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Influenza - Prevention

age aging nursing vaccine ltcfs residents mortality

Influenza vaccination represents the safest, most cost-effective means of prevention of morbidity and mortality from influenza virus. Current guidelines recommend influenza vaccine yearly in all individuals over age sixty-five, all residents of LTCFs, children or adults with chronic pulmonary or cardiovascular illness, children requiring chronic aspirin therapy, and women in the second or third trimester of pregnancy during influenza season. Yearly influenza vaccine is also recommended in health care workers, employees of LTCFs who come in contact with patients, and home care providers or others who have household contact with high-risk individuals.

At present, an inactivated vaccine directed at three viruses (influenza A H1N1, H3N2, and influenza B) is currently used. This vaccine can reduce the incidence of confirmed influenza, influenza-like illness, all respiratory infections, exacerbations of cardiopulmonary disease, hospitalization, and death in both community-dwelling elderly persons and in residents of LTCFs. Although the vaccine has only 30 to 40 percent efficacy in preventing influenza in residents of LTCFs, severe illness, hospitalization, and death are significantly reduced. High vaccination rates among residents of a LTCF significantly reduce the chances of an outbreak occurring in that facility, and should an outbreak occur, vaccination will decrease hospitalizations by 50 to 60 percent and mortality by as much as 80 percent. In order to maximize the effectiveness of the vaccine in the prevention of influenza-associated morbidity and mortality in residents of LTCFs, it is critical that high staff vaccine rates be maintained in hopes of reducing and delaying introduction of influenza into these facilities. A newly developed but not yet licensed cold-adapted, live, attenuated, trivalent, intranasal influenza vaccine has been shown to increase serum, mucosal, and cell-mediated immunity when given in combination with the currently available intramuscular vaccine.

SHELLY MCNEIL

See also LUNG, AGING; PNEUMONIA.

BIBLIOGRAPHY

BRADLEY, S. F., et al. "Prevention of Influenza in Long-Term Care Facilities." Infection Control Hospital Epidemiology 20 (1999): 629–637.

LIBOW, L. S.; NEUFELD, R. R.; OLSON, E.; BREUER, B.; and STARER, P. "Sequential Outbreak of Influenza A and B in a Nursing Home: Efficacy of Vaccine and Amantidine." Journal of the American Geriatric Society 44 (1996): 1153–1157.

"Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices." Morbidity and Mortality Weekly Report 47 (1998): 1–16.

TREANOR, J. J. "Influenza Virus." In Principles and Practices of Infectious Diseases, 5th ed. Edited by G. L. Mandell, J. E. Bennett, and R. Dolin. New York: Churchill Livingstone, 2000. Pages 1823–1849.

INSULIN

See DIABETES MELLITUS

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