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Educational Tools to Decrease Vaccine Hesitancy

By: Susan Strobel Michelle Anderson Kirsten Rosin

Essentials of the DNP education

Turned a class research effort into a portal to educate and encourage professionals

Purpose Our presentation reviews the literature regarding current vaccine information and parental attitudes towards vaccines. We offer an educational approach to increase vaccination rates of children, while at the same time assisting healthcare professionals to become vaccine confident, and able to address the needs of vaccine hesitant parents.

Core Beliefs School health professionals should be highly qualified in

and practice evidence based health and education strategies.

Schools should be safe, nurturing environments that

facilitate learning for all.

Significance to School Health The successful reduction of certain infectious diseases has shown immunization through vaccination to be one of the most successful and cost effective public health interventions available in the developed world.

(World Health Organization, 2008)

Significance to School Health “Increase Immunization Rates and Reduce Preventable Infectious Diseases”

is a Healthy People 2020 goal in the United States.

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Significance to School Health

A recent trend shows that parents are delaying, refusing or partially vaccinating their children. This trend has a social and a financial cost.

Vaccines are among the most cost-effective clinical preventive services and are a core component of any

preventive services package.

Childhood immunization programs provide a very high return on investment.

For example, for each birth cohort vaccinated with the routine immunization schedule (this includes DTap, Td,

Hib, Polio, MMR, Hep B, and varicella vaccines), society:

➢  Saves 33,000 lives.

➢  Prevents 14 million cases of disease.

➢  Reduces direct health care costs by $9.9 billion.

➢  Saves $33.4 billion in indirect costs

Significance to School Health

(Healthypeople2020.gov)

To Vaccinate or Not To Vaccinate…..

1.  Uncertainty in vaccine effect 2.  Overloading or overburdening the immune system

(Bakhache et al. 2013;Bystrom, Lindstrand, Likhite, Butler and Emmelin (2014)

3.  Vaccine safety

○  Distrust of big pharma and government agencies ○  Difficulty building trust with doctor

(Yaqub, Castle-Clarke, Sevdalis, and Chataway (2014)

4.  Misinformation on internet and through social media ○  Found that parents are asking provider to space out time between vaccinations

(Glanz, Kraus, and Daley (2015)

In The Past 3 Years, Research Has Reported Parents Biggest Vaccine Related Concerns As:

Uncertainty in Vaccine Effect

1.  If you approach the question from the perspective of our natural immunity, you will see from the evidence that natural immunity does not always provide lifelong immunity. In fact, natural immunity does not necessarily provide longer lasting protection than a vaccine

2.  Common for immunity to wane over time….which is why we use booster shots to achieve a

stronger immune system reaction

3.  Waning immunity is not the fault of neither the disease or the vaccine….it is a facet of our immune system...being human

4.  Thanks to vaccines, we can harness our bodies natural reaction to pathogens. Our bodies need

information about which threats to take seriously….

➢  With remarkably little side effects, vaccines manage the great feat of delivering that information to our bodies, creating immunity, and keeping the population healthy. Before vaccines, this was not possible without first enduring the risk of death or disability

Overloading or Overburdening the Immune System From the moment babies are born, they are exposed to numerous bacteria and viruses on a daily basis.

Eating food introduces new bacteria into the body Numerous bacteria live in the mouth and nose Placing his or her hands or other objects in his or her mouth hundreds of times every hour,

exposing the immune system to still more germs. When a child has a cold, he or she is exposed to up to 10 antigens, and exposure to

“strep throat” is about 25 to 50 antigens. Each vaccine in the childhood vaccination schedule has between 1-69 antigens. A child who receives all the recommended vaccines in the 2014 childhood immunization schedule may be exposed to up to 315 antigens through vaccination by the age of 2.

(http://www.cdc.gov/vaccinesafety)

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Vaccine safety

Since 2001, with the exception of a few influenza vaccine products, thimerosal has not

been used as a preservative in any routinely recommended childhood vaccines.

No link between thimerosal containing vaccines and Autism.

No link between vaccines and Autism.

Aluminum is the most common metal found in nature. It is in the air and in food and

drink. Infants get more aluminum through breast milk or formula than vaccines.

(www.immunize.org; www.cdc.gov/vaccinesafety/concerns)

Misinformation: Internet and Social Media

A 2011 study showed who parents’ trust for certain sources of Vaccine- Safety information

Solution: Open communication using Evidence Based Research

● 76% of parents trust what doctors say about

vaccine safety ● 27% of parents trust Web sites from doctor groups

like the American Academy of Pediatrics ● 23% of parents trust government vaccine experts

(Freed et. al, 2011)

● 74% of parents do not trust celebrities for vaccine safety information

Findings

Analysis shows that the use of pictographs improves vaccine compliance. The studies further demonstrate that when healthcare providers supplement their verbal instructions with health data containing pictographs, brochures, or infographic, patients’ understanding and compliance with health care recommendations are significantly improved.

Conclusion of our collaborative study: Tools to Decrease Vaccine Hesitancy

●  The literature conclusively demonstrates that the use of pictographs will improve the

vaccination rates of children as compared with verbal explanations alone, thus, moving

us closer to the Healthy People 2020 goal.

●  We recommend that further research utilizing a pictograph of evidence-based data in

populations of undervaccinated children or vaccine hesitant families be performed.

Concluding the study means……. The beginning of applying our knowledge gained to our various fields of practice through dissemination of our findings and improving healthcare outcomes.

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APHA - Healthiest Nation

WHO

WHO

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Concerns professionals have about vaccinations (objective 4) Doctors: Younger health care providers were shown to have a 15% decreased odds of believing vaccines are efficacious compared to older health professionals who have had experience with vaccine preventable disease (Mergler et. al, 2013). Civic leaders: The general population looks to civic and faith leaders to help support and guide population decisions. Many cultures and countries require close collaboration and trust with the government to reduce suspicions about new vaccines that may arise in the introduction of vaccines, especially in developing countries (Cover et. al, 2012).

Does your school need a revised vaccination education program?

1.  Who is in charge at your school? 2.  How are you communicating to parents? 3.  Do you Follow Up? 4.  Do you have the support you need at your school? 5.  Check out these resources

●  http://www.immunize.org/laws/ ●  http://www.cdc.gov/phlp/docs/school-vaccinations.pdf ●  http://www.astho.org/Immunization-Resource-Guide/

The National Education Association: Advocacy for Vaccines: A Leadership Guide for School Nurses and Allied Health Professional

●  http://neahealthyfutures.org/wpcproduct/advocacy-for-vaccines-a-leadership-guide-for-school-nurses-and-allied-health-professionals/

The Pink Book: Epidemiology and Prevention of Vaccine-Preventable Diseases, 13th Edition (2015) ●  http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/table-of

Family Health Perspective

●  Open, honest, nonjudgmental communication is key

●  Addressing vaccine hesitant questions ●  Formation of a trusting relationship

where your guidance can be heard ●  Having information on latest vaccine

research as well as the information that is circulating on the internet

●  Changing perception of the risk-benefit ratio that suggests a critical change in immunization beliefs of the new generation of providers and patients compared to their older counterparts

My Recent DNP Scholarly Project Data

School Health Perspective

Primary Prevention! ●  Generalized health promotion and specific

protection against disease ●  Actual disease protection

●  School nurses serve students as well as

teachers, and staff expanding the role to be a reliable and credible immunization resource for the health of the community.

As a future DNP: ●  I will utilize Idaho IRIS (Idaho Reminder Immunization

System). Ensuring school nurses/schools have the information they need ASAP.

●  Take time to communicate with parents to help them

make informed healthcare decisions. ●  Make community partners with schools to make

vaccination clinics and health fairs a reality. ●  Transparency is a key factor. Knowledge is always

evolving, staying current on research, and being able to provide parents with science based evidence, while at the same time addressing concerns and building vaccine confidence.

Current Vaccine Administration Rates

Routine 12: Measles, Mumps, Pertussis, Polio, Meningitis, Hep B, Pneumonia, Influenza, Rotavirus, Chickenpox, Hib, Hep A

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School Vaccine Exemption Laws, by State

(CDC, PHLP, 2015)

Public Health Perspective

1.  Vaccine safety gets more

attention than vaccine effectiveness.

2. Global World Travel

h"ps://www.youtube.com/watch?v=yx7_yzypm5w

Rise in Vaccine Preventable Disease

POLIO

Public Health Perspective

3. Vaccines prevent six million deaths worldwide & protect against other related diseases ●  Six diseases that have

reemerged are: measles, mumps, rubella, pertussis and polio. Influenza is always a problem.

4. Confusion regarding Herd Immunity

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Herd Immunity 101

a: herd immunity

b: moat around a castle

Questions

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http://www.www.aacn.nche.edu

ASTHO. (2016). Immunization Resource Guide | State Public Health | ASTHO. Retrieved from http://www.astho.org/Immunization-Resource-Guide/

Andre, Booy, Bock, Clemens, Datta, John, … Schmitt. (2008). Vaccination greatly reduces disease, disability, death and inequity worldwide. WHO,

86(2), 81–160.

Backache, P., Rodrigo, C., Davie, S., Ahuja, A., Sudovar, B., Crudup, T., & Rose, M. (2013). Health care providers’ and parents’ attitudes toward

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Bystrröm, E., Lindstrand, A., Likhite, N., Butler, R., & Emmelin, M. (2014). Parental attitudes and decision-making regarding MMR vaccination in an

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CDC (2016). VFC Program| Features | CDC. Retrieved from http://cdc.gov/features/vfcprogram

CDC, PHLP. (2015). State school immunization requirements and vaccine exemption laws. CDC. Retrieved from http://www.cdc.gov/phlp/docs/

school-vaccinations.pdf

Cover, J.K., Nguyen, Q.N., LaMontagne, D.S., Huyen, D., Nguyen, T.H., & Nga, L.T. (2012). Acceptance patterns and decision-making for human

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10.1186/1471-2458-12-6

DeStefano, F., Price, C. S., & Weintraub, E. S. (n.d.). Increasing Exposure to Antibody-Stimulating Proteins and Polysaccharides in Vaccines Is Not

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Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, & Hoffman RE. (2000). INdividual and community risks of measles and pertussis

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Freed,, G. L., Clark, S. J., Butchart, A. T., Singer, D. C., & Davis, M. M. (2011). Sources and perceived credibility of vaccine-safety information for parents.

Pediatrics, 127(Supplement 1), S107. https://doi.org/10.1542/peds.2010-1722P

Glanz, J.M., Kraus, C.R., & Daley, M.F. (2015). Addressing parental vaccine concerns: Engagement, balance, and timing Public Library of Science Biology,

13(8), 1-8. doi:10.1371/journal.pbio.1002227

HealthyPeople.gov. (2016, September 29). Immunization and Infectious Diseases | Healthy People 2020. Retrieved from https://www.healthypeople.gov/

2020/topics-objectives/topic/immunization-and-infectious-diseases/objectives

Retrieved from http://www.www.aacn.nche.edu

Immunize Action Coalition. (2016, August 11). Talking About Vaccines. Retrieved from http://www.immunize.org/talking-about-vaccines/

Glanz JM, Narwaney KJ, Newcomer SR, & et al. (2013). Association between undervaccination with

diphtheria, tetanus toxoids, and acellular pertussis (dtap) vaccine and risk of pertussis infection in children 3 to 36 months of age. JAMA Pediatrics,

167(11), 1060–1064. http://doi.org/10.1001/jamapediatrics.2013.2353

Office of Disease Prevention and Health Promotion. (2015). Immunization and infectious diseases. Retreived from

http://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases/objectives

Mergler, M.J., Omer, S.B., Pan, W., Navar-Boggan, A.M., Orenstein, W., Marcuse, E.K.,...Salmon, D.A. (2013). Are recent medical graduates more skeptical

of vaccines? Vaccines, 1, 154-166. doi: 10.3390/vaccines1020154

The Children's Hospital of Philidelphoia. (2014). Vaccine Safety: Are Vaccines Safe? | The Children's Hospital of Philadelphia. Retrieved from http://

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doi:10.1016/j.socscimed.2014.04.018

References