Most people know the value of childhood vaccines. They dutifully follow immunization schedules to get their children inoculated against wide range of contagious diseases. Yet, other than perhaps an annual influenza vaccine, they might not know adults need vaccines too.
"When people hear vaccines, they tend to think of children," remarked Pat Vranesich, RN, BSN, a nurse consultant for the Immunization Action Coalition. Sharon Stevens, RN, BSN, manager for the Cuero-DeWitt County Health Department in Texas and co-chair of the Crossroads Immunization Action Coalition agreed. "You see parents who are so good at taking care of their kids, but they don't take care of themselves."
Getting Used to Vaccines
Added Vranesich, "Adults frequently put off health decisions." Many older patients are from an era when they only go to the doctor when they are ill. Preventative care, like vaccines, can be a new concept. Sometimes, people are unaware of what is covered under their insurance plans. Nurses should encourage patients to check with their provider. Under the Affordable Care Act, certain vaccines are covered by insurance.
For uninsured patients, some states have safety net programs that offer low cost vaccines. "These programs could be expanded further so that more providers, including pharmacists are able to offer all the adult vaccines recommended by the CDC," advised Robyn Correll Carlyle, MPH, education program manager for The Immunization Partnership.
Some of the awareness problem comes from the medical community. "We need stronger recommendations," Vranesich said. "It takes a while for people to become aware of a standard." Adult healthcare providers think they do a good job advising patients to get vaccinated, but patients themselves feel otherwise.
The Immunization Action Coalition encourages the use of registries to track inoculations among adult patients, even as they move or change providers. A recent healthcare trend is for pharmacies to stock vaccines, increasing access. Patients don't need to make an appointment with their primary care physician or even need a primary care physician to receive certain vaccines, like those that protect against influenza or pneumonia.
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So, what are the recommended vaccines? Most healthcare providers look at HALO-Health Factors, Age, Lifestyle and Occupation Recommended vaccine schedules may vary from patient to patient; for example, international travelers require certain vaccines, as do healthcare workers. "Some people have increased risk factors, like cancer patients and HIV patients who are immunosuppressed and need vaccines more," explained Stephens.
According to Stephens and Vranesich some (yet not all) of the recommended adult immunizations are:
TDAP vaccine for all adults and especially pregnant women and any family member in close proximity
Meningitis A&B-between ages 18-23 for lifelong immunity
Hepatitis B-series of 3 shots for lifelong immunity
Shingles for senior citizens
Pneumonia PC313 and PSV13 for senior citizens-2 separate vaccines
Each year, the Advisory Committee on Immunization Practices (ACIP) approves immunization schedules recommended for persons living in the United States. The adult immunization schedule provides a summary of ACIP recommendations on the use of licensed vaccines routinely recommended for adults aged 19 years or older.
"It [vaccine-preventable diseases] is the monster lurking in the background because we haven't had outbreaks," remarked Stevens. Vaccinating even low-risk populations makes sure the monster stays in its cave. Even common illnesses can be deadly, such as the 20 adults who died from the flu in Steven's home state of Texas in 2015.
Protect the Weakest
Immunization reinforces the idea of herd immunity. Vranesich explained, "Pertussis is airborne. People ask: I don't have grandchildren, why would I be worried about that? We vaccinate against it to protect our community."
Carlyle continued, "If enough people in a community are vaccinated, the disease stops circulating, protecting everyone, even those who cannot be vaccinated due to age or medical conditions." Think of how smallpox or polio were eradicated from massive immunization campaigns.
Other vaccines, like shingles, are about improving your personal immune response and guarding against susceptibility to certain viruses. This relatively new vaccine is recommended for all adults ages 60 and over.
"When an individual is at low risk is actually a really good time to vaccinate because you want to give them time to develop antibodies to protect them against disease before they are ever exposed," said Carlyle.
Start the Conversation
Nurse, of course, play a vital role in recommending vaccines to patients. Setting a strong example by getting inoculated themselves is a good starting point. "We need to make sure we ourselves are protected so we can be at work and give care," noted Vranesich.
"I have influenced family and friends to get vaccinated," she said. "Nurses play a key role because we are trusted professionals."
"Many times nurses are the ones starting the conversation," said Stevens. "Under the ACA, preventive health is stressed more."
Hospital nurses can start the conversation by asking patients and their family members about influenza and pneumococcal vaccine coverage. Outpatient nurses can post reminders in offices and create standing order programs so patients can be vaccinated before leaving the office. If a physician's office does not stock the needed vaccine, nurses should learn where else the patient can get it.
Text message reminders about vaccine schedules are another way to make immunization top of mind. Vranesich has presented before community groups on the value of vaccination. Stevens' organization, Crossroads Immunization Action Coalition, has placed informative articles in local newspapers to try and reach a wider base than those that come in for medical check-ups. CIAC also hosted a lunch and learn for area healthcare providers. As a result, the local rates of HPV immunization went up.
"We need to start thinking of every clinic visit as a vaccine visit," Carlyle remarked. Nurses could review immunization records and proactively recommend needed vaccines. Changing the way the healthcare community views vaccination opportunities could be a step towards raising the coverage of adult immunizations.
Danielle Bullen is on staff at ADVANCE. Contact: email@example.com