Immunizations have been one of the best public health interventions of the past one hundred years, almost as impactful as clean water. Most vaccine-preventable diseases have been reduced dramatically with widespread use of immunizations, yet many people forego some recommended immunizations.
The Centers for Disease Control’s Advisory Committee on Immunization Practices recommends annual influenza immunizations for everyone over the age of six months. About 59% of children (ages 6 months to 17 years) and 42% of adults (18 and over) received an influenza vaccination for the 2013-2014 influenza season. 1 Can we reach the Healthy People 2020 goal of 70 percent influenza immunization rate in adults?
Barriers to Immunization
The reasons for not being immunized are many and varied. Two barriers to immunization uptake are needle phobia and the problem of having needles in some settings, such as community immunization events and correctional facilities.
Needle phobia is a common problem and one reason some people for avoid the annual influenza immunization. A survey of parents revealed almost one in four (24%) in a sample of parents (n=833) and two out of three (63%) children (n=1024) reported being afraid of needles. Seven percent of adults and 8 percent of children reported avoiding immunizations because of their needle fears. 2
In some settings, it is best to minimize the presence of needles. In recent years, creative opportunities for immunizing, outside of the clinical office, have multiplied. Pharmacies, grocery stores, churches, and community centers, bring make it so much easier for many people to get vaccinated. But needle disposal in these settings can add to the logistical problems.
One setting that needs careful control of needles and needs to avoid access to used needles is prison or jail. The prevalence of blood borne pathogens is higher among inmates.3 Correctional facilities have struggled for years with keeping needles out of the hands of inmates. Strategies to reduce the presence of needles may help keep used needles out of the inmate population and help reduce transmission.
One needle-free option is the live-attenuated vaccine, given as a mist. However, it cannot be used with those under the age of two or over the age of forty-nine, those with certain health problems, and pregnant women. 4
Another immunization system that eliminates the needles and can be used with a broader range of adults is the PharmaJet® Stratis® needle-free jet injector with Afluria® influenza vaccine. Unlike previous air compression-based injectors, this tool has a single use disposable cartridge at the end, elimina risk of spreading infection through the tip of the injector.
Patient satisfaction with the PharmaJet needle-free injector has been high. A survey of 1463 adults (ages 18-64) who received the needle-free air injection in retail clinics in college students, state employees, a military group, and grocery store pharmacies showed a high level (96 percent) of satisfaction and 93% intend to use the injection system next year. Over 90% would recommend it to friends.5 Nurses have another tool in our efforts to raise the influenza immunization rates.
1. Centers for Disease Control (CDC, 2014a), Flu Vaccination Coverage United States, 2013-14 Influenza Season Data sources: National Immunization Survey-Flu (NIS-Flu) and Behavioral Risk Factor Surveillance System (BRFSS) http://www.cdc.gov/flu/pdf/fluvaxview/vax-coverage-1314estimates.pdf
2. Taddio A, Ipp M, Thivakaran S, Parikh C, Smart S, Sovran J, Stephens D, Katz J.(2012) ,Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine. Jul 6;30(32):4807-12. doi: 10.1016/j.vaccine.2012.05.011. Epub 2012 May 19.
3. Centers for Disease Control (2014b) Correctional facilities and viral hepatitis. http://www.cdc.gov/hepatitis/Settings/corrections.htm.
4. Centers for Disease Control (2014c) Live, Intranasal Influenza Vaccine Information Statement, http://www.cdc.gov/vaccines/hcp/vis/vis-statements/flulive.html
5. Copeland, Karen, 2015, unpublished data
Nancy Rudner, DrPH, RN works for Health Action.