Focus flu shot vaccine discussions on parents who waffle

The December 2019 issue of Contemporary Pediatrics discusses current influenza immunization data from the Centers for Disease Control and Prevention (CDC).  Researchers looked at the 2016-2017 and 2017-2018 influenza seasons using inpatient data from 7 pediatric hospitals. Severe respiratory outcomes of immunized pediatric patients diagnosed with influenza were studied. Not surprisingly, the data demonstrated that immunization protects against hospitalization. Specifically, over the 2 influenza seasons, immunization decreased the risk of pediatric hospitalizations from influenza-related respiratory complications by 50%. 

In my experience as a pediatric Physician Assistant, discussing vaccination against influenza can go a few different ways. One group of families faithfully vaccinate their children every year. This is the easy group. These patient interactions do not require lengthy discussions about the risks versus benefits of vaccination and there is no tension in the room (at least among the adults, the patient might be a little tense!) Even better, families that fall into this category may initiate an appointment for a nurse-only flu clinic. They actively believe that vaccination is in the best interest of their family and community, and will find a way to get the vaccine.

The next group of families do not believe in vaccinating against the influenza, and often decline immunizations for other vaccine-preventable illnesses as well. Although most of us do our best to discuss the benefits of the vaccine and the risks of influenza to the patient and other members of the community, we understand that this is only 1 conversation in a long discussion. The goals of this discussion may include communicating a clear recommendation, strengthening the relationship with the family by respectfully listening and answering questions if they arise, and being available to facilitate vaccination if the family paradigm changes.

The third group is somewhat unique to the influenza vaccination discussion. These families may immunize against other conditions, but are not concerned about the influenza immunization. I have heard many stories from parents on how their children had influenza last year and ran a fever and coughed for a few days, but otherwise were fine. Other families may have immunized their children against influenza in previous seasons, yet their children acquired the illness anyways. In their minds, this nullifies the need for vaccination in subsequent years. 

These families may benefit the most from targeted, evidence-based patient education supported by the influenza immunization and hospitalization data that is highlighted in this issue. The truth is, although influenza may be a minor viral inconvenience for some patients, in others it leads to serious complications that can include hospitalization and even death. Parents need to be reminded of the facts, including that while their children may still get sick from influenza even though they received the vaccination, the chances of serious respiratory complications and hospitalization are significantly reduced. 

Kristy Luciano is a Physician Assistant who graduated from Midwestern University-Downers Grove Physician Assistant Program in 1999.  She is an Assistant Professor and Director of Didactic Education at Midwestern University and serves as a Member at Large on the Board of Directors for the Society for Physician Assistants in Pediatrics.