Immunisations: An interview with Immunisation Nurse Elaine Hui
Amanda: Hi, and welcome. Today I'm going to be chatting to Elaine. Elaine is a registered nurse and also a certified nurse immuniser. She is passionate about what she does, and she's going to share some insights on whether we should vaccinate whilst we are pregnant, whether young children should be vaccinated, and if those with allergies can also get immunisations, and her advice around those who think that vaccines are not safe for their little ones and what you should do. Welcome Elaine.
Hi Elaine, thank you for joining me today, and thanks for having this interview. So, what I'll do is I'll just ask you a couple of questions and if you could answer those for me that would be amazing. So, can you tell me first of all about your journey into motherhood, was it easy or was it difficult? How did that go for you?
Elaine: So, I think with my first child, we had problems actually becoming pregnant. So we tried for a bit, but eventually we went to doctors and got all of our questions answered, and eventually, so what turned out to be a challenge was actually both of us being too stressed. Yeah, so the doctor said just go, take a weekend away and boom, my first one came. So, since then I've had a couple more so I'm a mom to a five-year-old, a two-year-old, and now a two-month-old as well.
Amanda: Wow, congratulations.
Elaine: Thank you. It's sleepless nights but so worth it. So, for me the easy part I think was, I think every child's different but if I were to say one thing that's similar for all three of them is how much I actually love them, and I'll do anything for them. So, that's the easy part for me, and the challenging part I think is what a lot of moms experience as well, what we call mom guilt, where I actually need to just leave everything and just look after myself as well. That's the part I'm still struggling with at the moment, but other than that it's been such a wonderful journey with the three kids.
Amanda: Great, yeah I think we all get the mom guilt whether we work from home or whether we don't work, or we stay at home with the kids we, I think, all get it no matter what. There's no easy balance.
Amanda: So you're a certified immunization nurse and why are you passionate about that?
Elaine: Apart from being a nurse immunizer, I also work in oncology, which is where I look after cancer patients. That's where I see some of the sickest people in our community. They come in, they have chemotherapy, they have radiotherapy, and I also see children as young as 18 months are coming in for treatment. Some of them are not up to date with their vaccines because they're too unwell, they're immunocompromised. So, I think for me, it's a way of trying to advocate so that they can be protected, that they can be vaccinated. That we, as the well people, we can get vaccines and try not to give them any of this potentially fatal diseases that, you know, would make them even sicker and potentially they could die from it. So, that's why I'm advocating for this and hopefully people get the vaccines up to date.
Amanda: Yeah, definitely. So, should pregnant moms be immunized?
Elaine: Yes, definitely. We say women should be vaccinated when they're pregnant, and this provides protection for them and for their babies as well, especially against two serious infections. The first one is pertussis, or we know it as whooping cough. So, because babies can actually die from whooping cough, because when they're newborn they're too young to get the vaccines. So again you rely on mom, dad, brothers, sisters, people who visit, all to protect themselves so they don't come into contact with people who might bring this deadly disease to them. It's free in Australia, so the government gives it to pregnant women and we recommend it between 28 to 32 weeks of gestation. We don't see side effects. It's very rare to get side effects, it's completely safe for mom and for baby.
And, the second one is influenza, or people call it the flu. If a mom gets influenza during pregnancy it might actually cause premature delivery, or even infant death as well and it gets more severe with pregnant women. Pregnancies can actually be hospitalized from it as well, and babies under six months because they can't have the vaccine yet. High risk of being hospitalized as well. We'll try to prevent that from happening if mom gets the vaccine.
Amanda: Yeah, definitely. In New Zealand as well, the vaccine for whooping cough is free when you're pregnant and same with influenza. So, going on from that, why are vaccines so important? I think you've already touched on it with the people who you see who are immunocompromised, but why are they so important, especially when the diseases themselves aren't all that common?
Elaine: We don't see these diseases as often anymore because of the high percentage of people getting vaccines, and it's still needed to protect us because just because it's rare doesn't mean that it won't come back. Or, people who are too unwell, they can't get the vaccine, doesn't mean they won't get infected by it. So, the first thing is, we need to make sure people who can be vaccinated are still protected such as young babies, people with certain illnesses. It's just what we call the herd immunity. These people who are too unwell, they wouldn't be able to get any of these infections from us who have been vaccinated. We also need to make sure that, as I said before, make sure that the diseases don't return as well.
I think we've had some studies back in 1974, Japan actually had a high vaccination rate, so diptheria was at a very low rate. Then there were rumours saying that vaccines were unsafe or there's so few cases now we don't need the vaccines anymore. And then, I think, was it 1980 or 1979, that's when diptheria came back in the high rate again. So when they reintroduced the vaccine it went back down again, so it was probably in the 1980s that it happened. There's proof that vaccines actually work, and in Australia and New Zealand there are some diseases that are already quite rare but it doesn't mean that it's not happening in other countries. So, we need to prevent that from being reintroduced in our countries again and causing a massive outbreak. So, definitely vaccines are still very important, even though it's rarely seen, the diseases.
Amanda: Yeah, definitely even just any countries that don't have the measles or anything. If it's a lower rate in New Zealand, it's only a plane ride away.
Elaine: Exactly. It's happening in Melbourne now as well. We've seen measles happening from travellers overseas.
Amanda: We've got a huge outbreak of measles at the moment in Auckland. Which isn't fantastic, I've got a lot of pregnant friends and with babies under six months old.
Amanda: We used to not vaccinate for measles until, I think it was a year or, no 18 months old but now they've had to bring that even lower.
Elaine: To 12 months.
Amanda: Yeah, which is a shame. So how do immunizations and natural immunity work? Together or do they work in opposition?
Elaine: I think immunity from vaccinations and natural immunity, they're probably doing the same thing but vaccinations is better in the sense that it causes the immunity without actually causing the disease. So that's the safest way of developing the immunity. Natural immunity is in no way safer to develop an immunity because first of all, you may not survive it. That's my first point.
Elaine: Vaccines can make the diseases less severe, so even if the immunity wears off there is that booster. That way it prevents your body from catching the disease, or even if you do catch it it's a very mild form. You don't get the full-blown disease that again might potentially be fatal. Also, vaccinations provides community immunity, or herd immunity as we call it. I think with vaccinations, because there's combinations, it protects you against multiple infections, multiple diseases, and virus and bacteria and as I was saying, it's a lot safer than actually catching the actual disease and waiting for your natural immunity to kick in.
Amanda: So if I had the influenza vaccine, can it then cause me to get the flu?
Elaine: Influenza vaccine itself doesn't cause the flu. It's because the vaccine itself is inactivated, so it's not a live virus so you can't actually get the actual influenza. There's a lot of factors. First of all, when you get the flu vaccine, this is what I tell my patients, “Where were you when you were waiting for your flu vaccine? You're in a doctor's office, the waiting room. People there were sick, you probably got it from them as well”. Or else, it depends what strain you were vaccinated against and how well that strain matches the current strain that's going around that you come into contact with. If you do get any mild flu-like symptoms, that's just the body's way of telling you that the vaccine's working and it's developing the immunity against the flu vaccine. I was saying that the flu vaccine is not 100 per cent effective in preventing influenza, because of different strains that's happening. It mutates every year, so it's always important that you keep on top of the vaccines. Get vaccinated every year so that you are having the most recent one.
Amanda: Yeah, definitely. And, can young children have vaccines, and especially children even with allergies, can they have vaccines as well?
Elaine: Absolutely. Again, any parent who has any concerns we always say speak to the GP to get advice, but we rarely see allergies from vaccines itself. If anything, it's mostly latex allergy because of the vaccine equipment, it's not the vaccine itself. So if you've got asthma, you've got eczema, hay fever, food allergies, most of the children can still be safely vaccinated. And, actually, a person we know, one of my lecturers, her son had an anaphylactic reaction to one of the vaccines. He went to a hospital to get it done, and he's actually up to date with his vaccines and no other issues with that. Definitely if you have any concerns speak to your GP, and try to get all the vaccines up to date if possible.
Amanda: Yeah. I used to have an egg white allergy and I know a long time ago, when I was getting vaccines as a child, I think the vaccines used to possibly be, it was something stored or something in egg white, but now they're not. So, they always would make me stay an extra amount of time just to make sure that I didn't have a reaction.
Elaine: Exactly, yeah. Even with children who have, or any adults who has vaccines we usually say stay for the first 15 minutes, just to make sure you're fine before you go. Because, if there's any reaction it should happen in the first 15 minutes. In my 10 years as a nurse, I've never seen a reaction before, so that's how rare it is.
Amanda: Is it safe for children or adults to have more than one vaccine at a time? And also, why are the vaccines scheduled spaced out the way that they are for example?
Elaine: There's been a lot of research that now shows that giving children several vaccines at the same time is absolutely safe. They haven't had any reactions to it. So vaccines, there's some, which are combinations so there are a few in one injection, or there's some that come in separate injections. Both have shown to be very safe and use the same amount of even response as if they were to have it separately as well. The risk for giving it separately and spaced out is that it will delay the exposure of the antigens to the young children and they may potentially get you, because they're not up to date with their vaccines.
With the immunization schedule, it's basically giving the vaccines at the age where it's safe for them, and think of the child's body as like a brain where you study something and you have the memory of it so it's like your body having the memory of being exposed to the antigen. But because you are young, sometimes your immune response is not as good as an older person. So you need that boost, like a boost to the memory so that's why you get the boosters, and it's spaced out so that it gives your body time to attribute that immunity. And then, it just boosts it so that it's basically building up that memory so that if you do get exposed in the future then you have the immune response to it.
Elaine: In some vaccines, you still need boosters throughout your life because it can wear off. Whereas some like the measles, mumps and rubella, you should see lifelong immunity. But then again, it varies from individual to individual, so it's always good to be in touch with your GP and make sure you're up to date and you're protected.
Amanda: Right, great. And finally, what's your advice or your reaction to people who think that vaccines are dangerous, or harmful, or going to hurt their child in some way or cause some long term problem?
Elaine: I can understand some people probably have that idea, because they personally have had trauma to vaccines, or some because they've been told by certain sources that it's unsafe and giving them like scare tactics and, “Oh, I don't really want my child to be exposed to all this. It's dangerous, it's poisonous”. So what I usually say to them is that I understand that you may have gone through some difficulties or some trauma with the vaccines, but you can't deny that in this many years vaccines have saved a lot of lives. On the other hand, I can't force you or yourself or your child to be vaccinated. All I can say is make sure you make informed decisions, make sure the sources that you get this information from is credible, and that way you can make a choice whether or not you want your child to be protected against these potentially fatal diseases.
Myself personally, I'll state, I'll advocate for vaccination definitely. It's there and it's been proven to be safe, so please vaccinate your child, vaccinate yourself. Protect yourself, protect your child, protect the people around you who cannot actually get this vaccine.
Amanda: Thank you so much Elaine, for chatting with us today and giving us so much insightful information about vaccines. I hope that everyone has gained a little bit of knowledge about vaccines and the concept of herd immunity and helping actually protect those who potentially can't be immunized especially, and also not getting the disease itself, which is always ideal.
Amanda: Well thank you so much for chatting and we will see you later.
Elaine is a registered nurse working in oncology (Peter MacCallum Cancer Center in the radiotherapy department). She is also a certified nurse immuniser.