Jee Hae Kim
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A certain pregnant nurse was fired because of refusing to get a flu shot in Pennsylvania in December, 2013 (Murphy, 2013). Getting a flu shot is the one of the biggest issues for health care professionals who are especially pregnant health care workers. However, vaccination still remains the most effective way for preventing severe influenza illness. According Center for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists (ACOG), seasonal flu vaccination is recommended for all pregnant women (Goldfarb, Panda, Wylie & Riley, 2011). But, why do they hesitate to get a flu shot?
Current vaccination rate
Flu vaccination rate for pregnant women is still low in the US. In 2005, the US achieved just 16% influenza vaccination coverage of pregnant women, and it is estimated that less than 10% of pregnant women who are at highest risk of influenza receive the vaccine (Broughton, Beigi, Switzer, Raker & Anderson, 2009). Even with increased morbidity during pregnancy from seasonal influenza, only 11% of pregnant women were vaccinated during the 2008 through 2009 flu season (Dlugacz, Fleischer, Carney, Copperman, Ahmed, Ross & Silverman, 2012). In addition, influenza vaccination rates have remained substantially below 50% for Health Care Personnel (HCP). Within the population of HCP, nurses have been shown to have lower influenza vaccination rates than physicians (Clark, Cowan & Wortley, 2009). Although the rate is getting increase little by little, it is still low compared to physicians’ vaccination rate.
Barriers for vaccination
According to a certain survey, 58.3% of patients reported feeling scared about seasonal flu infection during their pregnancy (Goldfarb, et al., 2011). What are the main causes they are afraid of getting a flu shot? One of those reasons is that they have a fear uncertainly because they do not know specifically how safe flu vaccine is while they are pregnant. In addition, they do not know as well about how dangerous unvaccinated status is during pregnancy. Vaccinated nurses demonstrated greater knowledge about influenza and risk factors for influenza, while unvaccinated nurses believed they were not at risk (Clark, et al., 2009). These facts show that knowledge about safety of vaccine is one of the most important keys to decide whether they get a flu shot or not. Vaccine declination was associated with less knowledge about influenza, lower perceived susceptibility, and beliefs that the vaccine is not efficacious of safe (Eppes, Cameron, Gracia & Grobman, 2013). Furthermore, health care workers in the obstetric field also have limited knowledge about the epidemiology of influenza infection and most of them do not consider influenza as a potentially serious disease (Broughton, et al., 2009).
Political, social and economic backgrounds
The state’s role is to reduce morbidity and mortality by nosocomial inflammation of influenza and maintenance of a reasonable health care workforce and to show that mandatory influenza vaccination is sensibly related to reducing the flu budget (Ottenberg, Poland, Jacobson, Koenig & Tilburt, 2011). It can be one of the political reasons for getting a flu shot for health care workers and government forces them to vaccinate.
In addition, we can concern about economic aspect. The commerce legislation can make the federal government regulate activity essentially that affects inter-state commerce, including parts of the health care industry which is related to the management infectious disease and prevention. With the public health service act, health and human services department in the US has organized the national vaccine plan, the national vaccine advisory committee, and the national vaccine injury compensation program (Ottenberg, et al., 2011). Through these mechanisms, the commerce legislation permitted the federal government to control, strengthen, or potentially obligate the vaccination of health care workers against influenza and ensure fair movement to arbitrate complaints related to vaccination (Ottenberg, et al., 2011). It shows that mandatory vaccination can lead saving budget for government because they do not have to pay for the treatment of the secondary infection for people due to influenza.
There are also possible ethical arguments underlying mandatory vaccination. Hospitals are enforcing health care workers to vaccinate for two primary reasons. The one is for supporting of the professional duty of health care workers to benefit for patients individually and to ‘Do No Harm’ and another is for meeting the shared obligations of hospitals and health care workers to protect the public health with infectious disease which is preventable (Ottenberg, et al., 2011). In these situations, we can think about the important questions such as “What are the obligations of health care workers to their patients?” or “Is it proper for patients to expect health care workers to get a flu shot because of influenza?”
I suggest some solutions to promote vaccination for pregnant health care workers. First of all, the convenience of influenza vaccination is strongly needed such as using mobile vaccination carts. Instead of fixed date or time for vaccination, health care workers can have it depending on their schedules. Secondly, provision of free vaccination and peer vaccination is another good method for promoting vaccination. For example, some pregnant nurses who are already vaccinated could be a good model for other pregnant nurses who are not vaccinated yet. Thirdly, incentive programs also can be a great way for health care workers. If they can get extra pay, the rate of vaccination can be raised. Lastly, education about safety of vaccination for pregnant health care workers is the most effective method. Indeed, I had concerned about wearing a mask while they are working without vaccination, but this could be not a perfect prevention of pandemic influenza. Instead of this, it would be better to persuade them who refuse vaccination and to emphasize again about the safety of vaccination during pregnancy.
Safety of vaccination during pregnancy
There are already several studies to prove safety of vaccination during pregnancy. According to CDC, studies of a lot of pregnant women in scientific view have checked the safety of vaccination during pregnancy. These studies did not show any evidence of danger to pregnant women, even to the unborn fetus and to newborns of vaccinated women (CDC, 2013). In addition, the Food and Drug Administration’s (FDA) and CDC’s periodic monitoring of side effects’ occurrence has not raised safety concerns (CDC, 2013). Rumors and fears should not be an obstacle to promoting patient safety and public health. The implementation of mandatory vaccination should solve the ambiguous concerns and misconceptions of vaccine safety as well. Rates of serious side effects’ occurrence following vaccination, such as Guillain-Barre syndrome, are vanishingly low as no higher than 1 in 1,000,000 (CDC, 2013).
Among several solutions as I mentioned above, I guess the best way to promote the flu-vaccination rate for pregnant health care providers is education. An effective educational strategy should focus on known misconceptions and knowledge gaps. Furthermore, the influence of health care workers on patient vaccination coverage should not be underestimated. It has been shown that health care workers’ recommendations have positive effects on the likelihood of patients to be vaccinated (Broughton, et al., 2009). According to an article, women whose maternity care provider has recommended the vaccine are much more likely to receive it than those whose providers did not (Broughton, et al., 2009). It shows that how critical education affect not only pregnant health care workers, but also pregnant patients.
I insist that health care workers should be vaccinated because reducing the transmission of preventable diseases cannot prevent any harm in the clinical care area. Health care worker vaccination of influenza is consistent with a collective professional accountability to treat all patients moderately and to use appropriate precautions against preventable harms.
With mandatory health care worker vaccination, health care organizations should make sure that vaccination is an informed procedure. Health care workers should also get the information clearly about benefits and risks related to influenza vaccination and that vaccines are offered handily.
Broughton, D. E., Beigi, R. H., Switzer, G. E., Raker, C. A., & Anderson, B. L. (2009). Obstetric health care workers’ attitudes and beliefs regarding influenza vaccination in pregnancy. Obstetrics & Gynecology, 114(5), 981-987.
Center for Disease Control (2013, September 3). Seasonal Flu Vaccine Safety and Pregnant Women. Retrieved March 17, 2014 from: http://www.cdc.gov/flu/protect/vaccine/qa_vacpregnant.htm
Clark, S. J., Cowan, A. E., & Wortley, P. M. (2009). Influenza vaccination attitudes and practices among US registered nurses. American Journal of Infection Control, 37(7), 551-556.
Danzon, P. M., Pereira, N. S., & Tejwani, S. S. (2005). Vaccine supply: a cross-national perspective. Health Affairs, 24(3), 706-717.
Dlugacz, Y., Fleischer, A., Carney, M. T., Copperman, N., Ahmed, I., Ross, Z., … & Silverman, R. A. (2012). 2009 H1N1 vaccination by pregnant women during the 2009-10 H1N1 influenza pandemic. American journal of obstetrics and gynecology, 206(4), 339-e1.
Eppes, C., Wu, A., You, W., Cameron, K. A., Garcia, P., & Grobman, W. (2013). Barriers to influenza vaccination among pregnant women. Vaccine, 31(27), 2874-2878.
Goldfarb, I., Panda, B., Wylie, B., & Riley, L. (2011). Uptake of influenza vaccine in pregnant women during the 2009 H1N1 influenza pandemic. American journal of obstetrics and gynecology, 204(6), S112-S115.
Murphy Carrie (2013, Dec 23). Pregnant Nurse Wrongfully Fired For Refusing Flu Shot Because Of Miscarriage Concerns. Mommish.com. Retrieved March 21, 2014, from http://www.mommyish.com/2013/12/23/pregnant-nurse-wrongfully-fired-refusing-flu-shot.
Ottenberg, A. L., Wu, J. T., Poland, G. A., Jacobson, R. M., Koenig, B. A., & Tilburt, J. C. (2011). Vaccinating health care workers against influenza: the ethical and legal rationale for a mandate.American journal of public health,101(2), 212.