Bristol Consolidated School Nurse Linda Cosgrove, RN, never imagined herself a school nurse until she accepted a temporary position at a school and discovered how much she liked working with children.

The job she took comes with challenges very different from those of a school nurse a few decades ago.

While Cosgrove, an RN with 37 years' experience, still bandages skinned knees, she spends a lot of time working with children and their families to manage chronic conditions like diabetes or asthma.

Nationwide, the proportion of children with chronic health conditions more than doubled from about 13 percent in 1994 to about 27 percent in 2006, and the incidence of asthma continues to climb. According to the Centers for Disease Control and Prevention, about 9 percent of American children had the disease in 2012. People with asthma are at risk of potentially severe complications like pneumonia if they get the flu or other respiratory diseases.

At the same time, many families continue to struggle years after the "great recession." Cosgrove knows that sometimes parents send a sick child to school because they can't afford to take a day off to care for them. She knows a student may come to school without a hot shower because his or her family can't afford to fill the oil tank.

Keeping those children as healthy as possible and helping them avoid the medical crises that could keep them out of school means working with not just students, but also their families.

So when Cosgrove was contacted by Maine Center for Disease Control and Prevention last fall about holding a vaccination clinic at the school, it was an easy decision.

With the help of Lincoln Medical Partners Pediatrics, about 45 children were vaccinated along with 12 staff, more than a quarter of the school's population.

Even though this year's flu vaccine is only partially effective against the most common strain of the flu, there is no doubt in Cosgrove's mind that the clinic has kept her children healthier and safer this year. She hopes to hold another one next year.

Even in a year in which the flu vaccine is less effective, it is still the best protection Cosgrove can offer her children against what can be a very serious illness.

"When we can provide this to them free of charge, it keeps the school population healthier, it keeps their families healthier and I think it just contributes overall to the health and well-being of the community," she said.

Immunizations are the cheapest and most effective way of keeping children safe from a wide variety of illnesses, and from Cosgrove's perspective that not only keeps kids in school, it is a great way to support families.
Unfortunately, while vaccines have been proven to be safe and effective by study after study, they have also become victims of their own success. Because the diseases they protect against are now much less common, many parents see vaccinating their children as less important.

"We have had a generation or two now that didn't have to go through the childhood illnesses (that were much more prevalent before vaccines) and they don't remember how sick children got," said Cosgrove. "People forget that children died of chicken pox, measles and pertussis."

That trend is starting to chip away at herd immunity. Herd immunity is the protection that a population - a school or a community - gets when most of its members (about 90 percent for many diseases) are vaccinated. Think of it as a firewall created by those who get vaccinated that protects those who can't or won't.

As more parents choose not to vaccinate, herd immunity is growing weaker in many parts of the country, including Maine, and the chances of outbreaks of childhood diseases that were extremely rare only a decade or so ago are growing.

According to the Centers for Disease Control and Prevention, Maine has the fifth-highest rate of parents choosing to opt out of vaccinations for their children. Lincoln County has the second-lowest vaccination rate in the state for children up to age 2.

As a nurse who worked in hospitals for most of her career, Cosgrove understands what's at stake in the debate over vaccinations.

Early in her medical career, she saw a healthy 35-year-old man die of pneumonia so quickly that doctors and nurses were powerless to save him.

Experiences like that are part of the reason she had her own children vaccinated and it is also the reason she advises other parents to have their children vaccinated.

Vaccinated children are not only less likely to get sick; they are less likely to infect younger siblings and grandparents who are at the highest risk of developing serious complications.

That's not just good for Bristol Consolidated School, that's good for the whole community.

Mark Fourre, MD, is an emergency physician and Chief Medical Officer of Lincoln County Healthcare, the parent company of Miles Memorial Hospital and St. Andrews Hospital. He also serves on Lincoln County Healthcare's Board of Trustees. Prior to joining Lincoln County Healthcare, Dr. Fourre was attending faculty at Maine Medical Center, where he developed the Emergency Medicine Residency Program and served as Residency Director.