- Email: [email protected]
Flu vaccination: Get it
Geriatric Nursing 34 (2013) 507e508
Contents lists available at ScienceDirect
Geriatric Nursing journal homepage: www.gnjournal.com
Acute Care of the Elderly Column
Elizabeth Capezuti, PhD, RN, FAAN
Sarah Hope Kagan, PhD, RN, FAAN
Mary Beth Happ, PhD, RN, FAAN
Lorraine C. Mion, PhD, RN, FAAN
Flu vaccination: Get it Lorraine C. Mion, PhD, RN, FAAN Vanderbilt University School of Nursing, Nashvulle, TN, USA
It is September as I write this column . a time of cooler weather, autumn leaves, return to school, and the start of the football season. It is also the time of year we are strongly encouraged to obtain our annual influenza (flu) vaccine, both as individuals and as health care professionals. This column will appear in print in January/February 2014. If you have not yet received the influenza vaccine, it is not too late! The flu season begins as early as October, peaks in January and February and can persist until May.1 It has always been a source of disbelief to me that health care professionals, especially nurses, refuse to obtain the flu vaccine for non-medical reasons. As nurses, we claim to be patient advocates, to step in when others do not, and to always put the patient first. How then can we ignore such a basic public health issue as flu vaccine? Perhaps we need to revisit the scope and significance of influenza, myths associated with flu vaccines, and our professional and ethical responsibility as health care professionals. Influenza overview Influenza is a highly contagious respiratory illness caused primarily by influenza viruses A and B.1 Common symptoms are fever, chills, dry or sore throat, muscle pains, fatigue, headache and coughing. Uncomplicated influenza lasts 3e7 days, although cough and malaise may persist longer. Infected individuals can carry and shed the virus for up to 24 h prior to any symptoms. Moreover, they can continue to shed the virus for up to one week following resolution of the illness or absence of symptoms. Thus, visitors and staff can be carriers. Cases may be mild but many result in complications requiring urgent medical care. Influenza can cause viral pneumonia, exacerbate underlying medical conditions, lead to secondary bacterial pneumonia or contribute to coinfections. The seriousness of this E-mail address: [email protected]. 0197-4572/$ e see front matter Ó 2013 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.gerinurse.2013.10.005
disease is demonstrated in the number of hospitalizations yearly, an average of 226,000 each year in the US; and by the number who die, an average of 36,000 each year. At greatest risk are the elderly, critically ill patients, children and the immunocompromised. Consequently, older patients in long term and acute care settings are very susceptible to contracting influenza and developing serious complications. The best way to protect against influenza is through annual vaccinations. Annual vaccines are required because flu viruses frequently change and the immunity we receive from flu vaccines decline over time. With age, our immune defenses become weaker. Thus, older adults tend to have a poorer immune response after getting the influenza vaccine. Recent reports indicate that older adults can mount a stronger immune response after vaccination with a high dose vaccine containing up to four times the amount of influenza antigen (FluzoneÒ High-Dose) compared to standard dose influenza vaccine (FluzoneÒ).1 What is not known is whether the increased antibodies lead to greater protection against contracting the flu. There is an ongoing study to determine whether FluzoneÒ High-Dose is more effective in preventing flu in older adults; results are expected in 2014e2015.1 Myths of influenza vaccine There are a number of misconceptions and myths about not only the flu, but the flu vaccine. A couple of the more common ones are summarized below. For more detailed information, visit the CDC1 or the Harvard Health Publication2 websites. Myth: “Flu vaccines are ineffective.” Fact: Flu vaccines are comprised of three or four inactivated influenza viruses identified as most common for the upcoming season. The effectiveness of the vaccines can vary from year to year and among different individuals. Effectiveness for individuals can
508
L.C. Mion / Geriatric Nursing 34 (2013) 507e508
vary depending upon the individual’s risk factors and upon the match between the vaccine and actual strains that occur. Even if the flu vaccine for a given year is not a match with the actual strains, antibodies may still protect against related viruses. Strong evidence for the effectiveness of flu vaccines exists from several decades of epidemiological studies and several randomized controlled trials in long term and acute care settings that demonstrate the risk reduction when vaccines are used. Outcomes include not only reduced number of deaths among patients, but also lower work absences during the winter months.3 While vaccines will not prevent all flu cases, per the CDC, vaccines can lower risk by 60% or more. Myth: “I get the flu from the flu vaccine.” Fact: Vaccines have dead viruses. One can’t get ill from a dead virus. It takes one to two weeks to build up the antibodies after receiving the vaccine. If the person becomes symptomatic soon after receiving the vaccine, it’s easy to blame the vaccine for the illness. Myth: “Healthy people or those at low risk do not need to get the vaccine.” Fact: Healthy people can be carriers. Twenty to 30% who are infected have no symptoms. For the protection of others, getting the vaccine is recommended.
Most nurses get the flu vaccine. However, a clinically important number of nurses, up to 20% in some studies, refuse to be vaccinated for non-medical reasons.1 A recent review of studies on the attitudes of health care workers revealed several themes related to non-vaccination. These include inconvenience, lack of concern for self or others, doubt of vaccine efficacy, fear of adverse reactions, and self-perceived contraindications.3 To address health care workers’ vaccination, hundreds of hospitals and several states now mandate yearly flu vaccines for health care providers. Recent news coverage does not paint health care workers’ refusal in a positive light.4,5 According to Bloom, “The argument that a flu shot is a violation of your body rings hollow. By the time we reach adulthood, most of us have already gotten two dozen vaccinations.”4 At what point does our autonomy trump the ethical duty we have to protect others (beneficence)? Given that the individual risk of side effects from the vaccine is so incredibly low and the benefits have been repeatedly demonstrated in randomized trials as well as epidemiological studies, I contend we must act in the best interests of the patient. Hospitals and long term care settings are dangerous places for our patients. Nurses have an ethical as well as a professional responsibility to practice in ways that minimize patient risks. References
Nurses’ responsibility Let’s return to the point of this column. Given the exposure front line staff have to infected material, they are major sources of transmission to others, staff as well as patients. Indeed, the flu is responsible for a large number of health care worker sick days during the winter months.1 Similar to universal precautions, protecting our patients from nosocomial infections is a patient safety priority.
1. Centers for Disease Control. Seasonal Influenza (Flu). http://www.cdc.gov/flu. 2. Harvard Medical School. 10 flu myths. Harvard Health Publications. http://www. health.harvard.edu/flu-resource-center/10-flu-myths.htm. 3. Carman WF, Elder AG, Wallace LA, et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomized controlled trial. Lancet. 2000;355:93e97. 4. Bloom J. Mandate the flu vaccine for healthcare workers. U.S. News and World Report, http://www.usnews.com/opinion/articles/2013/02/04/mandate-flu-vacci nes-for-healthcare-workers; February 4, 2013. 5. Tanner L. Flu epidemic. Hospitals crack down on workers who refuse shots. Huffington Post, http://www.huffingtonpost.com/2013/01/12/flu-vaccine-nur ses_n_2464663; January 12, 2013.
Contents lists available at ScienceDirect
Geriatric Nursing journal homepage: www.gnjournal.com
Acute Care of the Elderly Column
Elizabeth Capezuti, PhD, RN, FAAN
Sarah Hope Kagan, PhD, RN, FAAN
Mary Beth Happ, PhD, RN, FAAN
Lorraine C. Mion, PhD, RN, FAAN
Flu vaccination: Get it Lorraine C. Mion, PhD, RN, FAAN Vanderbilt University School of Nursing, Nashvulle, TN, USA
It is September as I write this column . a time of cooler weather, autumn leaves, return to school, and the start of the football season. It is also the time of year we are strongly encouraged to obtain our annual influenza (flu) vaccine, both as individuals and as health care professionals. This column will appear in print in January/February 2014. If you have not yet received the influenza vaccine, it is not too late! The flu season begins as early as October, peaks in January and February and can persist until May.1 It has always been a source of disbelief to me that health care professionals, especially nurses, refuse to obtain the flu vaccine for non-medical reasons. As nurses, we claim to be patient advocates, to step in when others do not, and to always put the patient first. How then can we ignore such a basic public health issue as flu vaccine? Perhaps we need to revisit the scope and significance of influenza, myths associated with flu vaccines, and our professional and ethical responsibility as health care professionals. Influenza overview Influenza is a highly contagious respiratory illness caused primarily by influenza viruses A and B.1 Common symptoms are fever, chills, dry or sore throat, muscle pains, fatigue, headache and coughing. Uncomplicated influenza lasts 3e7 days, although cough and malaise may persist longer. Infected individuals can carry and shed the virus for up to 24 h prior to any symptoms. Moreover, they can continue to shed the virus for up to one week following resolution of the illness or absence of symptoms. Thus, visitors and staff can be carriers. Cases may be mild but many result in complications requiring urgent medical care. Influenza can cause viral pneumonia, exacerbate underlying medical conditions, lead to secondary bacterial pneumonia or contribute to coinfections. The seriousness of this E-mail address: [email protected]. 0197-4572/$ e see front matter Ó 2013 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.gerinurse.2013.10.005
disease is demonstrated in the number of hospitalizations yearly, an average of 226,000 each year in the US; and by the number who die, an average of 36,000 each year. At greatest risk are the elderly, critically ill patients, children and the immunocompromised. Consequently, older patients in long term and acute care settings are very susceptible to contracting influenza and developing serious complications. The best way to protect against influenza is through annual vaccinations. Annual vaccines are required because flu viruses frequently change and the immunity we receive from flu vaccines decline over time. With age, our immune defenses become weaker. Thus, older adults tend to have a poorer immune response after getting the influenza vaccine. Recent reports indicate that older adults can mount a stronger immune response after vaccination with a high dose vaccine containing up to four times the amount of influenza antigen (FluzoneÒ High-Dose) compared to standard dose influenza vaccine (FluzoneÒ).1 What is not known is whether the increased antibodies lead to greater protection against contracting the flu. There is an ongoing study to determine whether FluzoneÒ High-Dose is more effective in preventing flu in older adults; results are expected in 2014e2015.1 Myths of influenza vaccine There are a number of misconceptions and myths about not only the flu, but the flu vaccine. A couple of the more common ones are summarized below. For more detailed information, visit the CDC1 or the Harvard Health Publication2 websites. Myth: “Flu vaccines are ineffective.” Fact: Flu vaccines are comprised of three or four inactivated influenza viruses identified as most common for the upcoming season. The effectiveness of the vaccines can vary from year to year and among different individuals. Effectiveness for individuals can
508
L.C. Mion / Geriatric Nursing 34 (2013) 507e508
vary depending upon the individual’s risk factors and upon the match between the vaccine and actual strains that occur. Even if the flu vaccine for a given year is not a match with the actual strains, antibodies may still protect against related viruses. Strong evidence for the effectiveness of flu vaccines exists from several decades of epidemiological studies and several randomized controlled trials in long term and acute care settings that demonstrate the risk reduction when vaccines are used. Outcomes include not only reduced number of deaths among patients, but also lower work absences during the winter months.3 While vaccines will not prevent all flu cases, per the CDC, vaccines can lower risk by 60% or more. Myth: “I get the flu from the flu vaccine.” Fact: Vaccines have dead viruses. One can’t get ill from a dead virus. It takes one to two weeks to build up the antibodies after receiving the vaccine. If the person becomes symptomatic soon after receiving the vaccine, it’s easy to blame the vaccine for the illness. Myth: “Healthy people or those at low risk do not need to get the vaccine.” Fact: Healthy people can be carriers. Twenty to 30% who are infected have no symptoms. For the protection of others, getting the vaccine is recommended.
Most nurses get the flu vaccine. However, a clinically important number of nurses, up to 20% in some studies, refuse to be vaccinated for non-medical reasons.1 A recent review of studies on the attitudes of health care workers revealed several themes related to non-vaccination. These include inconvenience, lack of concern for self or others, doubt of vaccine efficacy, fear of adverse reactions, and self-perceived contraindications.3 To address health care workers’ vaccination, hundreds of hospitals and several states now mandate yearly flu vaccines for health care providers. Recent news coverage does not paint health care workers’ refusal in a positive light.4,5 According to Bloom, “The argument that a flu shot is a violation of your body rings hollow. By the time we reach adulthood, most of us have already gotten two dozen vaccinations.”4 At what point does our autonomy trump the ethical duty we have to protect others (beneficence)? Given that the individual risk of side effects from the vaccine is so incredibly low and the benefits have been repeatedly demonstrated in randomized trials as well as epidemiological studies, I contend we must act in the best interests of the patient. Hospitals and long term care settings are dangerous places for our patients. Nurses have an ethical as well as a professional responsibility to practice in ways that minimize patient risks. References
Nurses’ responsibility Let’s return to the point of this column. Given the exposure front line staff have to infected material, they are major sources of transmission to others, staff as well as patients. Indeed, the flu is responsible for a large number of health care worker sick days during the winter months.1 Similar to universal precautions, protecting our patients from nosocomial infections is a patient safety priority.
1. Centers for Disease Control. Seasonal Influenza (Flu). http://www.cdc.gov/flu. 2. Harvard Medical School. 10 flu myths. Harvard Health Publications. http://www. health.harvard.edu/flu-resource-center/10-flu-myths.htm. 3. Carman WF, Elder AG, Wallace LA, et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomized controlled trial. Lancet. 2000;355:93e97. 4. Bloom J. Mandate the flu vaccine for healthcare workers. U.S. News and World Report, http://www.usnews.com/opinion/articles/2013/02/04/mandate-flu-vacci nes-for-healthcare-workers; February 4, 2013. 5. Tanner L. Flu epidemic. Hospitals crack down on workers who refuse shots. Huffington Post, http://www.huffingtonpost.com/2013/01/12/flu-vaccine-nur ses_n_2464663; January 12, 2013.