1. Gould, Kathleen Ahern PhD, MSN, RN

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The influenza virus thrives in the human population, especially in winter months. The virus is common and highly infectious. The resulting illness may become a serious respiratory disease. This threat is certainly not new. Global influenza pandemics have occurred 3 times in the 20th century: 1968, 1957, and the Spanish Flu of 1918 to 1919, which caused more than 500 000 deaths in the United States and 50 million deaths worldwide. In a typical influenza season, 5% to 20% of the population becomes ill, many are hospitalized, and some will die.1 For this reason, local and national organizations such as the National Institute of Health recommend that everyone 6 months or older get a flu vaccine every year.


As a young child, I heard stories of how the flu epidemic affected my family. In Boston, during the early winter months of 1919, my grandmother became ill and was diagnosed with influenza. She was told that she, and her unborn child, would most likely not survive. However, she did survive and gave birth to my mother in February 1919. My mother became a public health nurse and later a school nurse, who would often share her own stories and remind us how she witnessed the eradication of many diseases over her lifetime. She was a champion of vaccines, hand hygiene, and all aspects of public health! Today, 100 years after my mother survived the flu, I carry her message, along with many nurse leaders and colleagues, as we share information, advice, and work to allay fears about vaccines. We are often the most trusted resource for our family, friends, and employees. We are in a unique position to educate many. But to develop an effective narrative, we must be armed with facts, stories, and evidence.


Lippincott's Nursing Center2 ( offers tools that may help you educate yourself and others. Many of these resources provide facts, data, and resources that will support your educational efforts, such as national and international fact sheets, talking points, and evidence-based literature. Downloadable PDF tools, such as Staying Healthy This Flu Season, includes the SHARE the Flu Vaccine Recommendations2 (Table 1). These resources may be distributed to staff and/or posted in public locations. The Nursing Center's current platform is focused on influenza and offers multiple education formats. For example, in a short video, Dr Anne Dabrow Woods, chief nurse of Wolters Kluwer, provides information, education, and evidence-based direction to prevent, diagnose, or manage influenza. As a counterpart to vaccines, she explains how antivirals are used and reviews the effective use of antivirals, explaining in plain language how the treatment depends on the identification of the virus and its susceptibility to the drug. Early diagnosis and administration of antiviral medications may shorten the duration of the disease and perhaps reduce some of the complications commonly associated with influenza. Dr Woods reviews treatment options such as oseltamivir (Tamiflu), prescribed in both liquid and tablets and prescribed for 5 to 10 days, depending on diagnosis or exposure. Zanamivir (Relenza) may be given nasally but cannot be used in patients with asthma or chronic obstructive pulmonary disease. In the clinical setting, peramivar (Rapivab) may be given intravenously. This 6-minute video is also available on YouTube ( and may be shared through social media or in professional communications.3

Table 1 - Click to enlarge in new windowTABLE 1 Lippincott's Nursing Center

Armed with strong evidence and many easily accessible tools, healthcare providers are well situated to inform the public and provide current information and clarification about the disease. The evidence is clear; the single best way to prevent against the flu is annual vaccinations. Yet, resistance still exists. Most vaccine resistance is based on fear and/or misinformation. Often, our role is to educate, answer questions, and ally fears with evidence-based facts.4 Because annual vaccination is somewhat of a variation from the typical vaccine routine, even this detail may require some additional information. Annual immunization is needed to combat the viral composition regulated by a process called antigenic drift, occurring when genes encoding the influenza surface undergo small changes-allowing the viruses to evade immune responses. Seasonal antigenic drift is the rational that determines that annual vaccinations are needed for influenza.1


All healthcare providers have an ethical obligation to keep patients safe from harm. The patients we serve are often immunosuppressed. Infants, children, pregnant women, people with chronic illnesses, and elderly patients also depend on us to keep them safe. Sadly, not all healthcare workers volunteer to receive the annual seasonal influenza vaccine. To address this, influenza vaccination is no longer a matter of personal choice.5 The importance of herd immunity is so strongly accepted by the medical community that laws requiring compliance now exist.6 As of 2016, 18 states have established mandates for healthcare personnel to receive the annual influenza vaccine. These laws are based on the hospital or facility type, including acute care, outpatient, and surgical settings. Of these 18 states, 11 permit medical exemptions, some permit religious exemptions, and 10 permit philosophical exemptions for receiving the vaccine.6 This information continues to be updated. Updates include clarification of terms such as Ensure Requirement, as this definition has changed from "requiring a healthcare facility to ensure that a healthcare worker or patient has been vaccinated, unless vaccination is specifically exempted or declined" to "the healthcare facility must require a healthcare worker or patient to demonstrate proof of vaccination or immunity against a specific vaccine preventable disease."6 For more information about the requirements and exemptions in your area, visit and search "Public Health Law." Additional information about all vaccines and the recommendations for healthcare workers can be found at The Centers for Disease Control and Prevention.


Lippincott's Nursing Center (Table 2) is a rich resource as it offers e-learning courses, short videos, blogs, info graphics, and free articles that can help you prepare an educational narrative. In addition, a downloadable PDF pocket card provides a quick handout or poster to reinforce your teaching.2,3,7-9 Links through the nursing center to government agencies and extensive evidenced-based literature provide more information about specific concepts such as community or herd immunity. This protection is important for the very small group of people who do not have a strong immune response from vaccines or who cannot receive vaccines for medical reasons.8,10-12 Bonsall's insightful blog teaches that as we protect ourselves, we are also protecting the most vulnerable members of our community.8

Table 2 - Click to enlarge in new windowTABLE 2 Focus on Influenza Resources

Ideas for community-based or unit-based education may include a "book read." John Barry's13The Great Influenza captures the stories of men, women, and scientists during the winter of 1918. Barry describes the effects of human suffering in tangent with the study of life science and the process of intellectual inquiry, applying mathematics to an epidemiological problem, employing germ theory, and catalyzing a team of scientist at Johns Hopkins who would transform American medicine as they confronted the Influenza of 1918. The historical narrative is well researched and weaves together multiple stories of patients, families, scientist, and providers. It is a fascinating look back at medical history and a true tale of triumph amid tragedy. In tribute to this history, it seems like getting the flu vaccine is a small but simple effort to protect our patients and loved ones 100 years after the gallant work of such dedicated scientist.


There are many ways we can protect ourselves, our families and our patients. Continue the discussion and share these evidenced based recommendations as we enter another challenging flu season.14,15




1. Influenza. Fact sheet. National Institute of Health. National Institute of Health. January 2011. Assessed October 15, 2019. [Context Link]


2. Lippincott. focus on influenza. and Accessed October 10, 2019. [Context Link]


3. Woods A. Focus on: influenza. Video transcript and media clip. [Context Link]


4. Gould K. Vaccine safety: evidence-based research must prevail. Dimens Crit Care Nurs. 2017;3(36):145-147. doi: 10.1097/DCC.0000000000000250. Accessed October 1, 2019. [Context Link]


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6. Centers for Disease Control and Prevention. Menu of state hospital influenza vaccination laws. 2016. [Context Link]


7. Lippincott. Recognizing and managing influenza. Pocket card. Accessed October 10, 2019. [Context Link]


8. Bonsall L. What is herd immunity? blog. January 18, 2018. Assessed October 10, 2019. [Context Link]


9. Lippincott. Nursing Center. CE program entitled Influenza are you ready.;jsessionid=A45CD75C965C113. Assessed October 1, 2019. [Context Link]


10. Centers for Disease Control and Prevention. (2017). Recommended vaccines for healthcare workers. Accessed October 15, 2019. [Context Link]


11. Centers for Disease Control and Prevention. Recommended adult immunization schedule for ages 19 years or older, United States, 2019. Accessed October 10, 2019. [Context Link]


12. US Department of Health & Human Services. (December 2017). Community immunity. Retrieved from [Context Link]


13. Barry JM. The Great Influenza: The Story of the Deadliest Pandemic in History. New York, NY: Penguin Books; 2005. [Context Link]


14. Cantor V. Protect yourself so you can continue to protect others. May 10, 2017. Accessed October 10, 2019. [Context Link]


15. Centers for Disease Control and Prevention. (December 11, 2017). Make a strong flu vaccine recommendation. Retrieved from the Centers for Disease Control and Prevention website: Accessed October 1, 2019. [Context Link]