Hate shots? This one’s to love!

Yes, it does seem like summer’s just arrived!  But it’s already time to be thinking about that dreaded bugaboo of winter: the flu.

Although influenza affects persons of all ages, the Centers for Disease Control and Prevention has identified residents of nursing homes and other long-term care facilities as being among those who are at increased risk for complications. During influenza epidemics, in fact, mortality rates among nursing home residents often exceed 5 percent.

Patients with influenza typically present with systemic signs of infection, including fever, myalgia, headache, sore throat, and cough. Outbreaks occur nearly every year during the winter months and significantly increase morbidity and mortality from all causes, especially cardiovascular and pulmonary diseases, and certain metabolic conditions.

Seniors should be vaccinated for the flu before December, according to recommendations from the CDC. The influenza season peaks between December and February. For adults over the age of 65, the flu vaccine's effectiveness can decline “significantly” in the months following vaccination, the CDC noted. While delaying vaccination may help older adults have greater immunity later in the flu season, the CDC encourages seniors to get vaccinated before the virus begins to circulate.  

This push for earlier vaccinations in seniors comes after a particularly nasty flu season, which saw higher-than-usual flu cases in nursing homes and other healthcare facilities. During the first full week of 2015, adults over 65 were hospitalized for the flu at a rate of 91.6 per 100,000, up almost 20 points from the same period in 2013, the CDC said.

Persons older than 65 years accounted for more than 90 percent of the deaths attributed to influenza in a recent study.  In addition to heightened susceptibility because of age, skilled-care and nursing home residents also have a higher risk of exposure. Nursing home staff, personal visitors, volunteers, and other visitors from the community provide numerous sources of exposure to the influenza virus.

As a result of these risks, influenza attack rates typically range from 20 to 30 percent among residents of nursing homes, and even higher rates have been documented. In addition, mortality rates during such influenza outbreaks often exceed 5 percent.

The influenza vaccine is recommended as the primary way of preventing the illness and its complications. Brian J. Kingston, M.D., and Charles V. Wright, Jr., M.D., M.M.M., of the Texas Tech University Health Sciences Center at Amarillo, writing for American Family Physician, have reported the results of studies that show that vaccination of nursing home residents and staff can significantly decrease rates of hospitalization, pneumonia, and related mortality. When an influenza outbreak occurs in a nursing home, several measures can be implemented by the treating physician.

Once an outbreak has been established, the doctors report, control measures, including vaccination of unvaccinated residents and employees, and limitations on resident movement and visits, can be implemented.

Administration of the influenza vaccine is the primary method of preventing the disease and its severe complications, the doctors said. A report from the Advisory Committee on Immunization Practices noted that the primary target group for the influenza vaccine is persons 50 years of age and older, and “a specific subgroup consists of residents of nursing homes and other long-term care facilities that house persons of any age who have chronic medical conditions.”

The vaccine has been shown repeatedly to decrease the serious complications of influenza in the nursing home setting. Although it is only 30 to 40 percent effective in preventing upper respiratory illness, the efficacy of the vaccine improves with the more serious effects of influenza infection. One recent analysis has shown vaccine efficacy of 50 percent in preventing hospitalization, 53 percent in preventing pneumonia, and 68 percent in preventing death.

A number of studies have also shown that nursing homes with high rates of vaccinated residents have fewer outbreaks of influenza than nursing homes with lower vaccination rates.

Staff members, too, would be well advised to get the flu vaccination.  The higher the proportion of staff receiving the influenza vaccine, the lower the incidence of influenza among staff and residents during an outbreak, the doctors have found.  In addition, vaccination of both residents and staff can lead to herd immunity. To achieve this goal, the vaccination rate among residents and staff should exceed 80 percent.

With the concurrence of the attending physician, all consenting nursing home residents should receive the vaccine at the same time before the influenza season begins, the CDC says. Nursing home staff should also receive the influenza vaccine at this time, and new nursing home staff and new nursing home residents admitted between October and March should also be offered the vaccine.

It’s the best antidote to date to a very dangerous condition!



McKnights Long-Term Care News

American Family Physician