CUH

1. STOP THE FLU
Chaminade University of Honolulu
NUR 401: Public Health Nursing
By: Alyssa Antonio, Sharlene Daligcon,
Joelle Devera, Brittany Fuller,
Skye Lam Ho, Satzy Pulido,
Jasmine Rapisura, and Jason Savaria,
with Professor Anna Motteler BSN, RN-BC

2. Fall 2014: Cohort #1
Clinical assignment:
Determine how effective school based flu clinics
are in increasing flu vaccine rates versus other
alternative flu vaccine providers/clinics
available in the community.
● Literature review and recommendations
● Conducted a survey at the Children and
Youth Day Fair at the Capitol
● Discussion & matrix of alternative flu vaccine
providers in the community

3. Fall 2014: Cohort #2
Clinical assignment
 Determine how the DOH PHN’s and Immunization
Branch can target parents and families of school
age children to educate them on the importance
and benefits of influenza vaccines and to
increase influenza vaccine rates. Also, discuss
what the literature says about trust, beliefs and
safety in the influenza vaccine and what that
means to parents.
 Literature review and recommendations
 Meta-analysis
 Designed a mobile application for SFAS including
consent, education and VIS forms

4. The Problem/Question
● The Stop Flu at School (SFAS) Program
● Flu vaccines for the general public
o Costs and coverages
● Similar programs in the US mainland and other countries
● Literature reviews related to school-based programs
● Recommendations for Public Health nurses
● Literature review with recommendations
● Performed island wide assessment of community flu vaccine providers
● Created tool for PHNB containing field research findings

5. Literature Reviews
● A Survey of Physician-Led Influenza Immunization Programs in Schools
● How Rural and Urban Parents Describe Convenience in the Context of School-Based
Influenza Vaccination: A Qualitative Study
● School-Based Influenza Vaccination: Parents’ Perspectives
● Influenza Vaccination of School Children and Influenza Outbreaks in a School
● Effect of School Closure on the Incidence of Influenza Among School-Aged Children in
Arizona
● Implementing and Sustaining School-Located Influenza Vaccination Programs:
Perspectives From Five Diverse School Districts
● School-Located Influenza Vaccination Reduces Community Risk for Influenza and
Influenza-Like Illness Emergency Care Visits
● Reaching Children Never Previously Vaccinated for Influenza Through a School-Located
Vaccination Program

6. A Survey of Physician-Led Influenza Immunization
Programs in Schools
● Led by Pediatric Physicians
● TAIV and LIV offered to schools
● Motivation was “need to protect children”
● Continuity has expanded to 13 schools over 2 -3 years
● Vaccines for Children program supplied vaccines
Recommendations
● Continue to apply for grants for funding
● Work with smaller schools
● Utilize nursing schools as volunteers

7. How Rural and Urban Parents Describe Convenience
in the Context of School-Based Influenza Vaccination
Rural vs. Urban
● Rural 22.5 vs Urban 366 opportunities for vaccination
● Transportation: other communities & traffic jams
Similarities
● Reduction in parental scheduling burden
● Reduction in parental lost time & stress
● Increased physical access
● Convenience potentially increases uptake of vaccine

8. School-Based Influenza Vaccination: Parents’
Perspectives
● Perceptions of parents of school aged children in Alberta, Canada
● Parents described advantages, disadvantages, and implications
● Advantages:
o Emotional support
o Convenient
o Decrease in lost time
● Disadvantages:
o Communication
o Feeling pressured
o Cost
● Consulting with parents is essential

9. Influenza Vaccination of School Children and Influenza
Outbreaks in a School
Aim of Study
● To demonstrate effectiveness of flu program
● Investigate flu vaccine coverage rates
● Total number of class cancellation days
Absentee rates in an elementary school
● Data Collected during 1984-2007 flu seasons
Recommendations
● Moderate increase in vaccinations
● Continuation of flu vaccines for schoolchildren

10. Effect of School Closure on the Incidence of Influenza
Among School-Aged Children in Arizona
● Study: School-aged children in Arizona
● Over four year span
o 2004-2005, 2005-2006, 2006-2007, 2007-2008
● School closure during winter holidays
o Lower influenza rates
● Recommendations
o Encourage and recommend flu vaccines
o Provide educational pamphlets for parents
 What is the flu vaccine
 Why flu vaccine is important
 Proper hand washing etc.
o Ensure community needs are met

11. Implementing and Sustaining School-Located Influenza
Vaccination Programs: Perspectives From Five Diverse
School Districts
● Study: five Los Angeles school districts
● Observed over three influenza seasons
o Pilot season: 2007-2008
o Seasons 2 & 3: 2009-2010, 2010-2011
● Based on district needs, programs were tailored
● Recommendations
o Look to resources already in place
o Utilize available nursing staff and community partnerships
o Avoid pressure of creating large-scale programs

12. School-Located Influenza Vaccination Reduces Community
Risk for Influenza and Influenza-Like Illness Emergency Care
Visits
● Study conducted in Alachua, Florida
● Compared against other counties not provided
School located influenza Vaccinations
● Influenza Vaccination made available for all
school children (5-17 years old)
● Reported 70-79% reduction of flu-like illness
hospital admissions compared to other counties

13. Reaching Children Never Previously Vaccinated for
Influenza Through a School-Located Vaccination Program
● Summary of in-school immunization clinic article
○ Improving vaccination coverage of
children
○ Methods used to advertise vaccination
program
○ Data collected based off study
● Recommendations based off of article data
○ Media implementation for advertisement
○ Automated voice calling to parents of
students

14. Matrix By Sections

15. West Honolulu (WHON)
Grocery Store Pharmacies
● Prices (Cheapest to Expensive)
● Ages/Types of vaccinations offered
● Insurance
Wal-Mart and Costco
● Prices
● Ages/Types of vaccinations offered
● Insurance
Clinics
● Prices
● Ages/Types of vaccinations offered
● What insurance is needed

16. East Honolulu (EHON)
Grocery Store Pharmacies
● Times Supermarket
● Longs Drugs
● Walgreens
● Safeway
● Mina Pharmacy
● Sam’s Club
● Costco
● Walmart
Clinics
● Wakiki Health Clinic
● Student Health Services (University of Hawaii-Manoa)
● Straub Outpatient Clinic
● Queen Emma Clinic
● Kapiolani Outpatient Clinic
● Island Urgent Care & Kahala Urgent Care
● Shriner’s Hospital Outpatient Clinic

17. Windward Oahu (WW)
Grocery Store Pharmacies
● Times Supermarket
● CVS minute Clinic
● Walgreens
● Safeway
● Longs Drug Pharmacy
Clinics
● Kaiser Permanente
● The Medical Corner
● Straub Family Clinic
● Waimanalo Health Center
● Braun Urgent Care
● Reis Pediatrics
● Trade Winds Family Medicine
● Oahu Medical Group
● Haleiwa Family Health Center
Government Agencies
● Kaneohe MCBH

18. Central Oahu (CONS)
Grocery Store Pharmacies
● Times Supermarket
● Longs Drugs
● Walgreens
● CVS Minute Clinic
● Target
● Sam’s Club
● Costco
Clinics
● Straub: Mililani Family Health Center;
Pearlridge
● Kaiser Permanente: Waipio
US Med Urgent Care: Pearl City
Hospital Pharmacies
● Pali Momi Medical Center Pharmcare
● Tripler Army Medical Center (Gov’t Agency)

19. Leeward Oahu (LONO)
Grocery Store Pharmacies
● Walgreens
● CVS Minute Clinic
● Safeway
● One Minute Clinics
● Times Pharmacy
● K-Mart
● Wal-Mart
● Target
● Safeway
Clinics
● Kaiser Permanente: Kapolei; Nanaikeola
● Waianae Coast Comprehensive Health Center
○ Waianae
○ Kapolei
○ Nanakuli
○ Waiola
○ Waipahu

20. Questions

21. References
Hull, H.F. (2010). A survey of physician-led influenza immunization programs in schools. Clinical Pediatrics 49(5), 439-442. doi
10.1177/0009922809346573
Kansagra, S.M., Papadouka, V., Geevarughese, A., Hansen, M.A., Konty, K.J. & Zucker, J.R. (2014). Reaching Children Never
Previously Vaccinated for Influenza Through a School-Located Vaccination Program. American Journal of Public
Health, 104(1), e45-e49. doi: 10.2015/AJPH.2013.301671
Kawai, S., Nanri, S., Ban, E., Inokuchi, M., Tanaka, T., Tokumura, M., & … Sugaya, N. (2011). Influenza vaccination of schoolchildren
and influenza outbreaks in a school. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases
Society of America, 53(2), 130-136. doi:10.1093/cid/cir336
Lind, C., Russell, M.L., Collins, R., MacDonald, J., Frank, C.J., & Davis, A.E. (2014). School-Based Influenza Vaccination: Parents’
Perspectives. Plos ONE, 9(3), 1-12. doi:10.1371/journal.pone.0093490
Lind, C., Russell, M.L., Collins, R., MacDonald, J., Frank, C.J., & Davis, A.E. (2015). How rural and urban parents describe
convenience in the context of school-based influenza vaccination: a qualitative study. BMC Health Services
Research, 15(1), 24.
Tran, C. H., Sugimoto, J. D., Pulliam, J. C., Ryan, K. A., Myers, P. D., Castleman, J. B, & Jr.Morris, J. G. (2014).School-Located
Influenza Vaccination Reduces Community Risk for Influenza and Influenza-LikeIllness Emergency Care Visits. Plos
ONE, 9(12), 1-17. Retrieved from
https://ezproxy.chaminade.edu/login?url=http://search.ebscohost.com/login.aspx
direct=true&db=aph&AN=100186608&site=ehost-live.
Wheeler, C.C., Erhart, L.M., & Jehn, M.L. (2010). Effect of school closure on the incidence of influenza among school-age children
in Arizona. Public Health Reports (Washington, D.C.: 1974), 125(6), 851-859.
Wilson, D., Sanchez, K. M., Blackwell, S. H., Weinstein, E., & El Amin, A. N. (2013). Implementing and sustaining school-located
influenza vaccination programs: Perspectives from five diverse school districts. The Journal of School Nursing, 29(4)
, 303-14. doi:http://dx.doi.org/10.1177/1059840513486011