As the daughter of a nurse, my first memory of being aware of vaccines involves diligently carrying my little yellow immunization card into my pediatrician’s office and feeling pride when all the boxes were filled in. Even as a small child, I was destined to be an ICU nurse. The chickenpox vaccine was not widely used when I was a child, and I remember “chickenpox parties” in which my mom and her friends would gather us all together when one child got chickenpox. The goal was for all of the children to get the illness and recover before attending kindergarten. The practice of intentional exposure to an infected individual to attempt to mitigate or prevent illness is a practice that goes back centuries if not millennia.
History of Vaccines
The development of vaccines hasn’t always followed the rigorous ethical standards we adhere to today. Nevertheless, vaccines have saved more human lives than any other intervention in history.
- 1806 – Napoleon Bonaparte and Thomas Jefferson endorse the smallpox vaccine.
- 1885 – Louis Pasteur prevents rabies through post-exposure vaccination.
- 1918 – “Spanish flu” kills one in 67 U.S. soldiers and sparks development of the influenza vaccine.
- 1952-1955 – The first effective polio vaccine is developed.
- 1971 – The MMR vaccine is developed by combining the measles vaccine developed in 1963, the mumps vaccine developed in 1967, and the rubella vaccine developed in 1969.
- 1978 – The pneumococcal pneumonia vaccine is licensed.
- 1985 – The first vaccine against Haemophilus influenzae is licensed.
- 2006 – The first vaccine against human papillomavirus (HPV) is approved and becomes key in the effort to eliminate cervical cancer.
- 2019 – WHO prequalifies the use of an Ebola vaccine in high-risk countries.
- 2020 – The first doses of the mRNA COVID-19 vaccine are administered.
- 2021 – A third-generation smallpox vaccine is approved for the prevention of Mpox (then known as monkeypox).
I’m struck by the relatively recent advent of many vaccines and how different life and nursing must have been before these vaccines were widely used.
Vaccines for the Ages
The CDC provides vaccine schedules for individuals from birth to 6 years, 7 to 18 years and adults. Many of us are familiar with the typical childhood vaccines, including HepB, DTaP, polio and MMR. These series are generally completed by the time a child enters school. The HPV vaccine is recommended for children 11-12 years old but can be started as early as 9 years old. Adults who have not received one before should receive a pneumococcal vaccination at age 65 or older. The vast majority of individuals should receive an annual flu vaccine. Some vaccines such as the Tdap require boosters at certain intervals. Individuals who are pregnant should receive a Tdap in the early part of gestation to protect their infant from pertussis, as the first DTaP cannot be administered until the baby is 2 months old.
The CDC also provides guidance for children and adolescents who start getting immunized later than the recommendations or who are more than one month behind.
Types of Vaccines
Vaccines are an instruction manual for our immune system on how to fight certain pathogens. Each type of vaccine does this in a slightly different manner.
- Inactivated vaccines are a killed version of the pathogen. They require several doses to provide full immunity. The hepatitis A, flu and rabies vaccines are inactivated.
- Live-attenuated vaccines are a weakened form of the pathogen. They create a strong, lasting immunity and often require only one or two doses. The MMR, smallpox, chickenpox and rotavirus vaccines are live attenuated.
- Messenger RNA (mRNA) vaccines make proteins that trigger an immune response in the host, so the host can mount immunity against the pathogen. They do not contain live virus and therefore cannot produce disease in the individual. The COVID-19 vaccine is an mRNA vaccine.
- Subunit, recombinant, polysaccharide and conjugate vaccines use pieces of the pathogen, such as its protein, sugar or capsid to create an immune response against the pathogen. They can be used on almost everyone, including those who are immunocompromised, but they may require a booster for ongoing protection. Some examples of these types of vaccines are Hib, hepatitis B, HPV and DTaP.
Currently, over 20 diseases can be prevented with vaccines, and over a dozen more are being developed. According to the CDC, UNICEF and WHO, vaccines prevent between 2 million and 4 million childhood deaths each year. Vaccines are one of the most effective means of preventing childhood disease and death. However, for the first time since the 1980s, childhood vaccination rates are declining. This decline may be attributed to many factors, including pandemic disruptions in access to healthcare, physical displacement and vaccine misinformation, which has resulted in approximately 25 million children missing lifesaving vaccines. It is estimated that vaccines prevented approximately 3.2 million COVID-19-related deaths, prevented 18.5 million U.S. hospitalizations, and saved $1.15 trillion in the United States.
The CDC’s Routine Immunizations on Schedule for Everyone (RISE) initiative calls on all healthcare providers to prioritize catching everyone up on routine vaccination. As nurses, we must generate conversation on this topic with our patients and providers. The CDC outlines strategies specifically designed for healthcare professionals to reinforce confidence in routine vaccination, make vaccination a sustainable practice and support a culture of vaccination in our work environments. We can identify communities where there are pockets of unvaccinated or undervaccinated individuals. Nursing is the most trusted profession and, as such, nurses can empower families and stop the myths and misinformation about vaccines. Since many patients may face systemic obstacles to receiving primary care, it would be amiss to not use every opportunity we have (such as during hospitalization) to encourage vaccination.
In the last three years, we nurses have persevered during a worldwide pandemic. If we weren’t already, we have become intimately aware of the lifesaving capabilities of vaccines. As a pediatric ICU nurse, I have witnessed the decline in meningitis and meningococcemia due to the meningococcal vaccine. I have seen children die because they did not receive the pertussis vaccine or were undervaccinated. I have seen ebbs and flows in the number of children contracting measles based on misinformation about vaccines. I’ve never seen a child with smallpox or polio due to the robust and comprehensive vaccine campaigns to eradicate those diseases.
As nurses, we have a pivotal and impactful role in informing and encouraging vaccinations for infants, children and adults.
How will you help your patients learn about vaccines?