Influenza Vaccination

Influenza Vaccination

Obviously, the audience (you all) who read these Morsels love critical care topics (Post-Tonsillectomy Hemorrhage has been the most viewed Morsel since it was written in 2012), but excellent care in the Peds ED often requires some considerations that emergency providers don’t often list in their skill set.  Issues that we might assume are in the realm of the Primary Care provider (ex, Asthma Control, Developmental Milestones, Firearm SafetySubmersion Prevention, and Injury Prevention) actually can play critically important roles in the management of our patients in the ED.  One such topic is Vaccinations.  We need to help children stay healthy by giving at risk patients the Influenza Vaccination.

 

Vaccination in the ED is NOT Unusual

  • The ED is a critical frontier for public health.
    • This is certainly true for critical injuries and illnesses.
    • It is also true for sub-acute and chronic disorders.
    • It has an equally important role in injury and illness prevention.
  • The ED has already been administering vaccinations as part of appropriate care.

 

Influenza

  • Influenza Vaccination has proven to be an effective means to reduce influenza-related morbidity.
  • Vaccination of one group of at risk patients can also reduce influenza-related morbidity morbidity in other groups. [Gatewood, 2011]
  • Unfortunately, influenza vaccination is still underused among at risk patients. [CDC, Flu Vaccination Rates]

 

Vaccination for Influenza in the ED

  • The vast majority of the vaccination should occur in the outpatient environment, but there are potential barriers to achieving this:
    • Lack of access to primary care office visit during the vaccination period
    • Lack of education about specific risk
    • Lack of education about recommendations
    • Parental preference / concern for vaccine safety [Strelitz, 2015]
    • Provider discomfort (hopefully, you are less uncomfortable now)
  • An ED visit offers an opportunity to influence many of these barriers.
    • Certainly discussing influenza, at risk populations, and the recommendations can improve awareness and influence subsequent vaccinations.  [Dappano, 2004]
    • Offering the influenza vaccination in the ED has also proven to be helpful. [Dappano, 2004]
  • Having a concurrent illness should not prevent vaccination.
    • The largest group of at risk patients we encounter in the ED are patients with asthma.
    • Does being on steroids interfere with the vaccination? NO.
    • Influenza vaccination can be given safely and effectively to kids with an asthma exacerbation even if they are on steroid therapy. [Park, 1996]

 

Moral of the Morsel

  • Providers in the ED encounter patients when they are most receptive to education about their illness.
  • Patients with asthma are often cared for in the ED and are one of the at risk populations.
  • Help prevent that patient from returning to the ED or causing someone else from becoming ill by expanding the exposure to influenza vaccination.

 

References

Strelitz B1, Gritton J2, Klein EJ3, Bradford MC2, Follmer K2, Zerr DM3, Englund JA3, Opel DJ4. Parental vaccine hesitancy and acceptance of seasonal influenza vaccine in the pediatric emergency department. Vaccine. 2015 Apr 8;33(15):1802-7. PMID: 25744225. [PubMed] [Read by QxMD]

Hoen AG1, Buckeridge DL, Charland KM, Mandl KD, Quach C, Brownstein JS. Effect of expanded US recommendations for seasonal influenza vaccination: comparison of two pediatric emergency departments in the United States and Canada. CMAJ. 2011 Sep 20;183(13):E1025-32. PMID: 21930745. [PubMed] [Read by QxMD]

Centers for Disease Control and Prevention (CDC). Influenza-associated pediatric deaths–United States, September 2010-August 2011. MMWR Morb Mortal Wkly Rep. 2011 Sep 16;60(36):1233-8. PMID: 21918492. [PubMed] [Read by QxMD]

Bramley AM1, Bresee J, Finelli L. Pediatric influenza. Pediatr Nurs. 2009 Nov-Dec;35(6):335-45. PMID: 20166462. [PubMed] [Read by QxMD]

Louie JK1, Schechter R, Honarmand S, Guevara HF, Shoemaker TR, Madrigal NY, Woodfill CJ, Backer HD, Glaser CA. Severe pediatric influenza in California, 2003-2005: implications for immunization recommendations. Pediatrics. 2006 Apr;117(4):e610-8. PMID: 16585278. [PubMed] [Read by QxMD]

Pappano D1, Humiston S, Goepp J. Efficacy of a pediatric emergency department-based influenza vaccination program. Arch Pediatr Adolesc Med. 2004 Nov;158(11):1077-83. PMID: 15520346. [PubMed] [Read by QxMD]

Park CL1, Frank AL, Sullivan M, Jindal P, Baxter BD. Influenza vaccination of children during acute asthma exacerbation and concurrent prednisone therapy. Pediatrics. 1996 Aug;98(2 Pt 1):196-200. PMID: 8692617. [PubMed] [Read by QxMD]

Sean Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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