications from influenza
To prevent transmission to
those who are at high risk
for influenza-related
complications:
Immunize the people who
live with or care for
them!
People Who are
Transmission Sources
• Healthy household contacts and
caregivers of
– children ages 0-59 months
– persons > 50 years old
– persons at high risk for severe
complications from influenza
Transmission Sources continued
Health Care Providers:
• People who provide home care to persons in
groups at high risk
• People working in health-care settings include
physicians, nurses, and other workers in
hospitals, long term care facilities, assisted
living and outpatient-care settings
• Medical emergency response workers
• Students in these professions who will have
contact with patients
Influenza Vaccine 2013-2014
• Injectable (IIV3 /Fluzone and RIV3/ Flublok)
– A/California/7/2009 (H1N1) -like virus
– A/Victoria/361/2011 (H3N2)-virus
– B/Massachusetts/2/2012-like virus
• Intranasal (LAIV/FluMist and Fluarix
Quadrivalent)
»Additional B/Brisbane/60/2008-like
virus
Vaccine
• Approx 2 weeks after vaccine-antibodies
develop
• Common reactions (Injectable)
– Soreness/erythema/induration at site
lasting 1-2 days (15-20%)
– Fever/chills/malaise/myalgias lasting
1-2 days (<1%)
– Rare: immediate hypersensitivity
allergic reactions
(hives/angioedema/allergic
asthma/systemic anaphylaxis)
Adverse Reactions
LAIV
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Runny nose or nasal congestion
Fever > 100°F
Sore throat
Headache
Vomiting
Abdominal pain
Myalgias
Age Group Dosage
IIV3/IIV4:Injectable
• 6 through 35 months 0.25 mL IM*
– Fluzone (IIV3)
• 36 months through 8 years 0.50 mL IM*
– Fluzone (IIV3)
– Fluarix (IIV4)**
• ≥ 9 years 0.50 mL IM
– Fluzone (IIV3)
• 36 months through 18 years 0.50 mL IM*
– Fluarix (IIV4)**
• *May need two doses administered at least 4 weeks apart
– **Reserved for children with asthma/limited doses available in
LHU
RIV3: Injectable
• 18-49 years of age 0.50ml
• Utilized for ADH employees with
egg allergies
• Available from Central Office
LAIV- FluMist®
(Live Attenuated Intranasal Vaccine)
• Approved for healthy, nonpregnant
persons 2 through 49 years of age
• Children 2 through 8 years of age may
need two doses of LAIV administered at
least 4 weeks apart
• One dose of LAIV may be administered
by the intranasal route to persons 9
through 49 years of age
Age Group Dosage
LAIV-FluMist®
• Age: 2 years through 49 years
• Prefilled, single-use sprayer containing 0.2 mL
of vaccine
– If not simultaneously administered, FluMist can be
administered 4 weeks after another live vaccine such
as MMR or varicella
– Do not administer FluMist until 48 hours after
antiviral cessation
– Antiviral agents should not be administered until 2
weeks after FluMist administration unless medically
necessary
Contraindications: All
Flu Vaccine (IIV/LAIV)
• People who had a severe (anaphylactic)
reaction to chicken eggs*
• People who had a severe reaction to a flu
vaccination in the past
• Children <6mo of age
• People who developed Guillain-Barre’
syndrome following influenza vaccination*
– *requires a consultation with patient’s physician
Contraindications and Precautions to the Use of
Influenza Vaccines: 2013-14
Vaccine
IIV (includes
IIV3, and
IIV4),
Fluzone and
Fluarix
Contraindications
Precautions
Moderate to
History of severe
severe illness with
allergic reaction to
or without fever.
any component of the History of
vaccine, including egg Guillain-Barre
protein, or after
syndrome within 6
previous dose of any
weeks of receipt
influenza vaccine.
of influenza
vaccine.
Contraindications and
Precautions
LAIV
(Flumist)
History of severe allergic
reaction to any component of
the vaccine, including egg
protein, gentamicin, gelatin,
and arginine, or after a
previous dose of any influenza
vaccine
Concomitant Aspirin therapy in
children and adolescents
Children aged 2--4 years whose
parents or caregivers report
that a health-care provider
(HCP) has told them during the
preceding 12 months that their
child had wheezing or asthma
Moderate to
severe illness
with or
without
fever.
History of
Guillain-Barre
syndrome
within 6
weeks of
receipt of
influenza
vaccine.
Contraindications LAIV continued
• Persons ages <2 years or those ages >49 years
• Persons with any of the underlying medical
conditions
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Asthma
Reactive airways disease
Chronic disorders of the pulmonary or cardiovascular systems
Metabolic diseases diabetes, renal dysfunction, and
hemoglobinopathies
– Known or suspected immunodeficiency diseases or immunosuppressed
states
• Pregnancy
• Vaccination within 4weeks with live virus vaccine
Influenza vaccine dosing algorithm
for children aged 6 months
through 8 years
Injection Technique
“Nursing 101”
Vaccine Administration
TIV(Injectable)
• Sites:
– Infants: vastus lateralis (anterolateral thigh)
– Young children over the age of 12 months-anterolateral
aspect of the thigh may be used if the deltoid is
underdeveloped
– Adults and older children: deltoid (upper arm)
• Dosage:
– Infants 6mo through 35mo of age: 0.25ml IM
– 3 years old and older : 0.5ml IM
(Vaccinator assistants (physicians and nurses) may prefill
syringes with vaccine preparing just enough vaccine to meet
the clinic’s needs on an ongoing basis. Discard any vaccinefilled syringes after the clinic closes.)
Injection Technique
“Nursing 101” (#1)
• Determine appropriate
injection site
• (Please note that the
ADH will be using
Safety syringes and
needles)
Injection Technique,
Continued
(#2)
• Prep site with
alcohol
wipe/cotton ball
• Using circular
motion/wipe from
center out/allow
to dry
Injection Technique,
Continued (#3)
• Spread skin taut between thumb
and forefinger OR grasp tissue and
“bunch up” muscle. (acceptable for
pediatric and geriatric patients)
• Insert needle fully into muscle at
90 degree angle and inject vaccine
quickly.
• While needle is still in the patient,
fully depress the plunger to
activate retraction .
“Nursing 101”
• Apply light pressure
to injection site for
several seconds with
dry cotton ball or
gauze
• Dispose of syringe in
sharps container
Administering LAIV
Step by Step x5
Note: Active
inhalation
“sniffling” is not
required by the
patient during
administration
Dispose used LAIV
applicator in Hazardous
Waste Bucket
Standard Precautions
Hand washing-if soap and water not available-use
alcohol-based waterless cleanser between each
patient (available at each nursing station)
Standard Precautions
continued.
Gloves-not mandatory unless provider has
open lesion on hands. (Available at each
nursing station) If latex free gloves
required-contact nursing coordinator
Needle Safety
DO NOT:
(If not utilizing safety syringes or needles or needle
fails to retract)
– Detach used needles from syringe
– Recap used needle
– Bend or break used needle before
disposing
If needle stick injury occurs-report
IMMEDIATELY to the nursing
coordinator
ADH Supplies
• Nursing staff/clerical staff
• Vaccine
• Syringes/cottonballs/bandages/biohazard
containers/tissue
• Hand sanitizer/gloves
• Trash bags
• Emergency kit
• Extra forms/pens/clipboards
School provides
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Adequate space/site
School Nurse(s)
Volunteers
Tables/chairs (set up prior to clinic)
Trash cans
Completed paper work/forms
Faculty/staff copy of insurance card
Forms
• Vaccine Information Statements
– LAIV (mist)
– IIV (injectable)
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Consent to Receive Vaccine Form
“Dear Parent” letter
Will be collated/stapled/50 per set
Spanish forms separate/blue print
FERPA* form provided by school
– Forms may be available prior to start of school/will be shipped weekly
when available
Volunteers reviewing
forms
Communicating between
office and clinic site
School district provided busing for
staff/volunteers between multiple
campuses same day clinic
Hotwash/debriefing with Local
Health Unit and school
staff/volunteers
Questions and
Suggestions