It is the position of the National Association of School Nurses (NASN) that immunizations are a key to primary prevention of disease from infancy through adulthood. The school nurse is in a critical position to create awareness and influence action related to mandated and recommended immunizations in the school community. The school nurse can also provide leadership in the development of school-located immunization programs.
NASN supports the Centers for Disease Control and Prevention (CDC) recommended vaccines; and federal, state, and local legislation that provides for the immunization of students and their families. In addition, NASN supports local and state policy that ensures reimbursement to schools that choose to provide immunizations to students.
NASN also supports the development of an immunization registry in each state. “Immunization registries are confidential, population-based, computerized information systems that collect vaccination data about all children within a geographic area” (CDC, 2009a). By providing complete and accurate information on which to base vaccination decisions, registries are key tools to increase and sustain high immunization rates.
Vaccination against childhood diseases is one of the greatest public health achievements of the last half century. Since 1900, substantial achievements have been made in the control of many vaccine-preventable diseases in the United States with many diseases either eradicated or greatly reduced in incidence. The American Academy of Pediatrics offered the first immunization guidelines in the 1930s (CDC, 2007). National efforts to promote immunizations among all children began in 1955 with the appropriations of federal funds for polio vaccinations.
All states require immunizations prior to entry into school with additional vaccines required during the school age years. Though regulations are similar, they often vary among states. With the advent of new vaccines, recommendations and school requirements are likely to change. Despite significant levels of vaccine compliance, segments of the public continue to voice concerns about potential adverse effects of vaccines. These concerns potentially threaten vaccine uptake, and place added burden on the medical and public health communities (Cooper, 2008; CDC, 2010).
DESCRIPTION OF ISSUE
Vaccines are responsible for the control and elimination of many infectious diseases that were once common in the United States. With new vaccines, combination vaccines, and the expansion of childhood, adolescent and adult immunization schedules -- the capacity to prevent infectious disease has markedly increased since 2002 (Pickering et. al., 2009). However, the viruses and bacteria that cause vaccine-preventable disease and death still exist and pose a risk for unvaccinated people. In addition, vaccine-preventable diseases have a costly impact on Americans, resulting in lost work time for parents, additional doctor’s visits, hospitalizations, and premature deaths.
Access to reputable vaccine information is an issue of growing importance. Society is mobile, with families relocating and needing to access their child’s immunization information. Healthcare providers often have an incomplete record from the parent or previous provider, creating a need for a centralized immunization registry at the state and national level. Natural disasters, such as flooding, have destroyed students’ records, both at their school and their healthcare provider’s offices. Immunization registries provide official, accurate records for the private provider, families, and schools. Registry data can also be used to target community immunization programs (CDC, 2009b).
To realize the full benefit of immunizations, individuals must recognize that vaccines are a safe and effective way to help the body defend against vaccine-preventable diseases. Healthcare providers, including the school nurse, are in a position to maintain and share current knowledge and recommendations regarding vaccines with the communities they serve.
To optimally prevent disease, disability, and death from vaccine preventable illnesses, the vaccine delivery system must target children, adolescents and adults. Professional school nurses practice in an ideal setting to educate families and staff regarding the indications, contraindications, side effects, and timeliness of initial and booster doses of immunizing agents.
As the primary health professional in schools, professional school nurses are responsible for coordinating school and public health immunization programs and have opportunities to counsel families and staff regarding immunizations throughout the lifespan. In collaboration with local public health groups, schools can be an effective location for the delivery of vaccines to children, particularly in areas where the population is under-immunized. NASN supports the position that schools should seek third-party reimbursement for these vital health services.
Immunization registries are important tools for school nurses and others to utilize to facilitate immunization compliance; they help school nurses identify fully immunized students as well as children that are at risk in the event of a disease outbreak (AAP, 2006). Immunization registries help prevent duplication of vaccinations when records have been lost, destroyed or misplaced.
American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine (AAP). (2006). Immunization Information Systems. Pediatrics, 118, 1293 – 1295. doi: 10.1542/peds.2006-1723
Centers for Disease Control and Prevention (CDC) (2010). History of vaccine safety. Retrieved from http://www.cdc.gov/vaccinesafety/Vaccine_Monitoring/history.html.
Centers for Disease Control and Prevention (CDC), (2009a). IIS frequently asked questions. Retrieved from www.cdc.gov/vaccines/programs/iis/faq.htm
Centers for Disease Control and Prevention (CDC) (2009b). Vaccination records: Finding, interpreting, and recording. Retrieved from http://www.cdc.gov/vaccines/recs/immuniz-records.htm#registries.
Centers for Disease Control and Prevention(CDC) (2007). Parents guide to childhood immunizations. Retrieved from http://www.cdc.gov/vaccines/pubs/parents-guide/downloads/2008-parents-guide.pdf
Cooper, L., Larson, H. & Katz, S. (2008). Protecting public trust in immunization. Pediatrics, 122(1), 149-153. doi: 10.1542/peds.2008-0987
Pickering, et al. (2009). Immunization programs for infants, children, adolescents, and adults: Clinical Practice Guidelines by the Infectious Disease Society of America. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19659433
Acknowledgement of Authors:
Mary Burch, RN
Kathy Inderbitzin, MEd, RN, NCSN
Debra Robarge, BSN, RN, NCSN
Sue Zacharski, MEd, BSN, RN
Adopted: June 1978
Revised: June 1982, June 1996, and November 2001
Revised: June 2006
Revised: September 2010