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Flu Vaccine and LEP Patients

Date Authored: October 14, 2011

The focus on flu vaccination offers an opportunity to educate refugees, immigrants, and LEP (limited English proficient) patients about the importance of vaccines.  This issue can be multi-faceted because of language barriers and cultural or religious issues. 

Translated Information

There are sites that provide translated patient education information and below are several of the ones known for providing good translations:

  • MedlinePlus"Flu - Multiple Languages" The National Library of Medicine links to information about flu and flu vaccine in dozens of languages.
  • Public Health - Seattle & King County: "Influenza facts in multiple languages" (Chinese, English, Korean, Russian, Spanish, Somali, Vietnamese).
  • RHIN: Refugee Health Information Network: Search for the term "flu" and see results including the document "Flu and You" from CDC/DHHS available in 11 languages (English; Amharic; Arabic; Burmese; Dzongkha; Farsi; Karen; Kirundi; Nepali; Oromo; Somali).

Somali Attitudes, Beliefs and Practices Regarding Vaccination

The cultural or religious issues can be complex and varied.  Public Health Seattle King County held focus groups with local Somali community leaders to learn about their attitudes, beliefs and practices regarding vaccination.  Some preliminary findings indicate there may be: 1) concern about vaccines containing porcine gelatin (consumption of pork or pork products is not Halal meaning not permissible according to Islamic law) (there are many vaccines which do not contain porcine gelatin); 2) lack of familiarity with the concept of preventive health care; 3) some belief in a link between vaccines and autism-like disorders; and 4) some disbelief in the seriousness of influenza.  In the Somali language, there is no word for “influenza” or “flu”, and the closest translation is “hargabka” which means “cough” or “cold”.   A more complete report of this information is available at the PHSKC website:  See Vaccine Hesitancy in the Somali Community.  

Talking Points For Discussing Flu Vaccine With Patients

Taking time to talk with patients about their reluctance to vaccinate will likely be more effective than written materials.  There are several talking points that might be useful when encountering resistance to vaccination, including:

  • The importance of protecting family members since it is the young, pregnant women, and the elderly who are most vulnerable.  HMC’s Dr. John Lynch recently told Community House Call’s community advisory board that keeping younger people from getting ill will keep older people more healthy.  
  • HMC’s Dr. Carey Jackson suggests that the closest illness to the experience of the flu for many from sub-Saharan Africa is a bout of malaria with fevers, shaking chills, headaches, photophobia, nausea, myalgias, arthralgias and vomiting. Likening flu to an episode like this rather than a cold may get more people’s attention.
  • Patients may say "I got the shot and still got the flu” largely because they had some viral syndrome with fevers and don't realize the flu is usually an order of magnitude worse.