Impact of the COVID-19 Pandemic on Pennsylvania School Nurse Management of Student Immunization Requirements.

School nurses play a significant role in the coordination of school-entry immunization requirements across the United States. The COVID-19 pandemic changed the school landscape and introduced additional responsibilities to a school nurse's workload. We conducted a cross-sectional survey with n = 110 Pennsylvania school nurses to explore the impact of the COVID-19 pandemic on school-entry immunization compliance management. Qualitative and quantitative data indicated increased difficulty obtaining school-entry immunization data (n = 52) and reduced school-level enforcement of immunization compliance (n = 30). We also observed increases in the percentage of students enrolled with an immunization exemption in Kindergarten, 7th, and 12th grades between the 2019-2020 and 2020-2021 school years. However, few respondents (15%) offered school-located immunization clinics (SLIC) for school-entry-required immunizations. While the benefits of SLICs are documented, the capacity required to execute recommended actions may be limited among school nurses-particularly post-COVID-19 pandemic. School nurses may need additional support to address these gaps.