Institutional Strategy for the Prevention and Management of Influenza and Pneumococcal Disease in the LTC Setting
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Influenza and pneumococcal disease are major causes of morbidity and mortality within the long-term care (LTC) continuum. Influenza kills an average of 36,000 Americans annually, with more than 90% of those deaths occurring in the elderly. While vaccination rates of LTC facility residents for influenza and pneumococcal disease have increased over the past decade, rates now appear to have reached a plateau. Since frail or debilitated individuals may not respond to vaccination with a protective immune response, low rate of immunization in healthcare workers, contact care, and communal living further increase the risk of transmission. Given the significant rates of morbidity and mortality, strategic steps must be taken to prevent and manage influenza and pneumococcal disease in LTC. (Annals of Long-Term Care: Clinical Care and Aging 2010;18[2]:20-26)
Introduction
Influenza and pneumococcal disease are major causes of morbidity and mortality within the long-term care (LTC) continuum. Influenza kills an average of 36,000 Americans annually,1 with more than 90% of those deaths occurring in the elderly; residents of LTC facilities are particularly at risk.2,3 In one well-studied outbreak, 65 residents developed influenza, of whom more than half developed pneumonia and two died.4 Illness rates up to 60% and fatality rates as high as 55% have been documented during influenza outbreaks in LTC facilities.5-8 Influenza and pneumococcal disease cause more deaths in the United States than all other vaccine-preventable illnesses combined.9,10 Influenza and pneumonia combined represent the fifth leading cause of death in the elderly; up to 20,000 residents of LTC facilities succumb to these illnesses (influenza and pneumococcal pneumonia) every year.11,12 The goal of this article is to discuss the strategic steps that must be taken to prevent and manage influenza and pneumococcal disease in LTC settings.
Vaccination in LTC
Since frail or debilitated individuals may not respond to vaccination with a protective immune response, low rate of immunization in healthcare workers, contact care, and communal living further increase the risk of transmission. Given the significant rates of morbidity and mortality, strategic steps must be taken to prevent and manage influenza and pneumococcal disease in LTC. Institutional interventions that can limit the spread of both the seasonal and H1N1 virus and reduce the morbidity and mortality of those infected can be of benefit to those living in LTC facilities.
Ample evidence exists to show that influenza vaccination of both residents and staff is beneficial in reducing hospitalizations and mortality rates.13 While vaccination rates of LTC facility residents for influenza and pneumococcal disease have increased over the past decade, rates now appear to have reached a plateau. Among Medicare beneficiaries, influenza and pneumococcal vaccines remain underused despite the fact that both are cost-effective, covered under Medicare Part B, and efficacious.
Federal regulations provide financial and regulatory incentives to increase influenza and pneumococcal immunization rates. The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) and the American Medical Directors Association (AMDA) recommend that influenza and pneumococcal vaccinations be targeted to persons who are over age 65 and those who are chronically ill. The influenza and pneumococcal disease vaccine is indicated for all residents of LTC facilities who are over age 65 and/or who have chronic medical conditions. This means that basically all residents of LTC settings are candidates for both influenza and pneumococcal vaccination.14 The Centers for Medicare & Medicaid Services (CMS) requires offering residents the influenza and pneumococcal vaccines, with rates reported in the Minimum Data Set (MDS) and as a Quality Indicator.
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