Jennifer Orton and Dr. Beth Luthy, College of Nursing
Comparing the pre-vaccine rates to the 2010 rates, vaccine preventable diseases have decreased by 98% or greater for diseases such as smallpox, diphtheria, measles, mumps, and rubella (American Academy of Microbiology [AAM], 2010). High vaccination rates are required to maintain low disease prevalence, and all 50 states have legislated mandates with childhood vaccination requirements before enrolling in public schools in an effort to maintain high vaccination rates (Centers for Disease Control and Prevention [CDC], 2011). Conversely, adult vaccination rates are low and many adults are unsure of their vaccination status (Johnson, Nichol, & Lipczynski, 2008) or are not completely vaccinated against diseases such as measles, pertussis, and influenza (Children’s Hospital of Pennsylvania [CHOP], 2010). These unvaccinated persons may be carriers of and spread infectious disease to others without exhibiting symptoms or awareness of infection. Additionally, adult vaccinations reduce disease transmission and healthcare costs when outbreaks do occur (AAM, 2012).
The close quarters and dense populations at schools create a susceptible environment for disease transmission, and low school employee vaccination rates are costly for school districts during disease outbreaks. For example, in 2011 there was a measles outbreak in Salt Lake County, Utah and school employees that were exposed to measles and had not received the adult Measles, Mumps, and Rubella (MMR) booster were quarantined and replaced with substitutes costing the school district $10,000. School employees and their families also experienced personal costs including unforeseen medical expenses, loss of wages, and time off work (Stewart, 2011).
Based on the beneficial impact of adult vaccinations and the risk factors in school environments, the purpose of this study is to evaluate why school employees have not received the adult MMR vaccine or an annual influenza vaccine and to identify their views on mandatory vaccinations for school employees. To measure these results, questionnaires were distributed to 1,400 employees in a rural Utah school district, and 835 questionnaires were completed and returned. The data analyzed included two multiple choice questions determining school employee’s reasons for declining the annual influenza and/or the adult MMR vaccinations and an open-ended question inquiring why adult vaccinations should not be mandatory for school employees.
The primary reasons that school employees in the rural school district did not receive an influenza vaccine was concern about the vaccine efficacy, lack of time or forgetting to get the influenza vaccine, and the difficulty of taking time off work to get the vaccine at a clinic. A possible solution is providing vaccine clinics at workplaces increases the vaccine rates among employees (Nowalk et al., 2010). Regarding MMR adult vaccination, a lack of awareness or knowledge about the adult booster was the most
prominent reason that school employees had not received this vaccine, and many employees believed the childhood MMR vaccine was sufficient to prevent the illness. Including education about the necessity of adult vaccinations to maintain protection may increase understanding about and improve the rates of adult vaccinations.
School employees in the rural school district expressed different concerns regarding mandatory vaccinations including efficacy of vaccines, need, and cost. However, the greatest concern of the respondents was mandatory vaccinations eradicates the right to make health decisions. Overall, school employees were not opposed to vaccinations in general, but many were opposed to the elimination of personal choice subsequent to mandatory vaccinations. The purpose of mandating vaccinations, however, is not to eliminate personal choice but to increase the protection against preventable diseases thereby increasing the health of individuals and the entire community.
Broadening vaccination education and efforts to adults and specifically school employees is an important intervention to consider, and recently Nebo School District created an adult vaccination mandate for their school employees. Dr. Luthy and I are finalizing the analysis and preparing the findings for journal publication. This past April I presented a resolution at the National Student Nurses’ Association Annual Convention about school employee vaccinations and used the literature review data to support and pass the resolution. I was unable to use our data in the resolution because our results were not yet published, but I discussed our findings with other students and faculty.
The experiences and knowledge I have gained through this ORCA project will assist me in my future career and education. I have learned the importance of research and how expanding knowledge can be used to create beneficial changes. The capabilities, guidance, and knowledge of Dr. Luthy has increased my interest in research and in continuing my education to a graduate degree.
References
- American Academy of Microbiology. (2012). Adult vaccines: A grown up thing to do. Washington, DC: American Academy of Microbiology. Retrieved from http://www.osaicri.org/AdultReport.pdf
- Centers for Disease Control and Prevention. (2011). State vaccination requirements. Retrieved from http://www.cdc.gov/vaccines/vac-gen/laws/state-reqs.htm
- Children’s Hospital of Philadelphia. (2010). Immunizations: Vaccines and Adults. A lifetime of health. Philadelphia, PA: Children’s Hospital of Philadelphia.
- Johnson, D. R., Nichol, K. L., & Lipcynski, K. (2008). Barriers to adult immunization. American Journal of Medicine, 121(7), S28-S35.
- Nowalk, M. P., Lin, C. J., Toback, S. L., Rousculp, M. D., Eby, C., Raymund, M. & Zimmerman, R. K. (2010). Improving influenza vaccination rates in the workplace: A randomized trial. American Journal of Preventive Medicine, 38(3), 237-248. doi:10.1016/j.amepre.2009.11.011
- Stewart, K. (2011, May). Utah tallies costs as measles outbreak runs its course. Salt Lake Tribune. Retrieved from http://www.sltrib.com/sltrib/news/51831839-78/measles-outbreak-health-county.html.csp