Influenza (Including H1N1) (BT)This is a featured page

This page lists research references, reports and planning/educational resources for monitoring and reporting on school-based and school-linked health and social development programs. Between September 15 and December 15, 2009, members of an International Discussion Group were invited to comment on and edit the text of this list using the tools provided in this wiki-based web site. This version has been completed by the team of contributors and writer as a first edition. Readers are encouraged to add to this list by clicking on the "easy edit" tool found above. Readers can also comment on the list by using the discussion "thread" tool found at the bottom of the page. If you would like to comment on or make suggestions about the overall web site, click on the "Discussions" in the top navigation bar.

Reducing the Spread of Influenza (Including H1N1)

In this outline, we identify relevant research, reports and resources within an understanding of the issue that we describe as an ecological and systems-based approach to school-based and school-linked health, safety, social and sustainable development. This outline suggests that we need a holistic understanding of the nature, prevalence, aspects and factors affecting the issue, the influence of the school's physical and social environment as well as its core practices, the effectiveness of comprehensive approaches, coordinated agency-school programs and whole school strategies as well as individual interventions, how these interventions can be implemented and sustained while ongoing capacities are built at all levels within education, health and other systems in a manner that respects the complex, open, loosely-coupled and bureaucratic systems that support schools. This outline also lists links that apply these interventions in a variety of local community and country contexts with a deep understanding of the core mandates and constraints of schools and educators. The outline concludes with items relating to future research questions, and methods.

Interventions are defined as including policies (including professional practice guidelines and organizational practices), educational programs, health, social, student & other services, social support activities such as parent involvement, youth engagement, working with media and community and changes to the physical environment or other practical resources such as transportation to and from school. The research cited here includes research reviews, important case studies and textbooks. The reports includes discussion/position papers and status reports. The resources include examples of programs/guidelines/mandates, planning guides/manuals, educational programs/curricula/educational methods guides, health or other agency service/clinical guidelines/mandates to work with schools, policy tools/guidelines/examples, assessment/evaluation tools, training tools and other resources such as key web sites or organizations

This framework or outline includes these sections:
A. Understanding the Problem: (Prevalence, nature, aspects of the problem, behaviour theories that explain it)
B. Impact, Role of the School on the Problem
(Influence of the physical and social environment, role of school in preventing and models describing school approaches)
C. Effects of Comprehensive Approaches
(Multi-issue, multi-level, multi-system programs) Coordinated Programs and Services (School-Agency Programs and Whole School Only Programs)
D. Effects of Individual Evidence-based Interventions
(Including Policy, Instruction, Services, Social Support, Physical Environment Interventions)
E. Implementation and Sustainability
(Including Evidenced-based, Practical and Strategic Implementation Strategies, diffusion or education change theories, Capacity-building/Continuous Improvement and Strategic Consideration of System/Agency/School Characteristics
F Consideration of Local Community Contexts
G. Consideration of and Integration within the Constraints and Educational Mandate of the School
H Questions related to Future and Current Research
(Methods, link to educational outcomes, cost-effectiveness etc)

A. Understanding the Problem

A-1 Prevalence & Nature of the Problem Among Young People
(Including holistic understanding of the problem and comprehensive approaches to program/policy/practice development)


Public Understanding/Reluctance about Vaccines/

Research Article Influenza Vaccine — Safe, Effective, and Mistrusted (NE J of Medicine - Dec -10)

Research Article (Sep-2010) Factors in vaccination intention against the pandemic influenza A/H1N1

Review. (nd) Cochrane Influenza Resources: podcasts and presentations

Szilagyi P, Vann J, Bordley C, Chelminski A, Kraus R, Margolis P, Rodewald L (2002) Interventions aimed at improving immunization rates. Cochrane Database Syst Rev. 2002;(4):CD003941. Review. Update in: Cochrane Database Syst Rev. 2005;(3):CD003941.

Bekker A, Chou C, Bernstein HH (2009) Update on universal annual influenza immunization recommendations for children. Curr Opin Pediatr. 2009 Feb;21(1):122-6

Schwartz B, Hinman A, Abramson J, Strikas RA, Allred N, Uyeki T, Orenstein W. (2006) Universal influenza vaccination in the United States: are we ready? Report of a meeting. J Infect Dis. 2006 Nov 1;194 Suppl 2:S147-54

Research Article (Sep-2010) Perceived risks of adverse effects and influenza vaccination: a survey of hospital employees

Vaccine Literacy(Equitable access & use issues)

Transportation and Employment related Problems

Child/Parent Emotional reactions to Vaccinations

Cochrane review Hand washing for preventing diarrhoea

Commentary. Do Public Health and Infection Control Measures Prevent the Spread of Flu?

Commentary (2008). Overview of Prevention of Influenza

Commentary (2007) Pandemic Influenza: Is This Threat Real?

Commentary (2007). List of Public Health Measures in an Influenza Pandemic

Articles in Supplement Issue of October American Journal of Public Health
  • A Primer on Strategies for Prevention and Control of Seasonal and Pandemic Influenza
  • Protecting Vulnerable Populations From Pandemic Influenza in the United States: A Strategic Imperative
  • Pandemic Influenza and Pregnant Women: Summary of a Meeting of Experts
  • Pandemic Influenza Planning: Addressing the Needs of Children
  • Protection of Racial/Ethnic Minority Populations During an Influenza Pandemic
  • Pandemic Influenza Preparedness and Vulnerable Populations in Tribal Communities
  • Pandemic Influenza Preparedness and Response Among Immigrants and Refugees
  • Preparing for and Responding to Pandemic Influenza: Implications for People With Disabilities
  • Effective Health Risk Communication About Pandemic Influenza for Vulnerable Populations
  • Pandemic Influenza and Jail Facilities and Populations
  • Screening for Influenza Infection in International Airline Travelers
  • Changes in Prescribing of Antiviral Medications for Influenza Associated With New Treatment Guidelines
  • Pandemic Influenza and Community Preparedness
  • Compliance With Multiple-Dose Vaccine Schedules Among Older Children, Adolescents, and Adults: Results From a Vaccine Safety Datalink Study
  • Experimental Pretesting of Hand-Washing Interventions in a Natural Setting

SH Articles in November Issue of Journal of Adolescent Health
The January Issue of Pediatrics articles in this issue include:
  • Health Care Utilization by Adolescents on Medicaid: Implications for Delivering Vaccines
  • Meeting the Needs of Adolescents: Pediatric Medical Education and Workforce Development
  • Recommended Childhood and Adolescent Immunization Schedules—United States, 2010

Web Site (Canada)

Fact Sheet Immunization Awareness (CPHA, 2010)

Fact Sheet Comparison of Effects of Diseases and Vaccines (Canada, 2006)

Web Site Global Handwashing Day

Policy Doc (USA) Recommended Influenza Vaccines for the U.S.2010-11 season
Web Site School Hygiene & Sanitation (World Bank)

Policy Doc ESSENTIAL PACKAGE of School Interventions for Developing Countries (UNICEF & WFP)

Web Site Sanitation England (My School Loo Campaign)

Policy Doc. WHO Pandemic (H1N1) 2009 briefing note 10

Website. Handwashing

Ed Resource. Web site Hygiene. CDC-Lysol.

Wikipedia Updated Summary on H1N1 in Canada.

Encyclopedia Summary. History of 1918 Spanish Flu.

Web Tools Cochrane Influenza Resources: podcasts and presentations

Web page. CMA Info on H1N1 Flu. Go to:

Flu Tracking web site to track flu in Canada. Media reports, official sites and more.

CDC page on H1N! virus. Go to:

Web Site. Sanitation in Schools. International agencies.

A-2 Specific Risks, Behaviours and Conditions related to the general issue (These can be a focus on higher risk populations or particularly important behaviours or conditions relevant to the problem)


A-3 Behavioral Theories that Explain the Problem or Approaches to Prevention (These can be a focus on higher risk populations or particularly important behaviours or conditions relevant to the problem)


B. Influence of the School on the Issue

B-1 Impact of the School Environment on the Problem (This section examines the impact of the natural social and physical environment of the school on the problem or behaviour. This is not focused on interventions that are listed below)

Influence of physical and social environment of the school

School as Incubator/Herd Effect

Loeb M, Russell, ML, Moss L et al, (2010) Effect of Influenza Vaccination of Children on Infection Rates in Hutterite Communities, JAMA. 2010;303(10):943-950

Glezen WP Gaglani MJ, Kozinetz CA, Piedra PA (2010) Direct and Indirect Effectiveness of Influenza Vaccination Delivered to Children at School Preceding an Epidemic Caused by 3 New Influenza Virus Variants J Infect Dis. (2010) 202 (11): 1626-1633.

Talbot HK, Poehling KA, Williams JV, Zhu Y, Chen Q, McNabb P, Edwards KM, Griffin MR (2009) Influenza in older adults: impact of vaccination of school children. Vaccine. 2009 Mar 18;27(13):1923-7

Playground and Recess Practices

Lunchtime Practices

Availability and Accessibility of a School Health Clinic Office

Personal, Family, School Hygiene Awareness and Practices

Curtis VA, Danquah LO, Aunger RV (2009) Planned, motivated and habitual hygiene behaviour: an eleven country review, Health Educ. Res. (2009) 24(4): 655-673

B-2 Rationale, Connection to the School's mandate, Models and Frameworks that describe a school approach to the problem (These can be a focus on higher risk populations or particularly important behaviours or conditions relevant to the problem)


C. Effectiveness of Comprehensive Approaches, Coordinated Agency-School Programs, Whole School Strategies on the Problem, Aspects of the Problem

C-1 Comprehensive Approaches
(looking at Whole Child, not just the health/social problem all children (especially vulnerable), developmental stages/life course, clusters of behaviours and conditions(eg mental health, crime, tobacco, sexual risk-taking, dropouts), community and systems context analysis, synergistic combinations of strategies and initiatives (eg police officers, safe schools, character education, early childhood programs), multi-level , intersectorial strategies, programs and policies)


Report National Immunization Strategy: Final Report 2003 (Canada)

Report Setting the Stage forAdvancements in Immunization in Canada (CPHA, 2009)

Web Page. Alberta Gov't Plan for Pandemic Influenza

Presentation. Oct 12-06. Alberta Interministry Planning for Pandemics.

C-2. Effectiveness of Coordinated Programs and Services (Differentiate (if possible) between Coordinated School-Community Programs (CSHP) and Whole-School Programs (HPS) involving only school-based personnel



Coordinated SH Programs (School-Agency-Community personnel are involved)


Whole School (HPS) (involving only school-based personnel in delivery)


How Principals Can Prepare Schools for the H1N1 Virus What impact will the H1N1 virus have on schools this fall? Listen to the School Leader's Review podcast with NASSP's Mel Riddile(NASSP)

Effects of Programs on Health and Social Development in General


Effects of Programs on the Disease/Social Problem, or speciifc Conditions/Factors/Behaviours in Particular


Pandemic Flu Checklist for Schools (USA Health & Human Services)

Policy Doc Flu Preparedness (NASBE, 2009)

Training Resource (Video) US. How to Prevent the Spread of Swine Flu in Schools

Effects of Programs on Learning (Educational achievement and school effectiveness)

Research Study (2008) Countywide school-based influenza immunization: direct and indirect impact on student absenteeism

Davis MM, King JC Jr, Moag L, Cummings G, Magder LS (2008) Countywide school-based influenza immunization: direct and indirect impact on student absenteeism. Pediatrics. 2008 Jul;122(1):e260-5

Nettleman MD, White T, Lavoie S, Chafin C (2001) School absenteeism, parental work loss, and acceptance of childhood influenza vaccination.
Am J Med Sci. 2001 Mar;321(3):178-80

Hull HF, Ambrose CS (2010) The Impact of School-Located Influenza Vaccination Programs on Student Absenteeism: A Review of the U.S. Literature.

J Sch Nurs. 2010 Nov 15

Maryellen Guinan, Maryanne McGuckin, Yusef AliAm (2008) The effect of a comprehensive handwashing program on absenteeism in elementary schools. J Infect Control. 2002 Jun ;30 (4):217-20

B Hammond, Y Ali, E Fendler, M Dolan, S Donovan (2000) Effect of hand sanitizer use on elementary school absenteeism Am J Infect Control. 2000 Oct ;28 (5):340-6

D. Effectiveness of Individual Evidence-based Interventions (Differentiate among primary, secondary, tertiary prevention of health promotion, prevention, assistance, rehabilitation etc)


D-1 Policy Interventions


Nandrup-Bus I. (2009) Mandatory handwashing in elementary schools reduces absenteeism due to infectious illness among pupils: a pilot intervention study. Am J Infect Control. 2009 Dec;37 (10):820-6

Master D, Hess Longe SH, Dickson H. (1997) Scheduled hand washing in an elementary school population.
Fam Med. 1997 May;29(5):336-9.

  • Coordination re surveillance

  • School Policy re Vaccines and School Entry/Immunization Registries
Linkins RW, Salmon DA, Omer SB, Pan WK, Stokley S, Halsey NA (2006) Support for immunization registries among parents of vaccinated and unvaccinated school-aged children: a case control study. BMC Public Health. 2006 Sep 22;6:236
Policy Doc (CDC, USA) Guidance for School Administrators to Help Reduce the Spread of Seasonal Influenza in K-12 Schools

Web Page. Yukon Government on H1N1 Preparation.

Policy Doc. Saskatchewan School Flu Guidelines.

Policy Doc. Manitoba Guidelines for Pandemic Influenza.

Policy Doc. Manitoba Govt. H1N1 Information for Schools and Daycares

PHAC School Guidlines for H1NI. Full text at:

Web Page. Mi"kmaq Community has Flu Management Plan.

Policy Doc. Quebec guide for schools during Flu pandemics Full text at:

Policy Doc. Newfoundland Government. Managing Flu in Summer & Day Camps. Full text at:

Communications Toolkit for School, College, University Administrators. Nova Scotia Government. full text at:

Policy Doc. School Guidelines re Flu. Victoria, Australia. Full text:

CDC Materials for Infectious Outbreaks. Go to:

Policy Doc. Australia State (Victoria) School Flu Policy. Full text at:

News Story & Video Clip. Aug 21. Tennessee SD explains their flu planning.

D-2 Instructional Interventions (Focus on general as well as specific skills, specific functional knowledge, normative beliefs, teacher skills, support for instruction, better scope/sequence of curricula)


  • Infection awareness (cough, cover)

  • Awareness of value of Vaccinations and Immunization


- Study (2004) The effect of a comprehensive handwashing program on absenteeism in elementary schools.

Review (2002) The Importance of School-Based Handwashing Programs

- Review (2006) Handwashing and risk of respiratory infections: a quantitative systematic review.


Tousman S, Arnold D, Helland W, Roth R, Heshelman N, Castaneda O, Fischer E, O'Neil K, Bileto S (2007) Evaluation of a hand washing program for 2nd-graders. J Sch Nurs. 2007 Dec;23(6):342-8.
Educational Resource. Lesson plans. Handwashing. Primary School

Educational Resources. Lesson Plans Handwashing High School .

"STOP! Clean your hands"Canada's Hand Hygiene campaign with CHICA-Canada, the Canadian Council on Health Services Accreditation, the Canadian Patient Safety Institute and the Public Health Agency of Canada:

Ed Resource. Hygiene. Primary Schools. Canada

Just Wash 'Em" is a 7 minute video directed to Elementary School aged children. View Sudsy Video Clip on Mac or Windows with QuickTime (1MB)
Download QuickTime

Hygiene/Prevention of InfectionsEd Resource Hygiene. Canadian Red Cross.

Ed Resource. Canada. National Infection Control Week

Instruction Resource (Curriculum & Lesson Plans) . Hygiene Education. UNICEF.

Lesson Plans. Hygiene Education. For Developing Countries.
Vaccine Safety

Glik D, Macpherson F, Todd W, Stone K, Ang A, Connell Jones M.(2004) Impact of an immunization education program on middle school adolescents Am J Health Behav. 2004 Nov-Dec;28(6) :487-97.

D-3 Health and Other Services Interventions

Policy Doc Immunization Issues (CPHA, 2010)

Policy Doc Canadian Immunization Guide (PHAC, 2006)

Ransom J.(2009) School-located influenza vaccination clinics: local health department perspectives. J Sch Nurs. 2009 Feb;25 Suppl 1:13S-7S.PMID: 19197009

Silfverdal SA, Nilsson L, Blennow M, Carlsson RM, Hanson LÅ, Lindberg A, Lindquist L, Magnusson M, Norlund A, Nyrén O, Olcén P, Olin P, Säwe J, Söderström A, Trollfors B, Örtqvist Å. (2010) Vaccination of children – summary and conclusions from a systematic review Acta Paediatr. 2010 Sep;99(9):1287-9

  • Review (2009) Update on universal annual influenza immunization recommendations for children.
  • Task Force on Community Preventive Services. Recommendations regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med 2000;18(1S):92-6.

  • Ferson MJ, Fitzsimmons G, Christie D, Woollett H. School health nurse
    interventions to increase immunisation uptake in school entrants. Public
    Health 1995;109:25–9.

  • Peterson L. Prevention and community compliance in immunization schedules. (1987) Prevention and Health: Directions for Policy and Practice 1987;5:79 –95.

  • Hand JS, Anderson D, Feffer D, Day CA. (1980) Successful school immunization program — or not? J Sch Health 1980;50:5.

  • Unti LM, Coyle KK, Woodruff BA, Boyer-Chuanroong L. (1997) Incentives and motivators in school-based hepatitis B vaccination programs. J Sch Health 1997;67:265– 8.

From September/October 2010 Issue of Canadian Journal of Public Health
  • Cost Analysis of Public Health Influenza Vaccine Clinics in Ontario
  • Youth Friendly Health Services
  • Barriers to Acceptance of Self-sampling for Human Papillomavirus across Ethnolinguistic Groups of Women
  • Pandemic Influenza (H1N1): Our Canadian Response
  • Research Review (2006) Incentives to encourage adolescent visits to health services.
  • Study (2004) Health information-seeking behaviour in adolescence: the place of the internet
SH Articles in November Issue of Journal of Adolescent Health

Role of School Nurse

Articles from February Supplement of Journal of School Nursing:Championing School Influenza Immunization: The School Nurse's Role
  • Introduction
  • Seasonal Influenza: An Overview
  • School-Located Influenza Vaccination Clinics: Local Health Department Perspectives
  • Championing School-Located Influenza Immunization: The School Nurse’s Role
  • School Nurse Perspectives

D-4 Social Support Interventions


Parent Education & Involvement

News Oct 17 Cervical vaccine letter (HPV) upsets mum in Australia

Allison MA, Reyes M, Young P, Calame L, Sheng X, Weng HY, Byington CL
(2010) Parental attitudes about influenza immunization and school-based immunization for school-aged children.
Pediatr Infect Dis J. 2010 Aug;29(8):751-5

Parent Education

Web Page Immunize your Child (Public Health Agency of Canada)

Fact Sheet Handwashing (APHA, 2010)

Ed Resource Childhood Immunization (Public Health Agency of Canada)

Ed Resource Vaccine literacy: Canada’s eight-step vaccine safety program

Web Page Vaccine-Preventable Diseases (Public Health Agency of Canada)

Ed Resource. How to Wash Hands

Educational Resource. Canada. National Infection Control Week

Ed Resource. Hygiene Campaign. Newfoundland.
Youth Engagement
Student Web Project. Online class exchange project - secondary schools- sanitation & hygiene
Staff Awareness

D-5 Physical Environment Interventions

School Sanitation & Hygiene

- Research Study. Critical issues regarding the planning of school sanitation and hygiene education programmes in India'

Planning Guide (USA) How To Clean and Disinfect Schools To Help Slow the Spread of Flu

School Self-Assessment Tool Environmental Health Ontario.
Hand Gels & Sanitizers

Morton JL, Schultz AA (2004) Healthy Hands: Use of Alcohol Gel as an Adjunct to Handwashing in Elementary School Children J Sch Nurs. 2004 Jun;20(3):161-7.

Meadows E, Le Saux N (2004)

Sanitary and Safe Bathrooms

Clean Surfaces/Precautions

Bright KR, Boone SA, Gerba CP. (2010) Occurrence of bacteria and viruses on elementary classroom surfaces and the potential role of classroom hygiene in the spread of infectious diseases.J Sch Nurs. 2010 Feb;26(1):33-41

Sandora TJ, Shih MC, Goldmann DA.(2008)Reducing absenteeism from gastrointestinal and respiratory illness in elementary school students: a randomized, controlled trial of an infection-control intervention.Pediatrics. 2008 Jun;121(6):e1555-62

E. Implementation and Sustainability (Including the use of Evidenced-based, Practical and Strategic Implementation Strategies, diffusion or education change theories, Capacity-building/Continuous Improvement Strategies and Strategic Consideration of System/Agency/School Characteristics (eg teacher work life research-use of lesson plans, school improvement research, open, loosely-coupled, bureaucratic systems)

E-1 Evidence-based, Practical and Strategic Implementation Strategies

National Pandemic Management, Influenza Campaign Implementation

Article (Can PH Journal, Dec-10) Influenza Pandemic Planning and Performance in Canada, 2009

Research Article (Sep -2010) Moderate pandemic, not many dead—learning the right lessons in Europe from the 2009 pandemic

Research Article (Sep-2010) Framing disease: The avian influenza pandemic in Australia

Centers for Disease Control and Prevention (CDC).(2010) Interim results: state-specific seasonal influenza vaccination coverage - United States, August 2009-January 2010. MMWR Morb Mortal Wkly Rep. 2010 Apr 30;59(16):477-84. Erratum in: MMWR Morb Mortal Wkly Rep. 2010 May 14;59(18):561

Centers for Disease Control and Prevention (CDC).(2009) Influenza vaccination coverage among children and adults - United States, 2008-09 influenza season. Morb Mortal Wkly Rep. 2009 Oct 9;58(39):1091-5

Web page. Case studies in school sanitation, low income countries.

Planning Guide. Sanitation for primary schools in Africa

Implementation of School Influenza, Vaccination, Hygiene and Infection Control Programs

Como-Sabetti K, Livingston F, Gahr P, Nagle K, Martin K, Morin G, Parilla E (2010) The 2009 H1N1 Influenza Pandemic and Minnesota’s K-12 Schools Minnesota Medicine, Sep, 2010,

Research Review (2010) Strategies for implementing school-located influenza vaccination of children: a systematic literature review.

Cawley, J., Hull, H. F. and Rousculp, M. D. (2010), Strategies for Implementing School-Located Influenza Vaccination of Children: A Systematic Literature Review. Journal of School Health, 80: 167–175. doi: 10.1111/j.1746-1561.2009.00482.x

Kempe A, Daley MF, Barrow J, Allred N, Hester N, Beaty BL, Crane LA, Pearson K, Berman S (2005) Implementation of universal influenza immunization recommendations for healthy young children: results of a randomized, controlled trial with registry-based recall. Pediatrics. 2005 Jan;115(1):146-54

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

Jenlink CH, Kuehnert P, Mazyck D (2010) Influenza vaccinations, fall 2009: model school-located vaccination clinics. J Sch Nurs. 2010 Aug;26(4 Suppl):7S-13S

Carpenter LR, Lott J, Lawson BM, Hall S, Craig AS, Schaffner W, Jones TF (2007) Mass distribution of free, intranasally administered influenza vaccine in a public school system.
Pediatrics. 2007 Jul;120(1):e172-8.

Levy DJ, Ambrose CS, Oleka N, Lewin EB (2009) A survey of pediatricians' attitudes regarding influenza immunization in children. BMC Pediatr. 2009 Jan 30;9:8.

Painter JE, Sales JM, Pazol K, Grimes T, Wingood GM, DiClemente RJ (2010) Development, theoretical framework, and lessons learned from implementation of a school-based influenza vaccination intervention. Health Promot Pract. 2010 May;11(3 Suppl):42S-52S

Kwong JC, Ge H, Rosella LC, Guan J, Maaten S, Moran K, Johansen H, Guttmann A. (2010)
School-based influenza vaccine delivery, vaccination rates, and healthcare use in the context of a universal influenza immunization program: an ecological study. Vaccine. 2010 Mar 24;28(15):2722-9

Tung CS, Middleman AB. (2005) An evaluation of school-level factors used in a successful school-based hepatitis B immunization initiative. J Adolesc Health. 2005 Jul;37(1):61-8

Watson M, Shaw D, Molchanoff L, McInnes C (2009) Challenges, lessons learned and results following the implementation of a human papilloma virus school vaccination program in South Australia. Aust N Z J Public Health. 2009 Aug;33(4):365-70

Boyer-Chuanroong L, Woodruff BA, Unti LM, Sumida YU (1997) Immunizations from ground zero: lessons learned in urban middle schools. J Sch Health. 1997 Sep;67(7):269-72

Rivest P, Grenier L, Lonergan G, Bédard L. (2005)
Varicella vaccination for grades 4 and 5 students: from theory to practice.
Can J Public Health. 2005 May-Jun;96(3) :197-200

Humiston SG, Rosenthal SL (2005) Challenges to vaccinating adolescents: vaccine implementation issues Pediatr Infect Dis J. 2005 Jun;24(6 Suppl):S134-40

Tran CH, McElrath J, Hughes P, Ryan K, Munden J, Castleman JB, Johnson J, Doty R, McKay DR, Stringfellow J, Holmes RA, Myers PD, Small PA, Morris JG (2010) Implementing a community-supported school-based influenza immunization program Biosecur Bioterror. 2010 Dec;8(4):331-41

Cassidy W (1998) School-based adolescent hepatitis B immunization programs in the United States: strategies and successes Pediatr Infect Dis J. 1998 Jul;17(7 Suppl):S43-6

Goldstein ST, Cassidy WM, Hodgson W, Mahoney FJ. (2001) Factors associated with student participation in a school-based hepatitis B immunization program. J Sch Health.2001 May;71(5):184-7

E-2 Use of Diffusion and Education Change Knowledge/Theory


E-3 Use of Capacity-Building Knowledge/Theory and Sustainability

General use of capacity-building/organizational development

Kuehnert P. (2010) Now more than ever: building and sustaining capacity for school-located vaccination initiatives. J Sch Nurs. 2010 Aug;26(4 Suppl):27S-29S

Specific capacities (according to WHO-SHRN model)

Coordinated Policies & Leadership


Staff Assigned to Coordination


Informal/formal Mechanisms for Cooperation


Ongoing Knowledge Synthesis, Transfer, Exchange


Ongoing Workforce Development


Regular Monitoring and Reporting on health/social development, learning and program capacity


Strategic Management of Emerging Issues/Trends


Explicit plan for sustainability


E-4 Consideration of Ecology and System Characteristics (This section list studies that specifically examine the attributes of school and other systems with a view to implementation and sustainability gains)

General Use of Ecological Approach/Systems thinking


Specific Applications of Ecological/Systems Thinking & Characteristics

Openness (Includes concepts such as system stasis and stability, open systems theory, boundaries between and within organizations, system-environment interactions, change in context, etc)

Loose-coupling between levels in the system (Includes concepts such as adopter concerns, policy levers, ecology/micro-politics of schools, role/style of senior leaders, role/style of middle managers, role/style of front-line staff)

Professional Bureaucracies (Includes concepts such as multi-level systems, influence of structure, internal communications (formal and informal), social networks within organizations, non-rational decision-making, knowledge as power and influence, organizational culture, readiness for innovation, professional norms/ideologies, sociology and work life, career patterns for teachers, nurses, police officers)

Working across Multiple Systems (Includes concepts such as degree of cooperation (communication-collaboration-merger etc), cooperation at different levels in systems)

F Consideration of Community or Cultural Contexts

General references to local community/neighbourhood context


Low Income Countries


Planning Guide. Sanitation for primary schools in Africa

Planning Guide (2006) Scaling up programmes for water, sanitation and hygiene in schools

Web site. Planning Hygiene & Sanitation in Schools.

Web Site. WHO Partners for Parasite Control.

Disadvantaged Communities

Federico SG, , Lisa Abrams, Rachel M. Everhart, Paul Melinkovich, and Simon J. Hambidge (2010) Addressing Adolescent Immunization Disparities: A Retrospective Analysis of School-Based Health Center Immunization Delivery September 2010, Vol 100, No. 9 | American Journal of Public Health 1630-1634

Zimmerman RK, Hoberman A, Nowalk MP, Lin CJ, Greenberg DP, Weinberg ST, Ko FS, Fox DE. (2006) Improving influenza vaccination rates of high-risk inner-city children over 2 intervention years Ann Fam Med. 2006 Nov-Dec;4(6):534-40

Foty RG, Guttmann A, Kwong JC, Maaten S, Manuel D, Stieb DM, Dell SD (2010) Predictors of universal influenza vaccination uptake in grades 1 and 2 Toronto school children: effective vaccination strategies should not end with at risk children.

Vaccine. 2010 Sep 7;28(39):6518-22

Britto MT, Schoettker PJ, Pandzik GM, Weiland J, Mandel KE (2007) Improving influenza immunisation for high-risk children and adolescents Qual Saf Health Care. 2007 Oct;16(5):363-8

Painter JE, Sales JM, Pazol K, Wingood GM, Windle M, Orenstein WA, DiClemente RJ (2010) Psychosocial correlates of intention to receive an influenza vaccination among rural adolescents. Health Educ Res. 2010 Oct;25(5):853-64

Urban Communities/Inner City Communities/Multi-ethnic Communities


Rural Communities


Aboriginal Communities/Schools


Faith-based/Heritage-based /Cultural Communities/Schools


Affluent Communities/Private Schools


G Consideration of and Integration within the Constraints and Educational Mandate of the School


H Questions related to Future and Current Research

Major knowledge/practice/policy questions and draft or existing research agendas


Use of new research methods (beyond RCT’s)


Methodological Issues and Questions


Research Showing the Connection between this Issue and Educational Outcomes or School Effectiveness


Research Showing Cost-Effectiveness or Cost-Benefits and/or Economic Burden of this Problem

White T, Lavoie S, Nettleman MD (1999) Potential cost savings attributable to influenza vaccination of school-aged children. Pediatrics. 1999 Jun;103(6):e73

Guay M, Clouâtre AM, Blackburn M, Baron G, De Wals P, Roy C, Desrochers J, Milord F. (2003) Effectiveness and cost comparison of two strategies for hepatitis B vaccination of schoolchildren. Can J Public Health. 2003 Jan-Feb;94(1):64-7.

Sadoway DT, Plain RH, Soskoline L (1990) Infant and preschool immunization delivery in Alberta and Ontario. A partial cost-minimization analysis. Can J of Public Health. 81 (2): 146-51

Schmier J, Li S, King JC Jr, Nichol K, Mahadevia PJ. (2008)
Benefits and costs of immunizing children against influenza at school: an economic analysis based on a large-cluster controlled clinical trial. Health Aff (Millwood). 2008 Mar-Apr;27(2):w96-104

Salo H, Kilpi T, Sintonen H, Linna M, Peltola V, Heikkinen T (2006) Cost-effectiveness of influenza vaccination of healthy children.
Vaccine. 2006 Jun 5;24(23):4934-41

Ryan J, Zoellner Y, Gradl B, Palache B, Medema J (2006) Establishing the health and economic impact of influenza vaccination within the European Union 25 countries.
Vaccine. 2006 Nov 17;24 (47-48) :6812-22

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