Schools could star in battle vs. flu

Mass. looks for help with shots for kids

It is a black-and-white portrait from a bygone era: children queued up in a school auditorium, arms bared for a shot of protection against a deadly disease.

Now, Massachusetts health authorities are asking schools to again be at the center of an immunization campaign, this time aimed at influenza, not polio.

With the federal government urging for the first time that all children 6 months and older get the flu vaccine, the state is preparing for one of the most ambitious public health campaigns undertaken in years.

Pediatricians would be inundated if they had to vaccinate most of the state's 1.5 million children every year, authorities said yesterday. So schools have emerged, much as they did half a century ago, as central to the effort.

"If you want to get it done, I don't see why you can't do it like that," said Dr. Barry Zuckerman, a member of the state Public Health Council who recalled receiving a polio shot in the 1950s at his New Jersey school. "I remember it was a Saturday, all of the kids in the school were in a line. It was really a community event where there was a sense that something important had been discovered and that we would all benefit."

Pilot programs making the flu vaccine available in schools could start as early as influenza season this fall, said John Auerbach, the state's public health commissioner. And if those succeed, Auerbach said yesterday, the initiative would be primed for expansion.

The campaign could encounter resistance from educators, who, according to the leader of a superintendents' association, already feel they're drowning in demands unrelated to teaching.

Trials in several states have demonstrated that vaccination drives in school succeed in delivering flu vaccine to children, with about half of students being immunized, said Dr. Anthony Fiore, a flu specialist at the US Centers for Disease Control and Prevention.

Earlier this year, federal doctors recommended that nearly all youngsters be vaccinated against the viral illness, which kills an average of 36,000 Americans each year.

While the disease poses the greatest threat to the aged and infirm, it can prove deadly to children: Last flu season, more than 70 youngsters died from the illness.

And researchers have found that children play a major role in spreading the disease, with day-care centers and schools acting like incubators for the virus.

But vaccinating children against the disease - which is a recommendation, not a requirement - turns out to be a daunting proposition. It is a matter of volume and time.

Massachusetts has about 1.5 million children between the ages of 6 months and 18 years. And, to maximize protection, the vaccine - as either an injection or a nasal spray - should be given during a two- or three-month period, every year. And children 9 years and younger being vaccinated for the first time need two doses, to establish a strong shield against the respiratory germs.

Dr. Alfred DeMaria, the state's top disease tracker, predicted it could take several years to smooth out the logistics of making flu vaccinations widely available in schools, which have not been regularly used for vaccinations of any kind since the 1990s, when the hepatitis B vaccine was introduced.

The state has purchased 808,000 doses of flu vaccine this year, with 500,000 targeted toward childhood vaccinations, DeMaria said; the rest of the vaccine used in Massachusetts, potentially another 2 million doses, comes from private sources.

"It's a major logistical challenge," DeMaria said. "You can talk about polio. You can talk about hepatitis. But this is different. This is every year, and it's a circumscribed part of the year. But it's the right thing to do."

In some cases, he said, big pediatric practices are planning to hold special clinics when large numbers of patients can be vaccinated. But many other practices might be swamped.

"If we are going to have to see them all in November or December, it'll overwhelm our appointment systems and our traditional clinics," said Dr. Sean Palfrey, a past president of the Massachusetts branch of the American Academy of Pediatrics and an ardent advocate of childhood immunizations.

Palfrey conceded that pediatricians are uncomfortable with the prospect of patients receiving vaccines outside the office of their regular doctor. "Vaccines are one of the several most powerful ways that we get people to keep their appointments at their medical home," he said.

Thomas Scott, executive director of the Massachusetts Association of School Superintendents, said any proposal to use schools for flu vaccination drives will inevitably confront two concerns: Who would give the immunizations, and who would pay?

"It's not that anyone questions the need or the fact that schools are the agency where kids show up," Scott said. "The schools just feel they have really become the place where virtually all social, medical, and academic issues are being addressed."

In some cases, vaccines might be given by nurses or other medical professionals in school clinics, perhaps using shots or nasal mist from the state's cache. In other cases, districts might enlist private companies that provide shots and bill insurers.

Despite reluctance in some quarters, school systems might embrace flu shots for a simple reason, said Glenn Koocher, executive director of the Massachusetts Association of School Committees: They want to reduce student absences.

Stephen Smith can be reached at stsmith@globe.com.