Squirt by squirt, students in Olmsted County have been vaccinated for the flu since 2009.

The collaboration between Mayo Clinic, Olmsted Medical Center, Olmsted County Public Health and local school districts began eight years ago with just two buildings participating.

Last year, roughly 40 percent of enrolled students were vaccinated, and 47 of the 50 public and private school buildings in the county took part in the blossoming program.

However, changes are in store for this fall based on new national standards.

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices(ACIP) voted in June to switch the federal recommendations on flu vaccines from nasal sprays to flu shots.

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That decision was based on national data from 2013-2016 that showed "no protective benefit could be measured" among children 2-17 who had received the nasal spray, according to CDC statement. By comparison, flu shots had an estimated vaccine effectiveness of 63 percent, according to CDC.

Mayo Clinic and OMC have both opted to accept that recommendation, which means altering their long-standing preference for the nasal spray flu vaccines.

In short, students need to prepare themselves for needles for the upcoming wave of vaccines that will be offered in local schools.

"We not only had the nasal spray, we preferred it," said Mayo Clinic's Robert Jacobson, medical director of Southeast Minnesota Region Immunization Program and professor of pediatrics at Mayo Clinic College of Medicine. "But now the data is telling us otherwise. We're going to focus on pain reduction. We're going to work very hard with parents and kids to make this as pain free as we can."

Dr. Jacobson says that pain reduction methods will be offered along with the flu shot, including a coolant spray. He remains hopeful that the change won't negatively impact vaccination numbers, which are among the best in the nation.

The program is as simple as it is effective. Students are rotated out of class throughout a single day to receive the flu vaccinations from visiting health care professionals, with dates scheduled in September and October. Parents are required to sign up for the convenient service, which Jacobson says is fully reimbursed by insurance, at the cost of missing roughly 15 minutes of class time.

Additionally, Mayo Clinic's financial analysis of the program suggests it costs up to $80 less per dose to administer flu vaccines in a school setting than at a hospital or clinic.

Since 2010, Olmsted County has averaged 62.4 percent flu vaccination rate for children 5-9 years old. The national rate over that same time period is 55 percent, but the other 10 counties in Southeast Minnesota have averaged just 35 percent, according to data published this spring by Jacobson and other local specialists.

"(Kids are) much more willing to sneeze and cough on each other," Jacobson said. "In fact, studies have shown that if you vaccinate the children, you can save the elderly from infection and possibly death."

The expansion of the local collaborative has played a key role in those numbers. After starting in just two elementary buildings in 2009, participation jumped to 30 by 2012. All but three school buildings across the county took part in 2015.

Due to the significant number of students involved, Mayo, John Marshall and Century high schools are the only local buildings not yet enrolled in the vaccination program. The full vaccination schedule is posted online, but the collaborative says its "goal for 2017 includes expanding to the last three Rochester public high schools" following a second year in the Rochester middle schools.

"We understand where they're coming from, so we really respect their decision to see how this year goes and see whether we can manage the middle schools and these larger numbers," Jacobson said. "We believe that we will get there. We all have the same vision."

RPS praised the work of the collaborative, while also confirming its goal is to eventually include all 23 Rochester buildings in the vaccination offerings.

"The middle schools were added last school year, which provided a good testing ground for how to manage schools with larger student populations," RPS said via written statement. "Everyone in the partnership has the goal of gradually adding schools until all are included in the immunization clinics."