Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-06T04:00:58.671Z Has data issue: false hasContentIssue false

Influenza and Pneumococcal Vaccination and Tuberculin Skin Testing Programs In Long-Term Care Facilities: Where Do We Stand?

Published online by Cambridge University Press:  02 January 2015

Margaret A. McArthur
Affiliation:
Departments of Microbiology, Princess Margaret/Mount Sinai Hospitals, Toronto, Ontario
Andrew E. Simor
Affiliation:
Sunnybrook Health Science Centre, Toronto, Ontario
Beverly Campbell
Affiliation:
Laboratory Centre for Disease Control, Health Protection Branch, Department of Health and Welfare, Canada
Allison McGeer*
Affiliation:
Departments of Microbiology, Princess Margaret/Mount Sinai Hospitals, Toronto, Ontario
*
Department of Microbiology, Room 690, Princess Margaret Hospital, 500 Sherbourne St., Toronto, Ontario, Canada, M4X 1K9

Abstract

Objectives:

1) To compare policies and procedures for distribution of influenza and pneumococcal vaccines to long-term care facilities for the elderly in Canada, 2) to determine vaccination rates of residents and staff, and 3) to describe vaccination and tuberculin skin testing programs in these facilities.

Design:

A cross-sectional survey consisting of telephone interviews and a mailed questionnaire was conducted in the spring of 1991. Telephone interviews were conducted with provincial/territorial epidemiologists. The questionnaire was sent to all (N = 1,520) Canadian long-term care facilities for the elderly with ≥ 25 beds.

Results:

There were 1,270 responding facilities (84%). The mean overall influenza vaccination rate for residents was 78.5%. The mean vaccination rate was higher in those provinces in which the vaccine was paid for by the government (79% versus 71%; P= 0.002). Only 19% of facilities reported staff vaccination rates >25%; rates again were higher in those provinces in which vaccine for staff was provided by the government. Pneumococcal vaccine was offered to residents in 12% of the facilities. The proportions of facilities with >10% and >75% of residents vaccinated were significantly higher in the provinces where the pneumococcal vaccine was recommended and paid for as compared with those where it was not (P<0.001 for both). Tuberculin skin testing programs for residents existed in 360 long-term care facilities (28%) across the country.

Conclusion:

In 1990, the number of residents living in Canadian long-term care facilities who were vaccinated against influenza and Streptococcus pneumoniae was suboptimal. Staff influenza vaccination rates were very low across the country. Most facilities did not have a baseline tuberculin skin test status for their residents. Vaccination rates are higher in jurisdictions in which governments provide the vaccine without charge.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Patriarca, PA, Weber, JA, Parker, RA, et al. Efficacy of influenza vaccine in nursing homes. Reduction in illness and complications during an influenza A (H3N2) epidemic. JAMA 1985;253:11361139.10.1001/jama.1985.03350320060017CrossRefGoogle ScholarPubMed
2. Barker, WH, Mullooly, JP. Influenza vaccination of elderly persons. Reduction in pneumonia and influenza hospitalizations and deaths. JAMA 1980;244:25472549.10.1001/jama.1980.03310220045026CrossRefGoogle ScholarPubMed
3. Ruben, FL, Johnston, F, Streiff, EJ. Influenza in a partially immunized aged population. Effectiveness of killed Hong Kong vaccine against infection with the England strain. JAMA 1974;230:863866.10.1001/jama.1974.03240060033027CrossRefGoogle Scholar
4. Saah, AJ, Neufeld, R, Rodstein, M, et al. Influenza vaccine and pneumonia mortality in a nursing home population. Arch Intern Med 1986;146:23532357.10.1001/archinte.1986.00360240071013CrossRefGoogle Scholar
5. Ebright, JR, Rytel, MW. Bacterial pneumonia in the elderly. J Am Geriatr Soc 1980;28:220223.10.1111/j.1532-5415.1980.tb00523.xCrossRefGoogle ScholarPubMed
6. Spika, JS, Fedson, DS, Facklam, RR. Pneumococcal vaccination: controversies and opportunities. Infect Dis Clin North Am 1990;4:1127.10.1016/S0891-5520(20)30321-4CrossRefGoogle ScholarPubMed
7. Garb, JL, Brown, RB, Garb, JR, Tuthill, RW. Differences in etiology of pneumonias in nursing home and community patients. JAMA 1978;240:21692172.10.1001/jama.1978.03290200047020CrossRefGoogle ScholarPubMed
8. Centers for Disease Control and Prevention. Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1993;42(RR-6):114.Google Scholar
9. National Advisory Committee on Immunization. Statement on influenza vaccination for the 1993-94 season. Canada Communicable Disease Rep 1993;19:6571.Google Scholar
10. Centers for Disease Control. Pneumococcal polysaccharide vaccine. Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1989;38:6476.Google Scholar
11. National Advisory Committeeon Immunization, Canadian Immunization Guide. 3rd ed. Ottawa. Canada: Health Protection Branch, Ministry of Supply and Services Canada; 1989.Google Scholar
12. Gable, CB, Holzer, SS, Engelhart, L, et al. Pneumococcal vaccine: efficacy and associated cost savings. JAMA 1990:264:29102915.10.1001/jama.1990.03450220076026CrossRefGoogle ScholarPubMed
13. Helliwell, BE, Drummond, MF. The cost and benefits of preventing influenza in Ontario's elderly. Can J Public Health 1988;79:175180.Google ScholarPubMed
14. Patriarca, PA, Arden, NH, Kaplan, JP, Goodman, RA. Prevention and control of type A influenza infections in nursing homes. Ann Intern Med 1987;107:732740.CrossRefGoogle ScholarPubMed
15. Tuberculosis Statistics, 1990. Ottawa, Canada: Statistics Canada; 1992;4(suppl 10).Google Scholar
16. Centers for Disease Control. Prevention and control of tuberculosis in facilities providing long-term care to the elderly: recommendations of the Advisory Committee for Elimination of Tuberculosis. MMWR 1990;39(RR-10):720.Google Scholar
17. Bureau of Communicable Disease Epidemiology, Health Protection Branch, Health and Welfare Canada. Infection Control Guidelines for Long Term Care Facilities. Ottawa, Canada: Bureau of Communicable Disease Epidemiology; 1987.Google Scholar
18. Price, LE, Rutala, WA. Tuberculosis screening in the long-term care setting. Infect Control 1987;8:353356.CrossRefGoogle ScholarPubMed
19. Canadian Long Term Care Association. Energy Survey of Long Term Health Care Facilities, Phase 1: Population Profile. Ottawa, Canada: Energy Mines and Resources; 1986.Google Scholar
20. Canadian Hospital Association. Directory of Long-Term Care Centres in Canada. Ottawa, Canada: Canadian Hospital Association; 1990:9.Google Scholar
21. McGeer, A, Shurtleff, S, McArthur, M, O'Rourke, K, Campbell, B, Simor, AE. Reliability of surveillance for infection in residents of long-term care facilities. Am J Infect Control 1992;20:108. Abstract.Google Scholar
22. McGeer, A, Campbell, B, Emori, TG, et al. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control 1991;19:17.CrossRefGoogle ScholarPubMed
23. SAS Institute Inc. SAS Procedures Guide. Release 6.03 ed. Cary, NC: SAS Institute Inc; 1988.Google Scholar
24. Sérié, C, Barme, M, Hannoun, C, Thibon, M, Beck, H, Aquino, JP. Effects of vaccination on an influenza epidemic in a geriatric hospital. Develop Biol Standard 1977;39:317321.Google Scholar
25. Smith, JWG, Pollard, R. Vaccination against influenza: a five-year study in the post office. J Hyg 1979;83:157170.10.1017/S0022172400025936CrossRefGoogle ScholarPubMed
26. Levy, E, Levy, P. La vaccination contre la grippe des personnes d'age actif (25-64 ans): un etude tout-benefice. Rev Epidem Sante Publ 1992;40:285295.Google Scholar
27. Weingarten, S, Riedinger, M, Bolton, LB, Miles, P, Ault, M. Barriers to influenza vaccine acceptance: a survey of physicians and nurses. Am J Infect Control 1989;17:202207.CrossRefGoogle ScholarPubMed
28. Watanakunakorn, C, Ellis, G, Gemmel, D. Attitude of healthcare personnel regarding influenza immunization. Infect Control Hosp Epidemiol 1993;14:1720.CrossRefGoogle ScholarPubMed
29. Quick, RE, Hoge, CW, Hamilton, DJ, Whitney, CJ, Borges, M, Kobayashi, JM. Underutilization of pneumococcal vaccine in nursing homes in Washington state: report of a serotype-specific outbreak and a survey. Am J Med 1993;94:149152.10.1016/0002-9343(93)90176-PCrossRefGoogle ScholarPubMed