In March 2019, an Israeli flight attendant flew from John F. Kennedy International Airport to Tel Aviv.
A week later she developed a fever and eventually slipped into a coma because of encephalitis. The mother of three had contracted measles, and she died from the disease on Aug. 13, 2019. Although death from measles is somewhat rare among adults, the illness is still a leading cause of vaccine-preventable infant mortality globally. Measles outbreaks are also on the rise in the United States, where 1,182 cases have been confirmed in 30 states this year. That is the greatest number of cases reported in the U.S. since the disease was declared eliminated in 2000, according to the Centers for Disease Control and Prevention (CDC).
Dire need for vaccine education
Despite these statistics, public opinion about the importance of vaccines has decreased throughout the past decade. One survey revealed a 10% decline from 2008 to 2018 in the percentage of people who believed vaccination is very important to the health of society, according to data from Research! America and the American Society of Microbiology. While these numbers may seem daunting for vaccination advocates, polls from the CDC are showing healthcare providers are the most influential factor in changing a vaccine-hesitant parent's mind to immunize his or her child.
"There is a tremendous amount of fake information about vaccines on social media and other websites, and it's important for nurses to stay up to date about the safety and efficacy of any vaccine they are giving," said Carol Hayes, CNM, MN, MPH, FACNM, immunization adviser to the American College of Nurse-Midwives and an adjunct professor at Georgia State University's School of Nursing in Atlanta.
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Carol Hayes, CNM, MN, MPH, FACNM[/caption] One of the most common misconceptions about vaccines is their link to developmental delays, and Hayes explains to parents and patients that there have been numerous studies disproving this link in his vaccine education. Another common concern is the flu shot can cause the illness. "I help people understand that this is impossible," said Hayes, who is also a representative on the CDC's Advisory Committee on Immunization Practices (ACIP). "The immune system may take 10 to 20 days to respond to the vaccine and produce antibodies. In that time frame, someone may get the flu, but the vaccine did not cause the flu." As a nurse-midwife, Hayes is versed in vaccine protocols for pregnant women. She recommends these patients receive the flu shot because pregnant women who contract the flu are at higher risk of developing complications such as pneumonia, and a fever during pregnancy can increase the risk that the child will suffer from developmental delays. In 2012, ACIP also voted to recommend that pregnant women receive a dose of the Tdap (tetanus toxoid, reduced diphtheria toxoid and acellular pertussis) vaccine during the third trimester of each pregnancy. The vaccine will allow the mother to develop antibodies to pertussis during the pregnancy and pass this immunity to her baby, which is critical because infants are not eligible to receive the pertussis vaccination until they are 2 months old.
Vaccine education protects adults too
Hepatitis A outbreaks also have started increasing in the U.S. in the last several years, with nearly 24,000 cases reported since 2016. Of those cases, 60% have resulted in hospitalizations, and Kentucky, Ohio, West Virginia and Florida are the states with the most cases. The highly contagious liver infection is spread by fecal-oral transmission, which is different than how Hepatitis B or C are spread.
"It used to be that Hepatitis A occurred in young children and was mild, but now more severe outbreaks are happening among adults who live in overcrowded, unsanitary conditions," said Christine Finley, APRN, MPH, immunization program manager for the Vermont Department of Health.
The Hepatitis A vaccine is recommended for children at the age of 1 and for travelers to countries where the disease is common, people who are homeless, recreational drug users and several other high-risk groups. The HPV vaccine is another immunization Finley has started recommending for children who are 11 or 12 years old because the vaccine is most effective at younger ages. While most parents understand that it's protective against cervical cancer, fewer are aware it can prevent oropharyngeal (mouth and throat) cancer in men. [caption id="attachment_56308" align="alignleft" width="250"]
Chad Rittle, DNP, MPH, RN, FAAOHN[/caption] Although the anti-vaccination movement has centered around immunizations for children, Chad Rittle, DNP, MPH, RN, FAAOHN, associate professor of nursing at Chatham University in Pennsylvania, is focused on increasing awareness and vaccine education about the importance of protecting adults from preventable diseases. "Many adults think they do not need vaccines," he said. "But there's a significant knowledge deficit among this population about their need for vaccines." Rittle encourages nurses to take advantage of opportunities to educate patients about the value of immunizations. "An objection is a request for more information," he said. "Nurses need to be vaccine champions in their communities and recommend that patients get what they need during an appointment rather than delaying." ACIP recommends that people 65 and older receive the pneumococcal conjugate vaccine and the pneumococcal polysaccharide vaccine to protect themselves from pneumonia, sinus infections, ear infections and meningitis. Nurses also can educate patients who are 50 and older about the shingles vaccine, Shingrix. Studies have shown more than 99% of Americans 40 and older have had chickenpox, the same virus that causes shingles. The virus remains dormant for years and can reactivate and cause shingles whenever the immune system is weakened. Rittle, who is the American Nurses Association's liaison on the ACIP, said there is a shortage of Shingrix, and nurses should learn where patients can receive the vaccine in their communities so they can make referrals.
Vaccine education is more than just facts
While nurses can inform patients about statistics and evidence-based reasons to get vaccinations, research is showing that people are more receptive to a combination of facts and stories when it comes to vaccine education, according to Finley.
"Sharing that you vaccinated your own children can be a powerful testimony," she said.
Finley will sometimes talk about realities she witnessed when she worked in the Central African nation of Cameroon, where children who had not been vaccinated died of measles and meningitis. Studies also have shown patients are more receptive to immunizations when multiple members of the care team discuss the topic with them. A nurse, for example, could explain to parents that a child is due for certain shots, leave the parent with information to read while waiting for the physician, and then the provider could answer further questions, Finley said. Even though nurses can play a critical role in talking to patients about vaccinations, this aspect of care is not covered thoroughly in undergraduate nursing school, Finley said. Fortunately, there are resources available for nurses who want to learn more, including continuing education or CDC resources. "Even if vaccinations are not covered in detail in nursing school, it's vital for nurses to recognize that they need to be informed," Finley said. "We've made significant gains in preventing disease, and the bottom line is that we need to find ways to communicate with people who are vaccine-hesitant."
Take these courses related to vaccine education:
- Measles Immunizations (0.5 contact hr) Measles is primarily a disease of childhood, but it can also occur in adolescents and adults. It is one of the most highly infectious human pathogens known. With exposure, up to 90% of susceptible individuals develop the disease. Measles is transmitted directly person-to-person via contact with respiratory droplets. Airborne transmission via aerosolized droplet nuclei has also been documented in closed areas (e.g., examination rooms), where the virus can remain suspended in the air for several hours. This module provides information for RNs, APNs, and physicians about measles and parental concerns regarding the safety of the MMR vaccine for their children.
- Adult Immunizations (1.25 contact hrs) Vaccine-preventable diseases strike millions of adults annually. Not long ago, what nurses needed to know about immunizations was simple: Infants and young children received most of the vaccines, and adult immunizations could be counted on one hand, with a few fingers left over. However, recently the number of recommended immunizations for people of all ages has increased to a level not seen before, and the number of vaccines keeps rising. This module addresses various vaccine formulations and indications and provides resources for healthcare professionals to stay up to date on vaccine recommendations.
- Covid-19: Challenges Around Vaccinations (0.5 contact hr) This course provides objective analysis about challenges with the COVID19 vaccine and its acceptance by healthcare workers.
