Tuesday, February 10, 2015

Free Measles Educational Materials for Healthcare Professionals and Patients


During this measles outbreak, Nurses Who Vaccinate would like to encourage our readers to utilize Immunization Actions Coalition’s free educational materials for healthcare professionals and patients; many available in other languages. Please refer to the following information and resources as we all work together to help stop the spread of measles during this multi-state outbreak.
  


Resources about Measles for Healthcare Providers
Resources about Measles for Parents and Patients
Vaccine Hesitancy Resources



Monday, February 9, 2015

Measles- What Nurses Need to Know

Measles was declared eliminated in the US in 2000 but now we are in the midst of a measles outbreak that is pretty near in numbers to an epidemic. So what happened?  There has been a small but growing number of parents who refuse or delay MMR vaccine based on the now discredited study that came out of England some years ago. While the U.S. has an overall high rate of measles immunization, pockets of unvaccinated children in some communities leave everyone vulnerable.  

Measles is the most infectious of all diseases. If you are not immune and walk into a room previously occupied by a person infected with measles 2 hours ago, you WILL most likely get measles. Unvaccinated people can hide in the head in the US because we have so many vaccinated here but once that unvaccinated person goes somewhere where measles is epidemic, that person can bring measles back here and cause a measles outbreak of catastrophic proportions. 

Once measles gets into the community, it is very difficult to eliminate it. 


So what are nurses to do? 


Nurses need to make sure that they are:
  • protected.
  • able recognize signs and symptoms of measles,
  • up-to-date with latest treatments.
  • using a respectful and effective method of education with vaccine-hesitant patients and families.
Protection

When it comes to making sure you are protected that means verifying your vaccination status. You should have been vaccinated yourself unless you are old enough to have had the disease yourself. According to the CDC:
If you were born in 1957 or later and have not had the MMR vaccine, or if you don't have an up-to-date blood test that shows you are immune to measles or mumps (i.e., no serologic evidence of immunity or prior vaccination), get 2 doses of MMR (1 dose now and the 2nd dose at least 28 days later). If you were born in 1957 or later and have not had the MMR vaccine, or if you don't have an up-to-date blood test that shows you are immune to rubella, only 1 dose of MMR is recommended. However, you may end up receiving 2 doses, because the rubella component is in the combination vaccine with measles and mumps. For health care workers born before 1957, see the MMR ACIP vaccine recommendations.

Signs and Symptoms of Measles


It can be quite difficult in the winter season, with cold and influenza patients seeking treatment, to differentiate measles patients from others early in the infection. 
  • 7-14 days after incubation, catarrhal symptoms manifest themselves.  They include: cough, soreness, temperature, sore throat, rhinorrhea (runny nose), and conjuctivitis (red eyes).
  • 2-4 days into the infection, Koplik spots (small white spots) resembling grains of salt, appear on the inside of the mouth.
  • 3-5 days after the initial symptoms, an itchy macular rash (reddish flat) and papules (solid, raised spots) develop on the face.
  • Within 1-2 days, the rash spreads to the trunk, arms and legs, while a rash on the face began to fade. At this point of the disease, the patient's temperature can reach as high as 104.
It is important to remember that the patient is infectious 2-4 days before the rash appears and remains infectious 2-5 days after the onset of the rash.



Treatment

There is no treatment for uncomplicated measles. The interventions below are to provide support and treatment of the symptoms. 
  • Isolation- Patients will need to be on isolation precautions to decrease transmission within the community. Emphasize the need for immediate isolation when early catarrhal symptoms appear 
  • Skin care- Measles causes extreme pruritus. Nursing interventions include keeping the patient's nails short, encourage long pants and sleeves to prevent scratching, keeping skin moist with health care provider recommended lotions, and avoiding sunlight and heat. 
  • Eye care- Treat conjunctivitis with warm saline when removing eye secretions and encourage patient not to rub eyes. Protect the eyes from glare of strong light.
  • Hydration- encourage oral hydration. Medical literature encourages the use of Oral Re-hydration Solution. 
  • Temperature control- Antipyretics should be administered to the patient as ordered for a temperature greater than 100.4 Fahrenheit unless directed elsewise by a healthcare provider. Be sure to remind parents not to administer aspirin due to the risk of Rey's syndrome.
  • Supplements- Vitamin A has been shown to help decrease mortality in children under the age of two years. The American Academy of Pediatrics  provides dosage recommendations here.
Patients should seek emergency medical treatment for the following signs and symptoms-

  • -Intolerance to food and/or unable to drink adequately.
  • -Altered level of consciousness and/or seizures.
  • -Severe respiratory infection.
  • -Severe diarrhea
Patient Education


The best way to treat measles is to prevent it. The best prevention is vaccination. The vaccine used to prevent the measles is the MMR vaccine (measeles, mumps, and rubella). According the the National Center for Immunization and Respiratory Diseases, "Two doses of this vaccine are needed for complete protection. Children should be given the first dose of MMR vaccine at 12 to 15 months of age. The second dose can be given 4 weeks later, but is usually given before the start of kindergarten at 4 to 6 years of age." 

Patients and parents will often have questions and concerns about the MMR vaccine used to prevent the illness due to the large amount of misinformation circulating the internet. Be sure to provide up-to-date handouts and patient education materials when the opportunity presents itself. The CDC provides patient education in a range of different languages, such as Spanish. If you're looking for studies that debunk the vaccines/autism myth- here is a list of 107 peer-reviewed, evidence-based research studies that show there is NO LINK between autism and vaccines. We also suggest providing them with this powerful letter written by famous children's author Roald Dahl about his personal (heartbreaking) experience with measles. 

The most important part of addressing and educating vaccine-hesitant patients is listening to the concerns expressed by patients and others who question vaccines. The following is a guided walk-though that allows nurses to effectively respond to frequently asked questions about vaccine safety.

  • Express your understanding of their reservations.
  • Explain to them that you have educated yourself about the dangers of measles disease because you want or be able to help them make healthy decisions for themselves and their children.
  • Tell them stories about measles disease in friends or family if you know any.
  • Then explain the science behind the safety of MMR vaccine and as a scientist yourself you trust the science.
  • Then tell them you are vaccinated yourself and you want to offer the same protection to them or their child and you want to vaccinate them today.
If this framework of conversation sounds familiar, it's based on the CASE method, a framework of conversation many of us at Nurses Who Vaccinate use for communicating with patients and families.  
Try it.

Nurses are the most trusted of all professions. Let's use that trust to help our patients and prevent them from the ravages of the measles. You can save a life doing this. And no one does it better than nurses!


Check Out Additional Educational Resources

Thursday, February 5, 2015

Guest Blog: Patients Should Speak Up, and Speak Out, About Anti-Vaccine Nurses


Vaccines are safe and save lives.


That is the determination of decades of research into and development of vaccines. Vaccines are considered by the vast majority of people to be one of the, if not THE, most important medical breakthrough during the last century. Billions of cases of disease have been prevented, millions of lives have been saved, and incalculable misery has been avoided, all because of vaccines. Say it aloud- Vaccines are one of the most successful public health initiatives EVER.

"Vaccines save tens of thousands of children every year. Vaccination has eliminated or reduced a wide range of once-common diseases in the U.S. [and everywhere else]. Without current vaccines, approximately 42,000 of the 4.1 million children born in the U.S. in 2009 would die early deaths. For that same group of kids, researchers estimate that vaccines have prevented and will prevent 20 million cases of disease." - Kevin Loria, Business Insider

That’s why when I see a nurse or other health care worker spouting anti-vaccine propaganda and lies, I question their ability to adequately care for me or for other patients. And I question why they are working in a science-related field at all.

Recently, I’ve seen a small but extremely vocal movement of nurses and other health care workers who are openly rejecting science and research by advocating against vaccines. These so-called professionals are taking pride in making statements that are the antithesis of hundreds of thousands of studies, conducted by experts, monitoring the efficacy, effectiveness, and safety of vaccines. It’s troubling to me that health care workers would dismiss science in favor of unproven nonsense.

Many of these health care workers repeat and spread misinformation regarding vaccines, such as the lie “vaccines didn’t reduce disease” (yes, they did) or “vaccines are more dangerous than diseases” (no, they are not).  Most troubling of all, it’s not uncommon for anti-vaccine and anti-science health care workers to reject even germ theory, claiming that germs do not cause disease. How can someone whose job it is to care for people who are physically vulnerable reject the very basis of their field?

These anti-science health care workers place their patients and their communities at risk through their actions and through their beliefs. As a past patient, I would not want such a person caring for me, a loved one, or indeed anyone in a health care setting.  Health care clinics and hospitals should not allow their employees to threaten the physical health of their patients through rejection of proven science. The existence of such employees undermines the trust that patients should have in their health care providers.




Nurses Who Vaccinate member Allison Hagood is the co-author of “Your Baby’s Best Shot: Why Vaccines are Safe and Save Lives."

Click here to join the Nurses Who Vaccinate movement. Speak up.

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Wednesday, January 28, 2015

When A Nursing Student Depends on Others To Protect Her

Nursing student Rachel writes about how being unable to rely on her immune system has made her into a stronger vaccine advocate.

Like every little kid, I always changed my career plans. However, unlike, most kids, they all had one common theme: they were all medical or health care fields. I switched from veterinarian to doctor, from pharmacist to physical therapist, and so on. All throughout my childhood and high school, I immersed myself in medical shows such as Mystery Diagnosis and researched different diseases and medical treatments just because I found them fascinating. Like my mechanical engineer brother whose first word was “car”, my family had a pretty good idea of what field I would be going into.

When I finally graduated high school, I decided to go into nursing. With so many interests, I felt that with a career in nursing, I would have many opportunities to explore new fields.  As I progressed through nursing school, I learned more and more about what I was interested in, but more than that, I fell in love with the field. I knew this is what I wanted to be doing with my life.

One topic I frequently researched in my free time was vaccines, and it developed into a passion of mine. I believe that education is one of the most important things we can do as nurses. The topic of vaccines is especially important to discuss because it is a subject flooded with misinformation. I used the knowledge I have acquired to discuss the topic with patients who refused vaccines for themselves or their children. I was very careful not to sound accusatory or pushy, and discussing the topic with patients allowed them to explore their fears and misconceptions about vaccination, and some of the patients changed their minds about them. This is something I’m very proud of.

Everything was going great, but the summer before my senior year, I noticed something was wrong. Long story short, I was diagnosed with Microscopic Polyangiitis (MPA), which is a rare autoimmune vasculitis of the small and medium-sized vessels in the body. Most patients are either middle-aged or elderly, but I was only 21-years old. In my case, it had affected the vessels in my skin, joints, lungs, eyes, and kidneys, but can also affect the ears and GI tract. The only treatment available for many autoimmune diseases is to suppress your immune system. While my first thought should have been directed towards my health, it was actually, “How can I continue nursing if I’m immunosupressed?” It was a scary time for my family and I.

I was extremely fortunate to have been diagnosed so early and over the summer before school started back up again. Even though my case was considered severe because I experienced an alveolar hemorrhage, there was no noticeable permanent lung damage, the kidney damage was minimal, and there was no permanent damage to anything else. I responded to treatment, Rituxan infusions and high dose prednisone, quite well (even though no one likes to be on prednisone). Most people who are diagnosed are not as fortunate as I have been and have more severe kidney and/or lung damage. After talking to my rheumatologist, he said I can continue nursing school and clinicals, but that I had to be careful and wear a mask around patients with URIs and certain other illnesses for the time being.

Thankfully, my diagnosis hasn’t otherwise affected my performance in nursing school. After completing over 3 years of schooling, I wasn’t going to let my diagnosis stop me. Other students noticed that my face got a bit puffier from the prednisone, but most of them didn’t say anything and thankfully, I’m now off of prednisone and the puffiness is gone. I’ve discussed my diagnosis with a few of the other students when it came up and used it as an opportunity to educate them. After exploring my interests, I ultimately fell in love with pharmacology and the operating room, which is why I’m striving to eventually become a CRNA. I’m now in the last semester of my senior year, and I’m set to graduate with my BSN from Rutgers in May.

I was a huge advocate of vaccines before my diagnosis, but this solidified my beliefs. I had to start treatment before the annual flu vaccine was available, so by the time I received it, my body couldn't create an immune response to it. I have to rely on others to be vaccinated in order to protect myself. With a weakened immune system and no B-cells, I’m vulnerable to many illnesses and catching them could be dangerous for me. Not many people under 60 can claim to have received the pneumococcal vaccine, but I am one of them. And since MPA has a high relapse rate, I will be receiving maintenance infusions of Rituxan every four months for two years.

My diagnosis, while not pleasant, has had many upsides. I learned what it was like to be a patient and how scary it is to be uncertain about your health. I’ve learned what it’s like to be dismissed, like when people just don’t believe you or think you’re making things up when you know something’s wrong. I’ve learned how frustrating it is be NPO for long periods of time, and go through test after test only to find nothing. I learned how important community immunity is for individuals like myself. But maybe most importantly, although MPA may not have left me physically stronger, it has certainly has made me mentally stronger, and it given me a new perspective that will allow me to be the best nurse I can be.




Nurses Who Vaccinate member Rachel Herman is in the last semester at Rutgers Camden for her BSN. Most of her interests are ridiculously nerdy, but she also loves animals, music, and traveling. She is by no means a writer, and hopes to pursue a career as a nurse anesthetist.


Do you have a story you would like to share with Nurses Who Vaccinate? Email us here- NursesWhoVaccinate@gmail.com


Tuesday, January 6, 2015

Online Forum For NWV Members

Nurses Who Vaccinate has created an online forum on Facebook for our members! Designed to be a interactive community, the purpose is to discuss vaccine news and Nurses Who Vaccinate events, educational & advocacy opportunities. The group is open to all Nurses Who Vaccinate members.

Before requesting to join, make sure you're a member of Nurses Who Vaccinate. You can check your status and sign up here- Membership Link.

Once you're a member, you can request to join the group, by clicking this link here- Forum Link

All requests will be processed by the NWV group administrators. Any questions or concerns, please email us at NursesWhoVaccinate@gmail.com. Looking forward to seeing you all there!


Thursday, December 4, 2014

CDC's Emergency Flu Health Advisory

The CDC has released an emergency advisory about influenza


The CDC advisory states that so far this season, influenza A (H3N2) viruses have been reported most frequently and have been detected in almost all states. This announcement comes along during a season that has already presented a few "Flu Season Surprises."

Why does this matter? During past seasons when influenza A (H3N2) viruses have predominated, higher overall and age-specific hospitalization rates and more mortality have been observed. Unfortunately 52% of the influenza A (H3N2) viruses collected and analyzed were antigenically different from the vaccine.

What that means is that the vaccine is not as close of a match for these circulating strains as scientists had hoped.  All things considered, clinicians should encourage all patients 6 months and older who have not yet received an influenza vaccine this season to be vaccinated against influenza. As nurses, it is important to share this update and stress to patients that the influenza vaccines still do protect against certain strains of the flu. While not 100% (and no vaccine is), being vaccinated to protect against the flu reduces the risk of influenza complications even among the strains that have mutated.

The CDC also stresses the usage of antiviral medications when needed and deemed appropriate. Roche's Tamiflu and GlaxoSmithKline's Relenza can shorten flu symptoms by around half a day however the CDC states that the benefit of these drugs is greatest when treatment is started early in the course of the infection.

You may see notorious websites using this information as a reason to refuse or avoid the influenza vaccine. Remember--Just because the vaccine is not a “perfect match” to  influenza A (H3N2) does not mean ones should refuse getting vaccinated. There are still other strains circulating and the vaccines still provide protection. If in the event you see websites or news sources advising against vaccination, contact them with the correct information, or direct them to the CDC for clarification. Voices for Vaccines recently wrote a blog post about the effectiveness of the influenza vaccine, and though not impervious, the influenza vaccine can make the difference of a child recovering from the flu at home on the couch or being treated in Pediatric Intensive Care Unit on a ventilator.


What else can we as nurses do to reduce the transmission of the influenza virus? 



Along with the flu prevention tips in the graphic above, the CDC urges you to "Take 3 Actions" to protect yourself and others from influenza (the flu).

  • 1-Take time to get a flu vaccine.
  • 2-Take everyday preventive actions to stop the spread of germs.
  • 3-Take flu antiviral drugs if your doctor prescribes them.

Skeptical Raptor provides a tl;dr version- The flu vaccine is incredibly safe. It’s fairly effective, though that can vary from year to year as flu variants mutate, like this year. This year’s vaccine may not be able to prevent a new variant of H3N2 flu, but it may lessen the symptoms of the variant.


The flu season has only just begun, and we've already had five flu-related pediatric deaths. It is imperative that nurses to educate patients, colleagues and their communities about the need to vaccinate against the flu. Protection is still protection, which is better than no protection at all. 

Tuesday, December 2, 2014

Nurses Need to Lead the Way When It Comes to Flu Shots

In recognition of National Influenza Vaccination Week (NIVW) Nurses Who Vaccinate is participating in a blog relay as part of a countdown to the first day of NIVW. 

Each day, a different Flu Vaccination Digital Ambassador will post about the importance of flu vaccination as it relates to their readers. You can follow the NIVW conversation on Twitter using hashtag #NIVW2014 and stay tuned as each Digital Ambassador shares who will be posting next.


-NIVW Blog Relay Schedule-

Monday, December 1  –     A Place for Mom – adults 65 years and older
Tuesday, December 2 –      Nurses Who Vaccinate – health care professionals
Wednesday, December 3  - Voices for Vaccines – parents and caregivers of young children
Thursday, December 4  –   Shot of Prevention – pregnant women and parents
Friday, December 5  –       Healtheo360 – people with a chronic illness, like heart disease or diabetes
Saturday, December 6 –    HealthCentral – people with asthma 
Sunday, December 7 –      About.com Cold & Flu – people at any age or stage of life



Nurses Who Vaccinate are proud to be partnering with our fellow Digital Ambassadors in sharing the importance of influenza vaccines in the week preceding National Influenza Vaccination Week (NIVW). Initiated by the CDC in 2005 to highlight the importance of continuing flu vaccination through the holiday season and beyond, this year's NIVW is scheduled for December 7-13, 2014.

Nurses are the leading teachers of health care.

Nurses are the main health care workers responsible for educating patients and communities. Like many public health initiatives, the best way to educate our patients about vaccines is to lead by example.

We can only expect our patients to follow our medical advice when we implement it ourselves. We need to walk the walk if we're going to talk the talk. A nurses' role is not limited to administering vaccinations.  It is a nurses' responsibility to be vaccinated and, importantly, do so publicly.

Many nurses and doctors have taken to social media to share that they've received their influenza vaccines. Many of our Nurses Who Vaccinate members have done just that!


Another way to demonstrate the evidence-based side of nursing is by taking the CDC Flu Vaccination Pledge for the 2014-2015 Season. Nurses are also encouraged to participate the  CDC-hosted Twitter chat on Tuesday, December 9 from 1­2pm EST. Nurses can follow this event on Twitter at  @CDCFlu, and with the hashtag #NIVW2014.
The chat will:
o Emphasize that getting vaccinated in December, January and beyond may still provide protective
benefit against influenza.
o Remind parents and providers of the need for certain children to receive a second dose of flu vaccine for optimal protection.
o Provide an opportunity for people to ask questions about the flu and flu vaccination.


The influenza vaccine is safe and effective.

Vaccinating nurses and health care workers has been proven to be effective in protecting patients from influenza. Several studies have shown that vaccination of health care workers protect elderly patients in long-term care. One analysis predicted that if all health care workers in a facility were vaccinated, then approximately 60% of patient influenza infections could be prevented.

Yet, the final numbers for last flu season reported that health care worker influenza vaccination coverage was only 75.2% , similar to coverage of 72.0% in the 2012-13 season. We need to do better.

According to the American Public Health Association, "Influenza vaccination of health care workers is the single most important measure for preventing occupation-acquired and nosocomial influenza from both known and unexpected sources. Other measures, such as hand hygiene and barrier precautions, are additional protective steps, not alternatives. Masks or respirators, whether worn by people with influenza-like illness (ILI) symptoms or those who are in proximity to them, are not as protective as preexposure immunization, especially given the high proportion of asymptomatic infectious people."




You can join the growing number of nurses who are getting their influenza vaccine. Be one of the main pro-science nurses proudly saying, "I won't spread the flu to my patients or my family this year!"




If you've already received your yearly influenza vaccine for this flu season-- kudos and THANK YOU! You're setting a positive example among your co-workers and patients.

Are you encountering questions and concerns from others who are flu vaccine hesitant? Seeing a large number of flu-refusing, mask-wearing co-workers? The CDC has complied common questions and misconceptions about influenza vaccines and answered them on this page. Feel free to print it out for educational handout material and even post it in the break room! Looking for more influenza information to help encourage colleagues to get their flu shots? Check out the CDC Flu campaign for healthcare workers. If you're uncomfortable answering questions personally, send them our way via email- NursesWhoVaccinate@gmail.com.


Remember: CDC says an annual flu vaccination is the best protection against flu. Nurses get your flu vaccine and encourage other healthcare workers to do the same by sharing your flu vaccine selfies (#vaxselfies) on social media using the #VaxWithMe tag! Be sure to stop by the other NIVW relay participants’ blogs to learn about flu vaccination for everyone – tomorrow’s post will be hosted by our friends over at Voices for Vaccines.


Nurses Who Vaccinate are nurses and health care workers who care about themselves, patients and communities. Are you a pro-science nurse? Supporter of evidence-based nurses? Become a member-http://www.nurseswhovaccinate.org/become-a-member-.html