Immunizations: Site-Based Services

Immunization, a term used interchangeably with vaccination, refers to giving a person an antigen to stimulate resistance to a disease. According to the Centers for Disease Control and Prevention (CDC), immunizations are among the 10 greatest public health achievements of the 21st century. Due to widespread acceptance of immunizations, most U.S. children are protected from severe and potentially lethal vaccine-preventable diseases such as smallpox, polio, and measles.

Protecting children and the general public from vaccine-preventable diseases relies on mandates, and mandates, in this case, refers to state laws requiring evidence of children having received certain vaccines to enroll in school. The vaccines are those recommended by the Advisory Committee on Immunization Practices (ACIP), a group that advises the Department of Health and Human Services (DHHS) and the CDC. The vaccines most commonly mandated for school entry include DTaP/Tdap, which protect against diphtheria, pertussis (whooping cough), and tetanus (lockjaw); MMR which protects against measles, mumps, and rubella (German measles); IPV, which protects against polio; hepatitis B; and varicella (chicken pox). Because of ongoing advances in vaccine research, vaccines are continually added to this list.

Most children in the United States receive health care from a primary care provider, such as a doctor or nurse practitioner, who provides preventive care including mandated vaccinations. Some children, however, fail to obtain timely vaccinations. The passage of a new mandate increases demand for the specified vaccine. Mandates for vaccines that require multiple doses (e.g., hepatitis B) or an annual dose (e.g., flu) escalate demand. These challenges can be addressed when schools allow vaccinations to be conducted at their sites: The students and those they could infect receive protection from vaccine-preventable diseases, there is minimal loss of learning time, and parents or guardians lose little to no work time.

[Page 321]After defining school-based and school-located programs, this entry details the elements of successful site-based immunizations programs and provides examples. This entry then addresses barriers to these programs and electronic tools that could assist in implementing site-based vaccinations.