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A: My mother contracted polio as a child, and I diagnosed her post-polio syndrome later in her life. My younger sister almost died from measles when she was a child. I can still see her face and my mother’s face as they dealt with the diseases. I’ve also seen other family members and classmates affected by vaccine-preventable diseases, so this is a field for which I’ve long had a passion.
I completed my master’s degree in 1991. As I was awaiting a pediatric nurse practitioner (PNP) position while working in a health center in 1992, I was asked to help establish Suffolk County's Immunization Action Program in Suffolk County, New York. This is a federally funded and state-administered program that provides children with medically recommended vaccinations for free or at a reduced cost. I’ve also served as an advisor for the Centers for Disease Control and Prevention (CDC) and previously served on the Advisory Board of the Immunization Action Coalition and National Vaccine Advisory Committee.
A: The symptoms of COVID-19 and influenza are similar, and so we really need to be testing to ensure correct diagnosis. Both influenza and COVID-19 are serious illnesses. The difference is that we have evidence-based treatments and a vaccine for influenza; we have neither for COVID-19. We need to work together to protect everyone — for example, we wear masks not just to protect ourselves, but also to protect others within our communities. Similarly, when more people are immunized, there is a reduced chance of seeing that disease in the community.
This year, the CDC has ordered more influenza vaccines than usual. It’s important that we, as health care providers, get as many people immunized against influenza as possible so we don’t wind up with a double whammy of COVID-19 and influenza cases.
A: As a public health nurse, I see a need for a rapid test for COVID-19 that is accurate, continued social distancing efforts and an increase in masks and personal protective equipment (PPE). By wearing masks to protect against COVID-19, we may also see a reduced prevalence of influenza this year, but there are many unknowns. Even when we get a vaccine for COVID-19, we don’t know how many people will take it or how long it will be effective. Masks are an essential piece of our immunization program.
The CDC has issued vaccination guidance for use during a pandemic, which includes details on best practices for the storage and handling of vaccines and vaccine administration. This year, the CDC is recommending the use of masks, gloves and face shields by those administering vaccines. Gloves are no longer considered optional. In addition, the CDC is particularly stressing the importance of influenza vaccination for health care providers. Our duty is to protect our patients. This is the prime reason we need to be vaccinated ourselves; we owe that to our patients. At the same time, we need to protect ourselves. We’ve heard stories of NPs from across the country not having access to things like PPE, among all kinds of other issues. Receiving the influenza vaccine is something all health care providers can do to protect ourselves and to ensure we can continue treating patients in the future.
The CDC has also issued guidance on administering the influenza vaccine to patients who are suspected to have or who have been diagnosed with COVID-19. You should not vaccinate patients during the acute stage of COVID-19. Afterwards, once the symptoms have resolved, you can return to recommending the vaccine. We want to make sure that we do not knowingly bring patients with COVID-19 into our offices.
A: I was recently speaking with a colleague on this matter, and I asked, “How can I, as a provider, do everything I can to make my patients who identify as a racial or ethnic minority understand and feel safe about vaccines?” She said that it’s all about trust — about building relationships with your patients so they trust you. That’s when your patients are going to accept vaccines.
As providers, we need to do everything we can to establish that trust bond to protect those who are at higher risk for being hospitalized with influenza and COVID-19. It’s also important to ensure everything is clearly transparent when it comes to health care research, as many minority groups are not included in studies. We also want to do all we can to encourage minority patients to take part in these studies.
A: The pandemic has affected everything. As a Vaccines for Children provider, I ordered vaccines and wound up having to find a colleague to take them before they expired. My regular patients were not coming in for their well visits. I work mostly in schools, and unfortunately, schools were closed, so I had fewer opportunities to administer immunizations.
However, when health care providers don’t immunize children, our country is vulnerable to experiencing a vaccine-preventable outbreak during the COVID-19 pandemic. There is now an entire cohort of children who are susceptible to many diseases, and experts predict it will take two to three years for us to catch up on all the children we missed in 2020.
Often, many of my more mature patients believe they will get influenza from the vaccine itself. It’s incredibly important to listen to them and ask about their fears. I then respectfully ask them, “Can I answer those questions for you?” I’ve never had anyone say, “No, you can’t.”
I explain that this vaccine has been carefully tested. I trust it, and I’ve taken it myself. I explain that you can have side effects from vaccines, including headaches, muscle aches, fever and runny nose. I ask patients, “If I tell you these symptoms can occur and they do, are you going to be afraid?” Many patients respond that they didn’t know these are common side effects, and I stress that if they experience more severe symptoms, it’s probably not because of the vaccine. It takes two weeks for the influenza vaccine to work. You may get infected before vaccine goes into effect.
I’ll ask, “Have I answered all of your questions?” If the patient answers yes, I then say, “I’d like to give you this vaccine today to protect you.” It’s really about taking the time to listen to people. Nurses and NPs are so good about vaccinating patients. We are the most trusted of all professions. If a health care organization wants to boost its immunization programs, it must get buy in from its nursing and NP staff.
Influenza vaccination can flatten the curve of illnesses, help protect essential workers and save medical resources for the care of patients with COVID-19. This year, it’s especially important that NPs encourage patients to get vaccinated — and get vaccinated themselves.
NP Pulse: The Voice of the Nurse Practitioner®, the official podcast of AANP, launched with episodes dedicated to infectious disease. AANP President Dr. Sophia Thomas sat down with NP experts Dr. Hudson Garrett and Dr. Ruth Carrico for a candid two-part discussion on COVID-19 and how NPs can take the lead in navigating infectious disease control. Listen on Apple Podcasts, Spotify, Amazon Music or anywhere else you enjoy your podcasts!
AANP is also compiling educational and clinical information regarding the COVID-19 pandemic, including a look at symptoms, testing, infection control, support for health care providers, treatment, research and, when available, funding opportunities. Three patient education infographics, designed to provide information on common symptoms and tips on protecting oneself and others from COVID-19, are now available for download. The AANP Infectious Disease page also includes continuing education (CE) courses, members-only clinical practice briefs and resources on other infectious diseases such as measles, hepatitis C and the Zika virus.