It is the position of the National Association of School Nurses (NASN) that immunizations are essential to primary prevention of disease from infancy through adulthood and that childhood vaccinations are an effective way of preventing serious childhood illnesses (U.S. Department of Health and Human Services [USDHHS], 2017). NASN supports elimination of all exemptions except those necessary for valid medical contraindications.
School nurses are leaders who use evidence-based immunization strategies, such as School Located Vaccine (SLV) clinics, parent/guardian reminders about vaccine schedules, state immunization information systems (IIS), i.e., state registries, strong support of vaccination recommendations, and vaccine education for students, staff, and families.
BACKGROUND AND RATIONALE
The CDC (2019a) currently recommends that U.S. children and adolescents be vaccinated against 17 diseases. Childhood immunizations have reduced the incidence of Vaccine Preventable Diseases (VPD) by more than 90%, and, in some cases, have spurred reductions as high as 99%. Smallpox, the only human disease ever eradicated, was eradicated through vaccination. Similarly, polio is near eradication as a result of widespread vaccination programs (American Academy of Pediatrics [AAP], 2018; Orenstein & Ahmed, 2017). In addition to reducing disease, disability and death, vaccines are credited with saving almost $69 billion in healthcare costs in the United States alone (Orenstein et al., 2017). Vaccines not only provide protection to those who are vaccinated, but also provide community protection or “herd immunity” where vaccination rates are above 95% (Eby, 2017). Herd immunity reduces the spread of disease to those who cannot be vaccinated, from the youngest infants to immunocompromised individuals of any age.
Childhood immunization has been so effective in preventing death and disease that many parents today have not encountered diseases that were common years ago. As a result, increasing numbers of parents believe that vaccine-preventable diseases are mild or “natural,” and that vaccines are no longer necessary (Navin, 2018). In the past 10 years, the number of parents refusing vaccinations or choosing alternate vaccination schedules has increased (Eby, 2017). In addition to their lack of concern about VPD, some parents cite worries about vaccine safety, fear of discomfort, and religious objections as reasons for not adhering to vaccination schedules (Navin, Wasserman, Amhmad, & Bies, 2019; Kubin, 2019). Decreasing vaccination rates, coupled with the ease of international travel and waning vaccine titers, has resulted in an increase in VPD outbreaks in the United States. Pertussis cases—which declined from over 100,000 per year to fewer than 10,000 per year between the 1940s and 1965, after the vaccine’s introduction—rose to over 18,000 in 2017 (CDC, 2017). Measles is also resurgent, with more cases confirmed in 2019 than since the disease was declared eliminated in 2000 (CDC, 2019b).
As vaccine rates in the United States decline and cases of vaccine-preventable illness increase, access for parents to reliable information about the safety and efficacy of childhood immunizations and accurate tracking of children’s vaccination records becomes even more important. School nurses are well equipped to inform about both. School nurses have regular access to students, are trusted by parents to deliver accurate health information, and have access to state immunization registries. One of the most practical solutions to increase vaccine availability and vaccine compliance is to support school-based vaccination clinics. The CDC (2014) notes that schools are one of the most efficient systems for providing health services to children and youth, because approximately 95% of U.S. children and youth attend school. NASN supports the ACIP vaccine recommendations adopted by the CDC and states and local vaccine mandates. NASN also supports full school nurse access to state registries, an important practice tool. School nurses use state registries to facilitate immunization compliance, identify the immunization status of students in the event of disease outbreaks, and prevent duplication of vaccinations when records have been lost, destroyed, or misplaced (CDC, 2013; AAP, 2006; Guide to Community Preventive Services, 2010). School nurses are strongly positioned within their communities to educate students, families, and school staff about the critical role vaccines play in preventing disease, allowing students and staff to remain healthy and in school.
American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine. (2006). Policy statement - Immunization information systems. Pediatrics, 118(3), 1293 – 1295. https://doi.org/10.1542/peds.2006-1723
Centers for Disease Control and Prevention. (2013). Progress in immunization information systems – United States 2012. Morbidity and Mortality Weekly Report, December 13, 2013, 62(49), 1005-1008. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6249a4.htm
Centers for Disease Control and Prevention. (2014). Whole school whole community whole child: A collaborative approach to learning and health. https://www.cdc.gov/healthyyouth/wscc/
Centers for Disease Control and Prevention. (2017). Pertussis surveillance and reporting trends. https://www.cdc.gov/pertussis/surv-reporting.html
Centers for Disease Control and Prevention. (2019a). Advisory Committee on Immunization Practices recommended child and adolescent immunization schedule for ages 18 or younger United States, 2019. https://www.cdc.gov/vaccines/schedules/hcp/index.html
Centers for Disease Control and Prevention. (2019b). Measles cases in 2019. Retrieved from https://www.cdc.gov/measles/cases-outbreaks.html
Eby, A. (2017). Impacting parental vaccine decision-making. Pediatric Nursing, 43(1), 22-34.
Kubin, L. (2019). Is there a resurgence of vaccine preventable diseases in the U.S? Journal of Pediatric Nursing, 44, 115-118.
Navin, M., Wasserman, J., Amhmad, M., & Bies, S. (2019). Vaccine education, reasons for refusal, and vaccination behavior. American Journal of Preventative Medicine, 56(3), 359-367.
Orenstein, W.A., & Ahmed, R. (2017). Simply put: Vaccination saves lives. Proceedings of the National Academy of Sciences of the United States of America, 114(16), 4031-4033.
U. S. Department of Health and Human Services. (2017). Healthy people 2020. Washington, DC: U.S. Government Printing Office. https://www.healthypeople.gov/
Acknowledgment of Authors:
Constance Griffin, BS, RN, AE-C, NCSN
Patricia Barker, BSN, RN, NCSN
Elizabeth McDermott, BA, BSN, RN, NCSN
Lynne Meadows, MS, BSN, RN, Coordinator
Cheryl Peiffer, MBA, RN, BS, CSN
Adopted: June 1978
Revised: June 1982, June 1996, November 2001, June 2006, September 2010, January 2015, January 2020
Suggested citation: National Association of School Nurses. (2020). Immunizations (Position Statement). Silver Spring, MD.
“To optimize student health, safety and learning, it is the position of the National Association of School Nurses that a professional registered school nurse is present in every school all day, every day.”
All position statements from the National Association of School Nurses will automatically expire five years after publication unless reaffirmed, revised, or retired at or before that time.