Considerations for Planning School-Located Vaccination Clinics | CDC

Guidance for assisting with jurisdictional planning and implementation of satellite, temporary, or off-site vaccination clinics by public and private vaccination organizations.

Purpose

The purpose of this guidance is to provide information for planning and implementing school-located vaccination (SLV) clinics for any routinely-recommended vaccine as well as COVID-19 vaccine. Modifiable template communication materials are also provided.

Target Audience

The target audiences for this guidance are public and private entities interested in planning and implementing SLV clinics, including staff from state and local public health departments, community health care clinics, pharmacies, pediatric practices, health systems. The information may also be useful and relevant to school and school district staff.

Background

Widespread COVID-19 vaccination is a critical tool to protect people, including eligible children, from COVID-19 and help stop the pandemic. Over the course of the pandemic, there has also been a decrease in non-urgent, face-to-face, routine medical visiting, including routine vaccinations. Because of this, children, adolescents, and adults have been left vulnerable to becoming infected with vaccine-preventable diseases, thus increasing the risk of vaccine-preventable disease outbreaks.

While children in the United States are vaccinated primarily in their pediatrician’s or family doctor’s office, schools provide unique opportunities for getting children vaccinated:

• Children are already present in schools
• SLV can be more convenient for parents and guardians (referred to from this point on as parents)
• SLV can be used to administer COVID-19 vaccine rapidly and efficiently to eligible students and possibly their family members, teachers, school staff, and others in the community
• SLV can be used to offer routine vaccinations and catch-up vaccinations for students behind in vaccination because of the pandemic
• SLV is often used for yearly influenza vaccination

SLV is defined as vaccination that is:

• Administered on school grounds via temporary clinics
• Primarily designed to vaccinate enrolled students
• Held before, during, and/or after school hours, or when schools are not in session (i.e., during summer break)
• Typically involves collaboration between public health departments and public and private schools/school districts, and sometimes other public or private entities

SLV Planning Considerations

The following planning considerations apply to SLV in general, regardless of vaccine type offered. For COVID-19 SLV (C-SLV)-specific considerations, see Special Considerations for C-SLV below.

Start by considering the need for SLV and feasibility of offering it:

• Is there a local need for SLV (i.e., is the availability of other vaccination providers in the community inadequate)?
• Are there sufficient resources and staff to implement SLV?
• Is there adequate community and stakeholder support?

If SLV clinics will be held, plan the basic approach:

• Which vaccine(s) will be offered?
• Will clinics be held during school, after school, or at other times like during the summer or when school is not in session, such as school breaks? Consider issues related to building access, need for extended hours for school staff, class disruption, vaccine availability, additional operational costs, etc.
• Will eligibility be expanded beyond enrolled students (e.g., students from other schools, home schooled students, school staff, parents and other family members, community members)? Consider vaccine supply, potential for vaccine wastage, and logistical issues (e.g., clinics held during school may not be conducive to inviting persons who are not school staff or students to be vaccinated).

Developing a list of SLV planning and implementation activities, along with a timeline, may help the program run more smoothly and efficiently. Below is a list of activities that may be useful for planning SLV clinics.

Establishing Partnerships

• Establish partnerships with entities that will help promote and implement SLV.
• Select schools/school districts that will be offered SLV.
• Contact superintendents and principals of selected schools to solicit interest in participation.

Scheduling Clinics and Developing or Gathering Materials

• Consistent with state law requirements, develop consent forms and parent communications.
• As applicable, develop or plan for use of an electronic registration and/or consent system.
• Plan for training vaccinators, school staff, and others involved in implementing the clinics , including training medical staff on how to work with children as this is a specific skill which not all may possess. See You Call The Shots: Vaccinating Adolescents.

• Plan to distribute promotional and educational materials for students and parents.
• Identify clinic staff.
• Schedule SLV clinics, including make-up clinics or clinics to administer subsequent doses for multi-dose vaccines, as applicable.
• Plan for clinic space and design clinic layout.
• Notify local healthcare providers of plans to offer SLV in schools their patients may attend.

Preparing for Clinic Day

• Provide consent forms and promotional and educational materials for the school to distribute to parents and students, including an Emergency Use Authorization (EUA) Fact Sheet or Vaccine Information Statement (VIS), as appropriate.
• Train all SLV staff. Some helpful links are provided below:

• Order vaccine and clinic supplies, possibly based on returned consent forms. Clinic supplies should also include those that will need to be immediately available for the assessment and management of anaphylaxis.

Clinic Day Activities

• Review consent forms to ensure they are complete.

• Screen for Contraindications and Precautions to receiving routine childhood and adolescent vaccines and use the Prevaccination Checklist for COVID-19 vaccines, to ensure each student is eligible for vaccination
• Administer vaccine(s).
• Report any adverse events and vaccine administration errors to the Vaccine Adverse Event Reporting System (VAERS).
• Record vaccine administration information (i.e., in local immunization information system (IIS) or “immunization registry”).
• Provide students and/or parents with post-vaccination materials, including EUA Fact Sheet or VIS, as appropriate.

Post-clinic Day Activities

• If not done on the day of the SLV clinic, record vaccine administration information (i.e., in the immunization information system or “immunization registry”).
• Communicate vaccination information to primary healthcare providers, as feasible.
• Communicate with school and school district partners about the clinic; tell them the number of students vaccinated and what is needed to prepare for subsequent clinics, as applicable.
• Consider sending thank-you notes to volunteers.
• To inform program improvement, consider collecting feedback from SLV participants and reviewing lessons learned.

Additional planning considerations can be found here:

Establishing SLV Leadership and Partnerships

A critical initial step in planning for successful SLV clinics is to form partnerships. Public health departments have traditionally led SLV efforts, but other public or private entities could alternatively serve as the lead. Neither schools nor school districts rarely usually lead SLV efforts unless there is a school-based health center (permanent health clinics often located on school grounds that deliver primary care to enrolled students) affiliation. Regardless of which entity leads or initiates the SLV effort, establishing partnerships is essential.

In soliciting the support and partnership of schools and school districts, outreach to superintendents should occur as a first step. However, it is essential to also form partnerships with the school boards and to communicate with and gain the support of school principals and other school leaders. Having support among school leadership can facilitate program implementation, increase student participation, and lead to more successful SLV clinics. Find customizable template communications designed for school principals or other school leaders for SLV in general  and for COVID-19 SLV specifically.

It may also help to be prepared to offer the schools and districts information and talking points to give to their stakeholders, especially parents. Additionally, we recommend that each participating school identify a liaison or point of contact, such as the school nurse, for the SLV. Regardless of the degree of school involvement, the SLV clinic should be viewed as a partnership between public health and the school/school districts, in addition to any other entities that participate.

Legal Issues Related to Minors, School Staff, and Volunteers

For additional legal considerations specific to COVID-19 SLV (C-SLV), see Special Considerations for C-SLV below.

Communications

Find a customizable template communication to parents about SLV, including one specific to C-SLV.

Following the SLV clinic, all parents who provided consent should receive an additional communication that includes:

• A statement on whether their child did or did not receive vaccination and the reason they were not vaccinated (i.e., illness, child refusal, or a contraindications). Parents should also be notified if a reaction, such as syncope, occurred.
• Optional: An additional copy of the VIS or EUA Fact sheet.

Find customizable templates for post-clinic parent communications, including one for C-SLV, specifically.

All communications should be translated and available in various languages, as locally appropriate.

Healthcare Providers

Local healthcare providers may have concerns that children vaccinated at SLV clinics will not see their primary healthcare provider for other preventive care services. They may also have concerns about patient record keeping. Therefore, it is critical to seek the buy-in of local healthcare providers early in the process and to ensure processes are in place to provide them with vaccination information related to their patients.

Find customizable templates for communicating with local healthcare providers about SLV here, including one for C-SLV specifically.

Clinic Day Considerations

Syncope (fainting) has been reported after vaccination. It is most commonly reported in adolescents. While clinical guidance recommends that vaccination providers observe patients for 15 minutes after vaccination, it is particularly important to do so for adolescents. SLV staff should be aware of common signs and symptoms of an impending syncopal episode including lightheadedness, dizziness, visual and/or auditory changes, nausea, diaphoresis, pallor, and palpitations, among others, and take appropriate measures to prevent injuries. If syncope develops, patients should be observed until symptoms resolve.

In addition, administering any medication, including vaccines, has the potential to cause adverse events. Find information on managing vaccine reactions in children and teens in a community settingexternal icon. For information on COVID-19-specific side effects, see the COVID-19 Post-vaccination Side Effects below.

Special Considerations for COVID-19 SLV (C-SLV)

• If resources are limited and C-SLV clinics must be offered to a subset a schools within a region or district versus all schools, decide how to prioritize schools or school districts based on the principles of health equity and ensure equal access to COVID-19 vaccine.
• Decide when to schedule C-SLV clinics, including second dose clinics if needed at the appropriate interval following first dose clinics, with an awareness of possible conflicts with school events (e.g., graduation, standardized testing) and lower student availability if clinics occur during the summer or during school breaks.
• Decide whether persons receiving a first dose elsewhere can receive the second dose at the C-SLV clinic, and then set criteria for what proof of first vaccination will be required.
• Determine if other routinely recommended vaccines will be offered.

C-SLV-specific Legal Issues

In addition to legal considerations for all SLV programs, C-SLV programs should also consult with their legal counsel on issues specific to COVID-19 vaccination. Some legal issues, laws, and regulations to be aware of include:

• Separate consent requirements for administration of each respective dose of a two-dose COVID-19 vaccine series.
• Some states are using certain types of healthcare providers to administer COVID-19 vaccine under the Public Readiness and Emergency Preparedness (PREP) Actexternal icon. This allows individuals such as retired physicians or providers licensed in other states to administer COVID-19 vaccinations. However, these providers may not be covered to administer other vaccines during a C-SLV clinic; consult with legal counsel for further guidance.

COVID-19 vaccines are currently available in the United States as part of the CDC COVID-19 Vaccination Program. This program has specific legal requirements that all COVID-19 vaccination providers must adhere to:

• For the entity receiving and administering the COVID-19 vaccine and supplies, enroll as a COVID-19 vaccination provider and sign the CDC COVID-19 Vaccination Program Provider Agreement.
• Follow all storage, handling, preparation, and administration requirements for the COVID-19 vaccine(s) being administered.
• Provide COVID-19 vaccine at no cost to the vaccine recipient. However, COVID-19 vaccination providers may seek administration fee reimbursement from private insurance, Medicare, or Medicaid. Providers may also seek administration fee reimbursement for underinsuredexternal icon and uninsuredexternal icon vaccine recipients.

• Provide the vaccine recipient or, as applicable, a legal guardian a copy of the EUA Fact Sheet for Patients and Caregivers for the vaccine to be given before vaccine is administered.
• Provide a COVID-19 vaccination record card to all vaccine recipients.
• Document vaccine administration in their medical record systems within 24 hours of administration, and report administration data to the relevant system for the jurisdiction (i.e., IIS) as soon as practicable and no later than 72 hours after administration.
• Follow and keep up with all existing and new COVID-19 vaccination provider requirements.

C-SLV-specific Communications

In addition to routine communication about SLV clinics, planners may wish to provide specific information to parents to answer the following questions about C-SLV:

• Why are students being offered COVID-19 vaccine at the school?
• Is it mandatory/required that my child receive the COVID-19 vaccine?
• Will the school also provide the second dose of vaccine (if applicable)?
• What if my child has a reaction to the COVID-19 vaccine at school?
• What if the vaccine makes my child feel sick and they miss school? Will their absence be excused?
• What are common reactions after vaccination (e.g., painful injection site)?
• How can I comfort my child after vaccination?
• When should I seek medical advice and who should I contact?

You can find customizable templates to communicate with parents prior to the first and second C-SLV clinic, as applicable, as well as post-vaccination communications for students who were and were not vaccinated.

Educating students, parents/guardians, and school staff on the safety and efficacy of COVID-19 vaccines, as well as the importance of COVID-19 vaccination, may increase vaccine confidence and contribute to the success of C-SLV programs and clinics. Promotional materials can be found on the COVID-19 Print Resources page.

See frequently asked questions about COVID-19 and COVID-19 vaccines  for additional information.

While many healthcare providers will likely be supportive of the C-SLV programs, they may still have concerns about vaccinations occurring outside of their practices. You can help alleviate healthcare providers’ concerns by keeping them informed about the program, involving them early in the process, and reassuring them that you will enter vaccination information into the IIS in a timely manner and promoting well child visits and routine vaccination catch up.

Find a customizable template communication to local healthcare providers.

C-SLV-specific Training

Because COVID-19 vaccines are new, it will be critical that all personnel involved with C-SLV programs receive appropriate training. Training is important not only for those who will prepare and administer vaccine, but also for those responsible for other critical, mandatory functions, including protecting the vaccine cold chain, inputting required data, and ensuring vaccine recipients receive documentation of vaccination. At a minimum it is highly recommended that all healthcare personnel review the COVID-19 module for the vaccine(s) being administered.

COVID-19 Post-vaccination Side Effects

It is not uncommon for people, including children and adolescents, to experience side effects following COVID-19 vaccination. Because of this, staff from schools/school districts participating in C-SLV should consider developing protocols for contacting parents/guardians and sending students home early if they are feeling ill post-vaccination. Also consider establishing protocols for excusing school absences one to two days after vaccination as students experience side effects.

Additional Resources

National Association of County and City Health Officials [NACCHO] School-Located Influenza Vaccination Toolkitexternal icon

References

Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration — United States, 2020 | MMWR 

Decline in Child Vaccination Coverage During the COVID-19 Pandemic — Michigan Care Improvement Registry, May 2016–May 2020 | MMWR (cdc.gov)

Notes from the Field: Rebound in Routine Childhood Vaccine Administration Following Decline During the COVID-19 Pandemic — New York City, March 1–June 27, 2020 | MMWR (cdc.gov)

Hull HF, Ambrose CS. Current experience with school-located influenza vaccination programs in the United States: a review of the medical literature. Hum Vaccin. 2011;7(2):153-160. doi:10.4161/hv.7.2.13668

Jenlink CH, Kuehnert P, Mazyck D. Key components of a school-located vaccination clinic: lessons learned from fall 2009. J Sch Nurs. 2010;26(4 Suppl):14S-26S. doi:10.1177/1059840510372345

Klaiman T, O’Connell K, Stoto MA. Learning from successful school-based vaccination clinics during 2009 pH1N1. J Sch Health. 2014;84(1):63-69. doi:10.1111/josh.12119

Lott J, Johnson J. Promising practices for school-located vaccination clinics–part I: preparation. Pediatrics. 2012;129 Suppl 2:S75-S80. doi:10.1542/peds.2011-0737F

Lott J, Johnson J. Promising practices for school-located vaccination clinics– part II: clinic operations and program sustainability. Pediatrics. 2012;129 Suppl 2:S81-S87. doi:10.1542/peds.2011-0737G

Mazyck D. School-located vaccination clinics: then and now. J Sch Nurs. 2010;26(4 Suppl):3S-6S. doi:10.1177/1059840510369231

Park K, Cartmill R, Johnson-Gordon B, et al. Preparing for a School-Located COVID-19 Vaccination Clinic. NASN Sch Nurse. 2021;36(3):156-163. doi:10.1177/1942602X21991643Vogt TM, Wortley PM. Epilogue: school-located influenza vaccination during the 2009-2010 pandemic and beyond. Pediatrics. 2012;129 Suppl 2:S107-S109. doi:10.1542/peds.2011-0737K