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Vaccine Use in Nursing Homes

PHILADELPHIA, PA — May 7, 2004 — Nursing home residents who received pneumococcal or flu vaccine were less likely to require hospitalization than unvaccinated residents, according to a report on a recent meeting of public health researchers (Medscape, April 21, 2004, Andrew Boswer). Dr. Sophia Kazakova, an investigator with the Centers for Disease Control (CDC), analyzed Medicare claims and other data for over 35,000 patients in 277 nursing homes from 2000 through 2002. During the first flu season, 25.3% of vaccinated residents became hospitalized, as compared to 37.1% of unvaccinated residents. Statistics were similar during the second winter. Dr. Kazakova considered these figures significant, although preliminary, because there have been some conflicting reports about the effectiveness of pneumococcal vaccine in the elderly.

Pneumococcal polysaccharide vaccine is used to fight pneumococcal disease, an infection by a bacteria called streptococcus pneumoniae. This bacteria has become more resistant to penicillin, which was once used to combat the disease. Pneumococcal disease can lead to pneumonia and infections of the blood (bacteremia) and of the brain covering (meningitis). It is responsible for 40,000 deaths per year in the United States, more fatalities than for any other bacterial disease that may be prevented by vaccine. Seniors are particularly susceptible to developing pneumococcal disease, and pneumonia is a major cause of death among nursing home residents. In addition, about 18,000 seniors per year die from influenza (Chart Book for Trends in Health of Americans, National Center for Health Statistics).

The CDC recommends that seniors receive both flu shots and the pneumococcal vaccine (Pneumococcal Polysaccharide Vaccine, What You Need to Know; Prevention of Pneumococcal Disease, Advisory Committee). However, in 1995, only 61% of nursing home residents received flu shots, and only 21% received the pneumococcal vaccine. A government report estimates that nursing homes today still fall far short of the agency’s goal of a 90% vaccination rate for residents (Department of Health and Human Resources, Office of Inspector General, Nursing Home Vaccination). It suggests the following:

  • Making vaccination a standard part of nursing home admission;
  • Better collection of data on vaccination status;
  • Helping nursing homes get access to vaccines through improved ordering, distribution, and reimbursement;
  • Enhancing education about vaccine safety and effectiveness.

Another study also recommends that nursing homes have good vaccination programs to minimize cases of pneumonia and flu. However, it also emphasizes the importance of excellent nursing care to help the pneumonia patient and good oral hygiene care to prevent the spread of bacteria. The level of patient care in the nursing home will in turn depend upon whether enough staff is available, and on their level of training and expertise.

Brayton Purcell is concerned about the conditions in nursing homes and other long–term care facilities. If you have questions about nursing home care and your legal rights or those of a loved one, please feel free to contact us at Brayton Purcell. We are experienced in handling cases of nursing home abuse, including those involving neglect and inadequate pain management.

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