Influenza Vaccination for Pregnant Women

This assignment discusses the benefits and considerations surrounding influenza vaccination for pregnant women. It highlights potential side effects, addresses common concerns and questions, and emphasizes the protective impact of vaccination on both mother and child. The document also provides statistical data on the burden of vaccine-preventable diseases in adults to guide informed decision-making.

Assessment 1 (2000 words)
Instructions:
 Please read the background information below. When you have read the
background information, you can proceed to the questions on the Assessment
Template. These questions relate to the background information.
 You will need to apply the knowledge that you have gained from Topics 1-4 to
complete these questions.
 The marks allocated to each question are stated next to the question.
 The word count is stated next to each question. Note that when the word count says
‘equivalent’ it means that you do not need to have that exact number of words to
answer the question – just provide as much detail as required to answer the question.
 You are advised to frequently refer to the Assessment Feedback Sheet to guide you
on what characteristics of a reponse constitute an F2, F1, P2, P1, C, D, and HD grade.
 As with all academic work, if you refer to the work of others to support your
responses, you must reference this information using the UniSA Harvard Reference
System. You do not need to reference the articles listed in the Tables in Question 5 but if
any other sources are used, these should be referenced.
Background: Immunisation – Health beliefs
*Nursing students: You are working as a registered nurse in a GP Practice and one of your
roles is to promote immunisation for children (this may be the MMR or other recommended
immunisations). You have had a few parents refuse vaccinations for their children and this
concerns you as you believe that this may leave the child and communities vulnerable to
outbreaks of serious diseases.
*Midwifery students: You are working as a midwife in an antenatal clinic. One of your roles
is to promote vaccination against pertussis(whooping cough) for pregnant women. You have
had a few pregnant women decline vaccination. This concerns you as you know that if the
pregnant woman is immune to pertussis that passive immunity is passed to her unborn baby
to protect them against pertussis when they are newborn until thery are able to be
immunised themselves
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You do not think that parents/pregnant women would deliberately expose their
children/baby/themselves to the risk of serious disease unless they were guided by a belief
that immunisation was not safe. You are vaguely aware via media reports that there is an
anti-vaccine movement, and you want a quick overview of what it is all about. As most of us
would do, you consult Google, and you find the following information. Read the information
video below:
The History of Vaccines: History of the anti-vaccination movement
The College of Physicians of Philadelphia (2017)
<https://www.historyofvaccines.org/content/articles/history-anti-
vaccination-movements>
You could now choose one (or all) of the following actions:
 Conclude that parents/pregnant women are entitled to make decisions about their
child’s/baby’s/own healthcare, even if it is against public health policy.
 You could question your own belief system – after all, you are basing your practice
on government guidelines and you trust that the government will make decisions
about health care that are evidence-based, informed by experts in the field, and in
the best interests of Australians. You haven’t checked the literature for evidence of
immunisation safety yourself.
 You could investigate whether there is any evidence of harm caused by
immunisation, and to identify information that may influence parent’s/pregnant
woman’s beliefs or fears about immunisation.
Naturally, you are a great nurse/midwife with an inquiring mind. You want to be certain that
there is good evidence that demonstrates that immunisations are safe for children and
pregnant women. You want to understand what information has led parents/pregnant
women to be concerned about immunisation. Finally, you want to be able to have an
informed discussion with the parents/pregnant women about their concerns based on
current evidence to enable them make the right decision for their children/babies and
themselves.
*Please do not include this page of background information when you submit the
assessment template to learnonline.
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Assessment 1 Template
*Equivalent means that your responses may not equate exactly to the number of words that
you have written. As the format for this assessment is a template an approximate word
count is given that reflects the work required to complete the template. Suggested word
counts may be given in the template to guide you in how much detail is required in your
response. The template word count is not included in your word count. The template itself
(without the background) equates to approximately 900 words. You will note an elevated
similarity percentage when this is submitted via TurnItIn because of the template. Your
lecturers/tutors are aware of this.
Questions 1-4 (25 marks – 500 word equivalent)
Question 1a. From the background information provided above relating to immunisation, develop a
researchable question. Type the question below:
What are the harmful impacts of vaccination on the children or pregnant women?
Question 1b: Identify the elements of (words relating to) PICO (or PIO, if appropriate) in the research
question that you have formulated:
P In pregnant women
I How vaccination impacts
C Compared to or against pertussis
O Affect health and safety of unborn
child?
Question 2a. What type of research methodology do you think should be used to answer the
research question that you have formulated?
☐Quantitative
☐Qualitative
☐Mixed methods
Question 2b. Justify why this methodology was chosen to answer the question (Approx 75 words -
reference/s used to support your response should be written below your answer and are not included
in the word count).
For researching about the use of vaccination and its impact on the unborn child and pregnant
women, the qualitative research methodology is used as it provides an in-depth understanding
and obtains information through conversational and open-ended communication (Maltezou and
et.al., 2019).
The qualitative method does not only provide answer about 'what' people think but also it
answers to question 'why' people think so. This is systematic observation method helps in
revealing the perception and behaviour of people, therefore, it is selected for gathering
information regarding use and impacts of vaccination.
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Lewis, R. and et.al., 2018. Coverage of pertussis and influenza vaccination in pregnant
women in Wales 2017/18.
Mallory, M. L., Lindesmith, L. C. and Baric, R. S., 2018. Vaccination-induced herd
immunity: Successes and challenges.
Question 3a. List 3 places/sources of information that can be used to obtain reliable evidence to
answer the research question that you have formulated:
1. Vaccines for Pregnant Women
2. 3 Questions: Seth Mnookin on research to encourage vaccination
3. How does immunisation work?
Question 3b. Using one of the resources listed above,provide the details of a specific
resource/publication that is an example of best available evidence to assist you in answering your
research question. Complete the table below:
Provide the full reference/title for the
resource/publication Vaccines for
Pregnant Women
Provide the URL https://www.vaccines.gov/who_and_when/
pregnant
Question 3c. Explain why the information source chosen is an example of best available evidence for
answering the research question that you have formulated. Refer to the Levels of Evidence and
Hierarchy of Evidence tables in Topic 2 (Approx 75 words - reference/s used to support your response
should be written below your answer and are not included in the word count).
The chosen source is an example of best available evidence for answering the research question
as this source provides the accurate and reliable data.
Level 1 provides evidence from meta-analysis or a systematic review of the relevant
Randomized Controlled Trial (Arriola and et.al., 2018). Level 2 provides evidence that are
obtained from one well-designated RTC. Evidence of level 3 are obtained from well-designated
controlled trials without randomization. Evidence for level 4 are from cohort studies and for
level 5 it is obtained from systematic reviews of qualitative and descriptive studies. Evidence for
level 6 evidence are obtained from single qualitative or descriptive study. Level 7 evidence are
the opinions of authorities and expert committees report.
Hofstetter, A. M. and et.al., 2018. Risk of rotavirus nosocomial spread after inpatient
pentavalent rotavirus vaccination. Pediatrics. 141(1). p.e20171110.
Kaufman, J. and et.al., 2018. Face‐to‐face interventions for informing or educating
parents about early childhood vaccination. Cochrane Database of Systematic
Reviews. (5).
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Question 4a: List three key words that will assist in finding suitable literature in a library database to
answer the research question that you have formulated. For each of the search terms, suggest an
alternate word for which the Boolean function “or” could be used and truncations and wildcards.
Keyword Search term/s for
Boolean ‘or”
Truncation/s Wildcards
1. Impacts of vaccinations Vaccination or its
impacts
vaccine* Vaccinations #
2 Pregnancy and
vaccination
Pregnancy &
vaccination
Preg* vaccine Pregnancy#
vaccination
3 Can vaccination harm
unborn baby?
Harmful or
beneficial
vaccination
Vaccination Harm* Harms& vaccine
Question 4b: What actions could be taken to extend or limit the number of articles found or
improve the quality/relevance of the articles found in the search? (Approx 75 words - reference/s
used to support your response should be written below your answer and are not included in the word
count).
The search requires a well-focused question or key word. While evaluating the sites extra care
needs to be made for looking for good web portals. One needs to first make a search strategy or
plan and the research question needs to break down into different key words (Mukherjee,
Zhang and Ayodele 2018). The person needs to think around the topic as it will help in
identifying various useful and related-able terms. One can also make use of truncating the words
and also insert wild-card for expanding the search.
Mukherjee, D., Zhang, N. and Ayodele, L., 2018. Burden of influenza and impact of
seasonal vaccination in Europe-a ten year forecast.
Munoz, F. M., 2018. Influenza Vaccination During Pregnancy Can Protect Women
Against Hospitalization Across Continents. Clinical Infectious Diseases.
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Question 5 (25 marks - 500 word equivalent)
Complete the template below by providing the requested information relating to some of the specific components of the research articles listed. IBNU
students only need to complete the two articles that are for ‘IBNU students only’ and IMBW students only need to complete the two articles that are for
‘IBMW students only’.
Table 1.
IBNU students only:
IBMW students only:
Nowak, GJ, Sheedy, K, Bursey, K, Smith, TM & Basket, M 2015, ‘Promoting influenza vaccination: insights from a qualitative meta-
analysis of 14 years of influenza-related communications research by US Centers for Disease Control and Prevention
(CDC)’, Vaccine, vol. 33, no.24, pp.2741–-2756.
https://doi.org/10.1016/j.vaccine.2015.04.064
Furuta, M, Sin, J, Ng, ES & Wang, K, 2017,. ‘Efficacy and safety of pertussis vaccination for pregnant women–a systematic review of
randomised controlled trials and observational studies’, BMC Pregnancy and Childbirth, vol. 17, no. 1,pp.1–-20.
https://doi.org/10.1186/s12884-017-1559-2
Type of study (e.g.: meta-
analysis, systematic review,
cohort, RCT, ethnography,
phenomenology, etc)
The type of study is qualitative meta analysis for 29 unpublished and primarily qualitative CDC sponsored study.
Issue/Topic (what was being
studied)
The topic being studied was related to flu and flu vaccination knowledge and attitudes and beliefs (Barrett and et.al., 2018).
Purpose/aims of the study
(why was the study being
undertaken?)
The study being undertaken in order to promote the knowledge, belief and attitudes for topic influenza and influenza vaccination.
Inclusion/exclusion criteria Inclusive criteria:
 healthcare professionals
 sub-population at risk
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Search strategy (methods) The search strategy used for researching this topic is phrase sentencing and use of boolean logic.
Data analysis The main finding through qualitative analysis states that there is progress in terms of knowledge, attitudes and beliefs but there is
still persistence of many barriers for acceptance of vaccine (Chan and et.al., 2019).
Results (main findings) The qualitative research suggests that public have limited understanding of influenza and recommendations for immunisation.
The data analysis also indicates that greater sub-group recognises about the value of flu vaccination. Still there are people who are
continuously resistance to vaccination. Overestimation is present among many that there are effectiveness of non-vaccine
measures.
Conclusion/recommendations The conclusion is that it is difficult to change knowledge, attitudes and beliefs of people related to influenza and influenza vaccine
and particularly on scale and scope needed to be greatly improve uptake.
Table 2.
IBNU students only
IBMW students only:
Knuf, M, Leroux-Roels, G, Rümke, HC, Abarca, K, et al, 2015, ‘Safety and immunogenicity of an MF59®-adjuvanted A/H1N1
pandemic influenza vaccine in children from three to seventeen years of age’, Vaccine, vol. 33, no.1, pp.174–-181.
https://doi-org.access.library.unisa.edu.au/10.1016/j.vaccine.2014.10.085
Wiley, KE, Cooper, SC, Wood, N & Leask, J 2015, ‘Understanding pregnant women’s attitudes and behavior toward influenza and
pertussis vaccination’, Qualitative Health Research, vol. 25, no. 3, pp.360–-370.
http://journals.sagepub.com/doi/pdf/10.1177/1049732314551061
Type of study (e.g.: meta-
analysis, systematic review,
cohort, RCT, ethnography,
phenomenology, etc)
The type of study for researching this topic is RCT that refers that randomly assigns participants into the experimental group.
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Issue/Topic (what was being
studied)
The topic of this study is safety and immunogenicity of an MF59®- adjuvanted A/H1N1 pandemic influenza vaccine in children
from three to seventeen years of age (Hofstetter and et.al., 2018).
Purpose/aims of the study
(why was the study being
undertaken?)
The purpose and aim of this study was to identify the optimal dose of an MF59® -adjuvanted, monovalent, A/H1N1 influenza
vaccination for healthy paediatric subjects.
Population (how many
participants, age, gender,
disease, etc)
The participants of this study were 194 children from age 3 to 8 and 160 children from age 9 to 17.
Materials/Method
(how was the study set up and
implemented; what
intervention was used)
The study was implemented by randomizing group of children ranging from 3 to 8 years and 9 to 17 years. The throughout study
was assessed for vaccine safety for up-to 18 months (Kaufman and et.al., 2018).
Data analysis Two primary dose of A/H1N1 vaccination that contains either 3.75 μg antigen with half standard dose of MF59 adjuvant and/or
7.5μg antigen was given with full dose of MF59 and non-adjuvant 15μg formulation for children from 3 to 8 years. The bosster
dose for MF59- adjuvant seasonal influenza vaccine that also included homologous A/H1N1 strain was given after one year of
priming.
Results (main findings) The priming dose of either MF59-adjuvanted formulation was well sufficient for meeting the European license criteria regarding
pandemic influenza vaccinations. Or two non-adjuvanted vaccines doses may be required for meeting the same criteria of license
(Kuchel and et.al., 2018).
Conclusion/
recommendations
MF59-adjuvanted influenza vaccination that contains 3.75μg of A/H1N1 antigen was tolerated and also sufficiently immunogenic
for meeting all the European license criteria after the single dose for healthy children of the age between 3 to 17 years of age.
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Question 6 – (45 marks – 1000 words)
Discuss the reasons why the studies above would or would not be helpful in enabling a nurse/midwife to have an informed discussion with parents/a
pregnant woman about immunisation for their children/themselves. Comment on the relative value of the studies to the argument. Identify any further
information that may be useful in an informed discussion with parents/a pregnant woman about immunisation for their children/ themselves.
(Reference/s used to support your response should be written below your answer and are not included in the word count).
*5 marks will be given for writing, presentation and correct use of Harvard UniSA referencing for all responses in the template as per the the assessment
feedback sheet.
The studies above will surely be helpful for enabling nurse to have informed discussion with parents about immunisation for their children. As the
research and study undertaken helps in explaining the importance and positive impacts of vaccination on the health of children. Various medical and health
scholars describes vaccination as the greatest achievement of public health. The immunisation helps in protecting the people and children from dangerous
diseases and supports in saving thousands of lives and keeps them healthy.
Vaccinations helps body to fight illness and it makes antibodies that helps in recognising the specific part of germs that can cause particular disease
(Lewis and et.al., 2018). The parents thinks that the immune system of child will be weaker if it rely on vaccine but it is not true. He immune system helps
in making antibodies against the germs. For example, chickenpox virus, it helps in encountering it in natural way or it can be exposed to it through the
vaccination. And if child is vaccinated against specific disease, it does not weakens the immune responses for another disease.
The nurse/ midwife can have informed discussion with parents by discussing about vaccines from many perspectives. The benefits of vaccinations,
its support in prevention of illness and also risk or not taking vaccination. The nurse or midwife can also tailor the discussion with concerns of parents as it
will positively affect the argument. The risk of vaccination needs to be also a part of the discussion as avoiding this will be tempting. The risk of vaccination
is even though very low but it is vital to be discussed. The nurse needs to tailor the discussion to parent's concern and accordingly responding to specific
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concern would be helpful to have informed discussion. It may include managing the common side effects and action methods if serious reaction happens
(Mallory, Lindesmith and Baric, 2018).
The nurse can also provide parents with quantifying data regarding the risk of not vaccinating versus risk of vaccinating as this be very helpful for
convincing them. Providing written information and materials for explaining risk can be considered as and effective strategy. This is clear through the
existing research that tailored communication and discussion with parents will be helpful to have informed discussion with parents to have vaccination for
their children. Recommendation of its benefits and importance will further help for enabling informed discussion and lead to increase the uptake of
vaccinations.
The studies will be helpful to have informed discussion with pregnant women regarding vaccination. The midwife needs to suggest that women
who are pregnant needs to be fully update with their vaccinations as it acts as a protective antibodies that crosses from mother to unborn baby via the
placenta or through breast milk. Therefore, women needs to receive whooping cough vaccines and influenza vaccines when they are pregnant. The
vaccination helps in supporting and protecting both the mother and the baby through the vaccine-preventable diseases. The seasonal influenza i.e. flu virus
and pertussis i.e. whooping cough are recommended vaccines for pregnant women as because of the high risk diseases that can pose and affect infants.
The influenza vaccine needs to be received by pregnant women and it is also safe for both women and the unborn child (Maltezou and et.al.,
2019). The midwife can also provide statistical data regarding the benefits and positive impact of the flu vaccine such as, the millions of pregnant women
has received the flu vaccine over the 45 years and it is also recommended by American College of Obstetricians and Gynecologists and also the CDC. The
influenza vaccination helps in protecting the mother and her unborn baby as it is prepared from inactivated virus and prevents spread of flu from mother to
baby after the delivery.
Midwife needs to suggest the vaccination which needs to be avoided by pregnant women as they affect to both the mother and unborn child. This
will enable a informed discussion and can lead to convince pregnant women to increase uptake of vaccination. The list of vaccination needs to be avoided
by pregnant women as it might potentially be transferred or transmitted to unborn child and may result in premature birth, birth defects or miscarriage.
Hepatitis A, Measles, Mumps, Rubella (MMR), Varicella, Pneumovcoccal, oral Polio vaccine (OPV) and Inactivated Polio Vaccine(IPV) needs to be avoided
during pregnancy.
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The side effects of some vaccine needs to be discussed and it may vary from one to those that may occur after upto three weeks of vaccination
(Mukherjee, Zhang and Ayodele 2018). The side effects may include Fatigue, Fever, Headache, Pain in Joints, red bumps, Non- contagious rash, severe
allergy reaction, redness or soreness at injection site, swelling of cheeks and neck glands.
The informed discussion regarding intake of vaccine for pregnant women can also include statistical data regarding cases on non-vaccine incidents.
Such as, burden of vaccination preventable diseases in US is high among adults. There are millions of influenza cases every year with average of 226000
hospitalisation and around 3000 to 49000 annual deaths and out of this mostly are among adults. About 9000 cases are of pneumococcal pneumonia and
400000 hospitalisation each year. The invasive pneumococcoal diseases affects 3700 deaths I the year 2013 and almost all were adults. There are also
approx 1 million cases for zoster on annual basis. This statistical information will guide pregnant women the effectiveness of vaccines and they may intake
recommended vaccine and prevent the unborn child and themselves.
When pregnant women are guided for receiving vaccine they have many questions in their mind which they want to be answered before making
any decision or taking vaccination (Munoz, 2018). The key factor may consider perceived susceptibility, such as how can one is likely to get disease, various
risk of effects and consequences, the seriousness of diseases for own self and for baby, how the vaccine works, what is one gets sick or ill after vaccination,
and its negative impacts or side effects. The bottom-ine can be that pregnant women really want to know if recommended vaccination is right for their child
and themselves. Therefore, midwife needs to provide important details that helps in clearing their doubts.
Additional information needs to be also provided for encouraging them for vaccine by addressing various key factors and benefits of in-taking
vaccine on both the mother and the unborn child. Positive experiences of vaccines needs to be highlighted in order to reinforce the benefits and also to
strengthening their confidence for vaccination. Pregnant women needs to be reminded that vaccines protect them, their unborn child and their loved ones
from many and serious diseases.
References
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Arriola, C. S. and et.al., 2018. Knowledge, attitudes and practices about influenza vaccination among pregnant women and healthcare providers
serving pregnant women in Managua, Nicaragua. Vaccine. 36(25). pp.3686-3693.
Barrett, T. and et.al., 2018. Influenza vaccination uptake in an Irish obstetric cohort. Br J Gen Pract. 68(suppl 1). p.bjgp18X697073.
Chan, H. J. and et.al., 2019. Influenza Vaccination Among Pregnant Women in the United States: Findings from the 2012–2016 National Health
Interview Survey. Journal of Women's Health.
Kuchel, G. A. and et.al., 2018. IMMUNOGENOMIC RESPONSES TO VACCINATION IN AGING: INSIGHTS INTO IMMUNE
RESILIENCE. Innovation in Aging. 2(Suppl 1). p.234.
Maltezou, H. and et.al., 2019. Knowledge about influenza and compliance with the recommendations for influenza vaccination of pregnant
women in Greece. International Journal of Infectious Diseases. 79. p.100.
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