The chosen patient scenario for this discussion in patient 4. This patient presents as a three-month-old whose mother is refusing vaccinations for her baby today, even though the baby’s records state that the baby has received all necessary immunizations up to this point. Her explanation for this sudden statement is that she feels as if her child is receiving “too many” shots and since majority of individuals are vaccinated, she feels like she can skip some of the vaccines and everything will be fine. There are many things that should be addressed related to this conversation and things that the mother could benefit from some education. The purpose of this discussion post is to discuss herd immunity and how it helps protect those that aren’t vaccinated, discuss Michigan’s vaccination rates and how they potentially contribute or do not contribute to herd immunity, and discuss what vaccinations this three month old baby should receive today and if there are any other options related to the plan of care for vaccines for her child.Herd immunity is a concept related to vaccinations and creating an immune response in individuals. The idea of herd immunity is that if there is a disease outbreak that takes place, enough individuals are vaccinated that it will limit the transmissible effects of the disease and protect both those that are vaccinated and those that are unable to get vaccinated (Casey, 2019). The idea is to protect the greatest amount of people in a given area. Waren (2017) states that immunizations are some of the most important public health interventions that can be performed and impact the greatest amount of people. Herd immunity is effective in protecting those that are unvaccinated or cannot receive vaccinations. Adashek (2016) discusses that herd immunity functions as one of the only protectors in some cases. The author himself was diagnosed with cancer and was fully vaccinated before receiving an organ transplant. Due to the transplant and leukemia, the patient could not receive any vaccinations that contained a live virus. He explains that he is not alone along with many other immunocompromised individuals and those that are treated with immunosuppressive medications. He lives fearful that as the vaccination rates decline in various areas, that he will no longer have protection from these conditions and could suffer significant consequences (Adashek, 2016). AHC Media (2019) supports this claim by stating it is difficult to claim that vaccines are not effective, especially as an endemic unfolds. The authors state that there is a significant amount of pushback against vaccines and this threatens herd immunity and creates a significant risk to the immunocompromised patients or those that simply cannot receive an immunization.Overall, the state of Michigan does not rank in the top in terms of following vaccination recommended schedules. The America Health Ranking shows that Michigan is ranked 29/50 for vaccination rates. The assessment explains that this data is based on the percentage of children ages 19-35 months that received their vaccines throughout their childhood and adolescent period on schedule. Comparing years 1996-2008 and 2012-2019 shows that the vaccination rate in Michigan has declined from approximately 76.8% to 70.4% and a majority of the decline is in children that live below the poverty level (American’s Health Rankings, 2020). There is a need for education and an increase in these rates to improve herd immunity. Bohm (2019) and colleagues explain through their study related to willingness to vaccinate and found that their hypothesis was confirmed that supported that individuals are more willing to get vaccinated if they are educated on the idea that them getting vaccinated would protect those that are unvaccinated or cannot receive vaccines (Bohm et al., 2019).When addressing the situation at hand, reassuring the mother that there is some flexibility in the vaccination schedule would be a good way to reduce her concerns. According to the vaccination schedule by the CDC, if the infant is up to date on vaccines, she likely would not need to receive any vaccinations at this appointment because Rotavirus, Hepatitis B vaccine 2nd dose, DTaP, Hib, PCV13, and PV are all due to be received at 2 months of age (CDC, 2020). There is flexibility that is possible in these vaccines, but some of them require timely administration when they are series vaccines, meaning they must be given within a certain period of each dose. Explaining that it is not advisable to stop vaccinating is the first discussion that needs to be had. Skipping administrations and doses will potentially result in extra vaccines needed because the series were incomplete. For example, the rotavirus can be adjusted because the infant has until they are up to 8 months old to receive the final dose. Setting up a schedule with the mother and being accepting of her concerns is important.To summarize, this patient situation is a common occurrence with the reduction of vaccination rates across Michigan. Herd immunity is important to address in these situations and educate patients on the importance of it. Some patients will have concerns with how many shots their child is receiving at a time, so understanding the series schedule and being flexible with patients and their concerns is an effective way to improve immunization rates and increase the effectiveness of herd immunity in the U.S.ReferencesAmerica’s Health Rankings. (2020). United Health Foundation. Retrieved by https://www.americashealthrankings.org/explore/annual/measure/Immunize/state/MIAdashek, J. (2016). When Herd Immunity Is the Only Protection. American Journal of Public Health, 106(6), 965. https://doi.org/10.2105/AJPH.2016.303150AHC MEDIA. (2019). Measles Woes Lead to Pushback Against Antivaxxers: A single case can lead to laborious follow-up. Hospital Employee Health, 38(10), N.PAG.Böhm, R., Meier, N. W., Groß, M., Korn, L., & Betsch, C. (2019). The willingness to vaccinate increases when vaccination protects others who have low responsibility for not being vaccinated. Journal of Behavioral Medicine, 42(3), 381–391. https://doi.org/10.1007/s10865-018-9985-9Casey, G. (2019). Herd immunity and protection. Kai Tiaki Nursing New Zealand, 25(9), 22.CDC. (2020). Immunization schedules: child and adolescent immunization schedule. Retrieved by https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.htmlWaren, D. E. (2017). Immunization dilemmas: consent for childhood vaccinations. Practice Nurse, 47(7), 16–19.

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