Mar 09, 2020, By: Susanne Priest
- Along with influenza, there are many other vaccine-preventable diseases that health care workers should be immunized against.
- Recognizing that there are barriers to vaccine uptake, the author described strategies that employers can use to address concerns of staff.
- Health care workers should be immunized against vaccine preventable diseases to protect themselves, their families and their patients.
By the nature of their work, nurses come into contact with many infectious diseases, including vaccine-preventable diseases (VPDs). Handwashing and universal blood and body fluid precautions are important steps to stay protected from disease. Likewise, vaccination is another way to reduce the risk of disease transmission.
The rationale for vaccinating health care workers (HCWs) against diseases relies on the need to protect both the providers of care and those receiving care (Maltezou & Poland, 2016). Vaccinations can prevent the transmission of disease and protect nurses, their clients, and the nurses’ families.
Influenza outbreaks are associated with absenteeism of HCWs and a disruption of health care services, resulting in staffing issues and increased cost to the health care system (Maltezou & Poland, 2016). Therefore, all nurses have a responsibility to their employer, to their clients, and to themselves in ensuring they are up to date on recommended routine vaccines.
Vaccinations can prevent the transmission of disease and protect nurses, their clients, and the nurses’ families.
Influenza is a contagious respiratory illness that can shift its antigens from one season to another; for this reason, annual outbreaks of influenza are a major concern (Rizzo, Rezza, & Ricciardi, 2018). Preventive measures to limit the spread of influenza include both individual and public health interventions, such as handwashing, coughing into your sleeve instead of your hand, staying home when sick, wearing masks as appropriate when providing health care, and influenza vaccination (WHO, 2018).
The Canadian Nurses Association recommends that nurses receive an annual influenza immunization and that employers work with key stakeholders to increase vaccination rates of employees (CNA, 2019). Deficits in knowledge, false perceptions, and fear of an adverse reaction are the most common barriers for vaccine uptake and may also influence how nurses communicate about vaccines with the public and their clients (Maltezou & Poland, 2016).
While at work, a nurse may unknowingly transmit a disease to a client before the nurse shows symptoms of illness. Given the importance to health and the serious risk to vulnerable clients (infants, older persons, pregnant women, and individuals considered to be immunocompromised), strong recommendations for health care providers with regard to immunizations should be considered by all employers providing health care services. Information from employers should include, but is not limited to, statistics of mortality and morbidity from VPDs; risks and benefits of vaccination; the cost of HCW absences due to VPDs; and strategies to reduce the spread of VPDs.
Health care environments are where nurses are exposed to many communicable diseases and infections. Therefore, they should be immunized for the following VPDs:
- tetanus, diphtheria, and pertussis;
- measles, mumps, and rubella;
- hepatitis B;
- varicella; and
- meningococcal disease (PHAC, 2018a).
When a person is given antibodies via a vaccine, passive immunity occurs. Active immunity occurs when antibodies are produced by an individual’s immune system after coming into contact with or experiencing a disease. Passive immunity protection is immediate and preventive, and therefore considered a good option for HCWs (PHAC, 2018b).
Barriers to influenza vaccination uptake
- Evidence for influenza vaccination of HCWs is not conclusive. Thus, doubt in the effectiveness of the influenza vaccine is a negative factor in vaccine uptake (Lytras, Kopsachilis, Mouratidou, Papamichail, & Bonovas, 2016).
- Fear of suspected adverse events from the flu vaccine is considered a significant obstacle to vaccine uptake (Maltezou & Poland, 2016; Rizzo et al., 2018).
- The evidence-informed benefit in terms of both personal protection and the protection of clients is less clear with influenza than with measles and hepatitis B (Lytras et al., 2016).
- Personal belief among HCWs that they are not at high risk for contracting influenza (low-risk perception) is also a determining factor in non-vaccination (AlMarzooqi, AlMajidi, AlHammadi, AlAli, & Khansaheb, 2018; Dini, Toletone, Sticchi, Orsi, Bragazzi, & Durando, 2018).
- Perceptions that pharmaceutical companies influence the influenza data and that there is financial gain to providers of a vaccine (pharmacists/physicians) negatively influence the uptake of the influenza vaccine (Dini et al., 2018).
… increasing vaccination coverage is best done in a collaborative spirit that focuses on keeping clients as safe from harm as possible.
Considerations to improve HCW influenza vaccine uptake
- Hard mandates (which include mandatory vaccination for all HCWs unless it is medically contraindicated) can be very effective for increasing vaccine coverage but are not without ethical challenges regarding human rights (Dini et al., 2018). Therefore, other methods for encouraging HCWs to receive vaccination coverage, including the annual influenza vaccine, should be explored.
- There are mixed reports of whether or not increased awareness of influenza and knowledge of vaccines will improve HCW uptake. Employer incentives and increased accessibility for getting the vaccine are also found to be statistically insignificant in improving the uptake of influenza vaccination (Lytras et al., 2016; Rizzo et al., 2018).
- Having a mandatory “get vaccinated or sign a declination form” process did improve influenza vaccine uptake. Seeing the pros and cons of receiving the vaccine and then being required to either accept via consent or reject via signed declination causes HCWs to actively weigh their decision and take accountability for it (Lytras et al., 2016).
- Research has shown that a combination of declination statements, on-site education, and easy access to vaccines with no cost, combined with an active promotional campaign, should achieve a higher vaccine uptake among HCWs (Dini et al., 2018; Lytras et al., 2016; Maltezou & Poland, 2016).
As with any initiative, increasing vaccination coverage is best done in a collaborative spirit that focuses on keeping clients as safe from harm as possible. Vaccinations can reduce morbidity and mortality; therefore, it is regarded as an occupational health measure, an element in controlling infection, a positive step in pandemic planning, and within the duty of a nurse to protect patients (Lytras et al., 2016).
For additional information on influenza, Health Canada, Infection Prevention and Control Canada, and the World Health Organization have resources available for the public and for health care professionals at:
Flu (influenza): For health professionals
Global Influenza Strategy 2019-2030
Seasonal Influenza, Avian Influenza and Pandemic Influenza
AlMarzooqi, L. M., AlMajidi, A. A., AlHammadi, A. A., AlAli, N., & Khansaheb, H. H. (2018). Knowledge, attitude, and practice of influenza vaccine immunization among primary healthcare providers in Dubai Health Authority, 2016–2017. Human Vaccines & Immunotherapeutics, 14(12), 2999–3004. doi:10.1080/21645515.2018.1507667
Canadian Nurses Association (CNA). (2019). Position statement: Influenza immunization of nurses. Ottawa: Author.
Dini, G., Toletone, A., Sticchi, L., Orsi, A., Bragazzi, N., & Durando, P. (2018). Influenza vaccination in healthcare workers: A comprehensive critical appraisal of the literature. Human Vaccines & Immunotherapeutics, 14(3), 772–789. doi:10.1080/21645515.2017.1348442
Lytras, T., Kopsachilis, F., Mouratidou, E., Papamichail, D., & Bonovas, S. (2016). Interventions to increase seasonal influenza vaccine coverage in healthcare workers: A systematic review and meta-regression analysis. Human Vaccines & Immunotherapeutics, 12(3), 671–681. doi:10.1080/21645515.2015.1106656
Maltezou, H.B., & Poland, G.A. (2016). Immunization of health-care providers: Necessity and public health policies. Healthcare, 4(3), 47. doi:10.3390/healthcare4030047
Public Health Agency of Canada (PHAC). (2018a). Canadian immunization guide: Part 3 – Vaccination of specific populations; immunization of workers. Ottawa: Author.
Public Health Agency of Canada (PHAC). (2018b). Canadian immunization guide: Part 5 – Passive immunization. Ottawa: Author.
Rizzo, C., Rezza, G., & Ricciardi, W. (2018). Strategies in recommending influenza vaccination in Europe and US. Human Vaccines & Immunotherapeutics, 14(3), 693–698. doi:10.1080/21645515.2017
World Health Organization (WHO). (2018). Influenza: (avian and other zoonotic).
Susanne Priest RN, MN has practised in the state of Maine and the province of New Brunswick since 1996, in acute care, and in community health with the Maliseet population. She currently works as a nurse consultant in Fredericton. She attained her undergraduate and graduate degrees in Nursing at UNB with a focus in the nurse practitioner stream and nurses living with problematic substance use.