Technically Speaking — Improving the Vaccination Experience: Immunize.org’s New Materials

Few people of any age enjoy getting needles, and a small number have full blown needle phobia (about 2% of adults). A meta-analysis by McLenon and Rogers (J Adv Nursing, 2019) found that “the majority of children exhibited needle fear, while prevalence estimates for needle fear ranged from 20-50% in adolescents and 20-30% in young adults.” The authors noted that avoidance of influenza vaccination due to fear of needles was very common, occurring in about 16% of adult patients. In a survey of adults, needle fear was higher among females, people who did not work as healthcare professionals, people with non-needle-related medical fears, and those who had a condition that required frequent injections or blood draws.

To address these ideas and align with its mission of increasing immunization rates and preventing disease, Immunize.org created a new suite of materials designed to help improve the vaccination experience. Keep reading to find out more!

Screening checklists for clinicians

As immunization providers, many of us know that the first step in any effort aimed at improving the vaccine experience is identifying people who are experiencing stress related to receipt of a vaccine. This may include people who have felt dizzy or fainted during previous vaccination appointments (before, during or after getting a shot) and those who outwardly express anxiety. While some care is worth extending to all patients (e.g., having them stay seated for 15 minutes after vaccination), identifying people with stronger emotional reactions to needles can help healthcare teams focus extra efforts.

To help identify folks who need this extra attention, Immunize.org added two questions to their screening checklists. It should be noted that even though other questions on the checklists screen for contraindications to vaccination, vaccination-related anxiety or a history of syncope (fainting) or presyncope (near fainting characterized by nausea, flushing, sweating, blurred vision and lightheadedness) are NOT contraindications or precautions to future vaccination.

Be sure you are using the updated versions of these useful screening checklists. All are available on the Immunize.org “Screening Checklist” landing page and are listed by age groups:

• Screening Checklist for Contraindications to Vaccines for Adults
• Screening Checklist for Contraindications to Vaccines for Children and Teens
• Screening Checklist for Contraindication to HPV, MenACWY, MenB, and Tdap Vaccines for Teens
• Screening Checklist for Contraindications to Injectable Influenza Vaccination

Prevention of syncope and presyncope

Syncope is an important adverse event following vaccination. In contrast to what some people believe, syncope is not related to vaccine ingredients. Rather, vaccination-related syncope or presyncopal symptoms are the result of a decrease in heart rate and blood pressure. Despite the benign cause, people who have experienced fainting after vaccinations may avoid future vaccinations. Likewise, seeing someone faint after vaccination may alarm others and lead to the spread of misinformation about the safety of vaccines. Some simple and inexpensive steps can prevent these outcomes. The steps are outlined on one-page sheets targeted to either healthcare personnel or the public:

• Vaccination-Related Syncope: Information for Healthcare Personnel
• Fainting Related to Vaccination: What You Need to Know

Reducing vaccination-related anxiety

The reduction of vaccination-related pain and anxiety is a good goal in and of itself. First, it helps build trust because it shows we care. Second, if vaccination visits are not associated with pain and anxiety, both patients (and their parents) may be more willing to accept future vaccinations. While in some cases vaccination-related fear is deeply ingrained, we may be able to turn the tide for some people. Immunize.org’s suite of one-page sheets can be found on the their “Addressing Vaccination Anxiety” landing page or you can check out the sheets designed for specific age groups below:

For clinicians

• Addressing Vaccination Anxiety in Adolescents and Adults: Strategies for Healthcare Professionals
• Addressing Vaccination Anxiety for Infants and Toddlers: Strategies for Healthcare Professionals
• Addressing Vaccination Anxiety for Children Strategies: for Healthcare Professionals

For the public

• Addressing Vaccination Anxiety in Adolescents and Adults: Strategies for Vaccine Recipients and Caregivers
• Addressing Vaccination Anxiety for Infants and Toddlers: Strategies for Parents and Caregivers
• Addressing Vaccination Anxiety for Children: Strategies for Vaccine Recipients and Caregivers

Webinars for clinicians

Immunize.org has also hosted two webinars relevant to these topics. Both are available for archived viewing:

• Improving the Vaccination Experience: Reducing Pain and Anxiety for Children and Adults
  • Invited speakers: Anna Taddio, BScPhm, PhD; Professor, Faculty of Pharmacy, University of Toronto; Senior Associate Scientist, The Hospital for Sick Children (SickKids), Toronto, Ontario; and Lucie Marisa Bucci, MA; Director, Policy and Government Relations, Society for Infodemic Management (SIM), Québec, Québec
  • Webinar slide set
  • Discussion included the principles behind vaccination pain and anxiety and simple, evidence-based strategies to reduce apprehension.
• Improving the Vaccination Experience: Accessible Vaccination for Neurodiverse People at Any Age
  • Invited speakers: Danielle Hall, MSW, and Allie Tasche, BEd, MSLOD; both were from the Autism Society.
  • Webinar slide set
  • Discussion focused on practical tips to improve vaccine confidence by employing strategies to reduce stress when vaccinating neurodiverse patients.

The materials described herein can be used in informal educational settings, such as during a huddle or monthly in-service. Likewise, they can serve as the basis for an entire quality improvement program.

Regardless of how you use them, reducing the pain and anxiety of vaccination will be popular with patients of all ages and may end up improving practice vaccination rates as well as job satisfaction for the clinical staff involved in administering vaccines.