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Influenza Outbreaks in Nursing Homes: How Effective Is Influenza Vaccine in the Institutionalized Elderly?

Published online by Cambridge University Press:  21 June 2016

Matthew L. Cartter ,
Philip O. Renzullo ,
Steven D. Helgerson ,
Stanley M. Martin  and
James F. Jekel
Matthew L. Cartter*
Affiliation:
Division of Field Services, Epidemiology Program Office, Centers for Disease Control, Atlanta, Georgia Epidemiology Program, State of Connecticut Department of Health Services, Hartford, Connecticut
Philip O. Renzullo
Affiliation:
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut Division of Preventive Medicine, Walter Reed Army Institute of Research, Department of the Army, Washington, D.C. Office of the Director, Centers for Disease Control, Atlanta, Georgia
Steven D. Helgerson
Affiliation:
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut Indian Health Service, Department of Health and Human Services, Seattle, Washington
Stanley M. Martin
Affiliation:
Indian Health Service, Department of Health and Human Services, Seattle, Washington Statistical Services Activity, Division of Bacterial Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia
James F. Jekel
Affiliation:
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
*
State of Connecticut Department of Health Services, Epidemiology Program, 150 Washington Street, Hartford CT 06106
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Abstract

During the 1984–1985 influenza season, outbreaks of influenza A (H3N2) occurred in three Connecticut nursing homes. Influenza vaccination rates were 67% (96 out of 144), 35% (30 out of 85) and 69% (332 out of 483), respectively. The relative risk of illness for vaccinated compared to unvaccinated residents was 1.8 (95% confidence interval, 0.6, 5.9), 1.6 (95% confidence interval, 0.8, 3.0) and 1.1 (95% confidence interval, 0.8, 1.7) for each of the three nursing homes, respectively. In the third outbreak, 22 vaccinated residents without clinical illness had a geometric mean titer of hemagglutination-inhibition (HI) antibody of 20. Although low, this titer was significantly higher than that of nine unvaccinated residents without clinical illness (12, p<.05); only three (14%) vaccinated residents had HI titers of 340. These results suggest that levels of HI antibody in vaccinated residents were not protective at the time of the third outbreak, four to five months after vaccination. In general, the study of vaccine effectiveness in nursing homes is limited by sample size and statistical power. Despite these limits, the retrospective investigation of influenza outbreaks in nursing homes is often the only practical way to evaluate influenza vaccine effectiveness in the elderly on a yearly basis.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 11 , Issue 9 , September 1990 , pp. 473 - 478
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1990

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