Importance Of Influenza Vaccination For The Elderly

Influenza is a largely preventable infectious disease through the use of vaccination. The role in prevention of influenza through vaccines is well understood in the management of public health. Seasonal influenza and influenza pandemics pose a threat to human health and are the elderly are at a higher risk of prolonged morbidity and mortality due to the contagious infection. The community nurse plays an important role in interacting with patients while giving vaccination. It is important for all health professionals to get vaccinated and remain updated about the information concerning the vaccine. The high rate of mutation of the virus requires new vaccines to be developed ahead of each season. Patient concerns about vaccine safety need to be addressed by nurses and physicians. Misconceptions about vaccines abound and it is an important task for nurses to clear them. The timing of the vaccine has to be such that the patients’ immune system is primed well before the flu season begins. Larger number of immunisations across a population is advantageous because it allows for herd immunity and the overall protection from infection for the community is high. For herd immunity to be established it is important that coverage of vaccination be high. Targeting a large proportion of the population for immunisation is beneficial. Reluctance on the part of the patients to receive  vaccine can be a major hurdle for community nurses. Some may be concerned about vaccine safety, others may have assumptions about the low effectiveness of vaccines and yet others may have strange misconceptions about all vaccines in general.

Though not considered dangerous, influenza incidence can lead to hospital admissions and can cause debilitating complications that may led to death in some cases, particularly among the elderly. Immunization can be used as a strategy to prevent the occurrence of influenza and the adverse health outcomes. Influenza is a seasonal disease and vaccines can be given before the advent of the annual season. Complications following an influenza infection can affect people with low immunity that include young children, people with transplants and the elderly. People with diabetes, kidney disease and cancer are also considered to be at a high risk. A seemingly minor bout of influenza can lead to pneumonia and acute lower respiratory tract infections. Pneumonia can be caused by the influenza virus or a secondary bacterial infection and can prolong the duration of recovery and patients may even require hospital admissions.  90% cases of mortality due to influenza and related complications occur among the elderly (Kovács, et al., 2014). 54-70% cases of patients that are diagnosed with seasonal influenza and need hospitalizations are 65 years or above in age. Most of the economic burden due to influenza is incurred due to long and expensive hospital treatment of influenza related complications among the elderly (Kovács, et al., 2014). Many of the elderly patients have underlying medical conditions and this increases the risk and cost of treatment (Torner, et al., 2017). In case of the elderly, several contacts with influenza viruses through the life span produces a width of immune memory that offers protection but senescence on the other hand impairs their immunity, so they are more susceptible to the virus (Torner, et al., 2017).

The high propensity of the influenza virus to mutate and cause pandemics across continents makes it imperative that new flu vaccines have to be developed every year. The flu vaccine has to be taken annually before the season begins and may be taken throughout the season (Lang, et al., 2012). Even delayed vaccination confers some protection from the incidence of influenza and the complications that accompany the disease. In the Australian context the right time to get an influenza vaccine is between April and May, so that immunity offered by the vaccine peaks from July to September, that is, three to four months from the time of vaccination (PSA, 2018).

It is important that community workers and healthcare workers get immunised against influenza. It prevents flu and helps them to stay fit for the job and it offers them protection from getting the infection from patients. It also helps nurses and other healthcare staff in preventing nosocomial infections. In a study in New Zealand, it was found that only 46% of the nursing staff had taken an influenza vaccination. The reason for low figures of vaccination is because many healthcare workers view it as unnecessary and may also have doubts regarding its safety and efficacy (Mcloughlin, 2013). Other reasons that discourage nurses and healthcare staff from getting an influenza vaccine include fears about the safety of the vaccine, doubts about side effects of the vaccine, fear of getting infected with the influenza virus and a fear of the vaccine causing the Guillain-Barre syndrome (Mcloughlin, 2013). During an outbreak, immunized healthcare staff can help in maintaining the workforce, and remain protected from getting the infection while giving care to the affected patients (Lansbury, Brown, & Nguyen?Van?Tam, 2017).

Barriers to vaccine acceptance have prevented health professionals and the public from receiving the annual vaccine against influenza. Vaccine uptake may be low across all vaccines or only for the influenza vaccine.  Many reasons unique to influenza vaccine hesitancy exist (WHO, 2016). One myth is that the influenza vaccine causes flu. It is also believed that the vaccine is ineffective and does not prevent the virus from infecting. For many complacency, convenience and confidence causes the avoidance of vaccination. Often people decide against the vaccine because influenza is perceived as a low risk disease. Among pregnant women the fear of miscarriages and birth defects appears to be a deterrent against the influenza vaccine (WHO, 2016). Coughing or sneezing in the vicinity of patients can cause the virus to spread and expose them to the risk of an infection. Fear of vaccine safety among healthcare workers, incomplete knowledge about the vaccine, and deficient faith in the newly developed vaccines leads to non-compliance (Jaiyeoba, Villers, Soper, Korte, & Salgado, 2014). It is important to clear misconceptions about the influenza vaccine.

In a scenario where the patient refuses the vaccine, it is important to make the distinction between common cold and flu before the patient. Nurses are at the forefront when the need arises, to convince patients about the safety of vaccines. Often they are the ones who administer the vaccine. It becomes part of their work to explain the life saving function played by vaccines and to resolve doubts that are expressed by the patient (Miller, et al., 2015). Doubts about the efficacy of vaccine are likely to be raised. The severity of symptoms and the number of days in bed, the possible need for hospitalization should be made clear to the patient. It is a recognized fact that the patient is more likely to follow advice when a vaccine is recommended by the physician. It is important to communicate the reluctance/willingness of the patient about the influenza vaccination to the physician (Fogarty & Crues, 2017). Awareness of elderly patients regarding vaccination is likely to be lesser than younger age groups, so they need to be informed of the choice available to them and how it can prevent infection or reduce the severity of the disease (Brown, Lora, Anderson, & Sinsky, 2014). More attention towards vaccinating elderly living in aged care homes is required because the risk of transmission of infection is higher. The elderly are highly susceptible to influenza infections so it is recommended that they be given a booster dose of the vaccine in the middle of the flu season, after having received the first dose in April. They also need to be informed about the mutated and highly virulent strains like H3N2 can be lethal (Woods, 2017). Elderly people in the community need to be educated about the possibility of pneumonia or bronchitis if they are not immunised against influenza. Infection may also result in musculoskeletal, neurological and cardiovascular manifestations (Lansbury, Brown, & Nguyen?Van?Tam, 2017). While trying to convince the elderly about the necessity of taking an influenza vaccine, it is important to consider their culture, beliefs and philosophy (Miller, et al., 2015). Precise and updated information can be obtained about flu vaccines from the government website so that questions about vaccines can be addressed   (Beta.health.gov.au, 2018). Fluad and Fluzone high dose are the vaccines currently recommended for the elderly. Queries about side effects need to be answered such that the understanding of the person taking vaccines is enhanced and nothing remains hidden from them. Once trust is established the likelihood of taking vaccines as per the annual routine is higher. Misconceptions about the vaccine should be cleared by the health professionals.

An important aspect of immunization programs is herd immunity. It is defined as ‘a situation in which a sufficient proportion of the population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. Even individuals not vaccinated are offered some protection because the disease has little opportunity to spread within the community.’ (CDC, 2016). Several populations in Australia receive free vaccination under the National Immunisation Program and these include children, Aboriginals and Torres Strait Islanders, the elderly aged above 65 years. But national registries for adults are not mandatory in all states, so it is difficult to determine the coverage of the immunisation program for influenza among the adults. It has been reported that coverage among the elderly may be about 82% but this is based on sample surveys. To establish herd immunity a national registry for adults is necessary so that gaps in coverage   can be determined (Dyda, et al., 2016).

Vaccine effectiveness issues have become a cause for concern because in 2017 several cases of influenza and consequent fatalities were reported even after immunisation was done (Sullivan, et al., 2017). This may have occurred due to unusually different mutations in the virulent strain. But faith of the population in the vaccine used for immunisation may suffer.

In conclusion, the influenza vaccine for the elderly is an essential part of their annual healthcare routine. The fact that co-morbidities among the elderly can get exacerbated due to the seasonal viral infection and can even prove fatal in some cases undermines the importance of immunisation. Community nurses and healthcare professionals working in their vicinity also need the influenza vaccine so that nosocomial infections can be prevented and they can remain fit and contribute to the healthcare. Part of the job of the nursing staff is to remain updated about the latest developments or changes related to the vaccine. Misconceptions about the vaccine and reluctance to get immunized are common. The community nurse has to convince the patient about the need to get immunized and make them aware about the risks of an influenza infection. Complications and hospitalizations can be avoided and the severity of the disease be contained if a person is immunized. Secondary infections, such as, pneumonia and bronchitis are real threats in case of the elderly and so they must get immunized. Although the immune memory among the elderly is high against the flu virus but their immune response is not very robust due to ageing. They may have doubts about the efficacy of the vaccine. Herd immunity can reduce the incidence of the disease in the population if many or most people have received the vaccine. But this requires that the vaccine coverage be measured. The constant mutations in the viral genome mean that every season the vaccine has to be developed anew so that it remains effective against the virus in the upcoming season. The elderly are more vulnerable to influenza than other age groups and their immunization is a priority for health professionals.

References

Beta.health.gov.au. (2018). /flu-influenza-immunisation-service. Retrieved from https://beta.health.gov.au: https://beta.health.gov.au/services/flu-influenza-immunisation-service

Brown, M., Lora, A., Anderson, M., & Sinsky, C. (2014). Resolving Patients’ Vaccination Uncertainty: Going From “No Thanks!” to “Of Course!”. Faamily practice management, 21(2):22-26.

CDC. (2016). /glossary.html. Retrieved from https://www.cdc.gov: https://www.cdc.gov/vaccines/terms/glossary.html

Dyda, A., Karki, S., Hayen, A., MacIntyre, C. R., Menzies, R., Banks, E., & Liu, B. (2016). Influenza and pneumococcal vaccination in Australian adults: a systematic review of coverage and factors associated with uptake. BMC Infectious Diseases, 16: 515.

Fogarty, C., & Crues, L. (2017). How to talk to the reluctant patient about the flu shot. Family practice management, 24(5):6-8.

Jaiyeoba, O., Villers, M., Soper, D., Korte, J., & Salgado, C. (2014). Association between health care workers’ knowledge of influenza vaccine and vaccine uptake. American journal of infection control, 42(1): 69–70.

Kovács, G., Kovács, G., Kaló, Z., Kaló, Z., Jahnz-Rozyk, K., Jahnz-Rozyk, K., & … Macabeo, B. (. (2014). Medical and economic burden of influenza in the elderly population in central and eastern European countries. Human Vaccines & Immunotherapeutics, 10(2):428-440.

Lang, P.-O., Mendes, A., Socquet, J., Assir, N., Govind, S., & Aspinall, R. (2012). Effectiveness of influenza vaccine in aging and older adults: comprehensive analysis of the evidence. . Clinical Interventions in Aging, 7: 55–64.

Lansbury, L. E., Brown, C. S., & Nguyen?Van?Tam, J. S. (2017). Influenza in long?term care facilities. Influenza and other respiratory viruses, 11(5), 356–366.

Mcloughlin, N. (2013). influenza-vaccine-and-health-professionals/. Retrieved from https://nursingreview.co.nz: https://nursingreview.co.nz/influenza-vaccine-and-health-professionals/

Miller, E. R., Shimabukuro, T. T., Hibbs, B. F., Moro, P. L., Broder, K. R., & Vellozzi, C. (2015). Vaccine Safety Resources for Nurses: The CDC supports nurses in promoting vaccination. The American Journal of Nursing, 115(8): 55–58.

PSA. (2018). /influenza-vaccinations-critical-for-boosting-herd-immunity. Retrieved from https://www.psa.org.au: https://www.psa.org.au/media-releases/influenza-vaccinations-critical-for-boosting-herd-immunity

Sullivan, S. G., Chilver, M. B., Carville, K. S., Deng, Y.-M., Grant, K. A., Higgins, G., & Fielding, J. E. (2017). Low interim influenza vaccine effectiveness, Australia, 1 May to 24 September 2017. Eurosurveillance, 22(43), 17–00707.

Torner, N., Navas, E., Soldevila, N., Toledo, D., Navarro, G., Morillo, A., & PI12/02079., …. t. (2017). Costs associated with influenza-related hospitalization in the elderly. Human Vaccines & Immunotherapeutics, 13(2):412–416.

WHO. (2016). WHO-HIS-TTi-GAP-16.2-eng.pdf;jsessionid=3EA5AECFC7B44AEAFE25DCE15879D746?s. Retrieved from https://apps.who.int: https://apps.who.int/iris/bitstream/handle/10665/251671/WHO-HIS-TTi-GAP-16.2-eng.pdf;jsessionid=3EA5AECFC7B44AEAFE25DCE15879D746?sequence=1

Woods, E. (2017). calls-for-elderly-to-be-given-extra-influenza-vaccination-after-deadly-flu-season-20170915. Retrieved from https://www.theage.com.au: https://www.theage.com.au/national/victoria/calls-for-elderly-to-be-given-extra-influenza-vaccination-after-deadly-flu-season-20170915-gyibw9.htm