Prevention of influenza and pneumococcal pneumonia in Canadian long-term care facilities: how are we doing?

Abstract

BACKGROUND:

Influenza and pneumococcal pneumonia are serious health problems among elderly people and a major cause of death in long-term care facilities. We describe the results of serial surveys of vaccination coverage and influenza outbreak management in Canadian long-term care facilities over the last decade.

METHODS:

Cross-sectional surveys consisting of questionnaires mailed to all Canadian residential long-term care facilities for elderly people in 1991 and to a random sample of respondents in 1995 and 1999.

RESULTS:

The response rates were 83% (430/515) in 1995 and 75% (380/506) in 1999. In 1999 the mean reported rates of influenza vaccination were 83% among residents and 35% among staff, and the mean rate of pneumococcal vaccination among residents was 71%; all 3 rates were significantly higher than those in 1991. The rates were also higher in facilities with an infection control practitioner than in those without such an individual (88% v. 82% for influenza vaccination among residents [p < 0.001], 42% v. 35% for influenza vaccination among staff [p = 0.008] and 75% v. 63% for pneumococcal vaccination among residents [p < 0.001]). Obtaining consent for vaccination on admission to the facility was associated with higher influenza and pneumococcal vaccination rates among residents (p = 0.04 and p < 0.001 respectively). Facilities with higher influenza vaccination rates among residents and staff reported lower rates of influenza outbreaks (p = 0.08 and 0.03 respectively). Despite recommendations from the National Advisory Committee on Immunization, only 50% of the facilities had policies for amantadine prophylaxis during influenza A outbreaks. Amantadine was judged effective in controlling 76% of the influenza A outbreaks and was discontinued because of side effects in 3% of the residents.

INTERPRETATION:

Influenza and pneumococcal vaccination rates among residents and staff in Canadian long-term care facilities have increased over the last decade but remain suboptimal. Vaccination of residents and staff against influenza is associated with a reduced risk of influenza outbreaks. Amantadine is effective in controlling influenza outbreaks in long-term care facilities.

• Authors: C G Stevenson, M A McArthur, M Naus, E Abraham, A J McGeer
• Journal: CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne (CMAJ) Vol. 164 Issue 10 Pg. 1413-9 (May 15 2001) ISSN: 0820-3946 [Print] Canada
• PMID: 11387913 (Publication Type: Journal Article)

Chemical References

• Antiviral Agents
• Amantadine

Topics

• Aged
• Amantadine (therapeutic use)
• Analysis of Variance
• Antiviral Agents (therapeutic use)
• Canada (epidemiology)
• Cross-Sectional Studies
• Disease Outbreaks (prevention & control, statistics & numerical data)
• Guideline Adherence (statistics & numerical data, trends)
• Health Personnel (statistics & numerical data)
• Homes for the Aged
• Humans
• Infection Control (methods, standards, statistics & numerical data, trends)
• Influenza, Human (epidemiology, prevention & control)
• Logistic Models
• Occupational Health (statistics & numerical data)
• Pneumonia, Pneumococcal (epidemiology, prevention & control)
• Population Surveillance
• Practice Guidelines as Topic
• Skilled Nursing Facilities
• Surveys and Questionnaires
• Vaccination (standards, statistics & numerical data, trends)