Influenza outbreak detection and control measures in nursing homes in the United States

OBJECTIVE: To evaluate the use of influenza vaccine, rapid influenza testing, and influenza antiviral medication in nursing homes in the US to prevent and control outbreaks. METHODS: Survey questionnaires were sent to 1017 randomly selected nursing homes in nine states. Information was collected on influenza prevention, detection and control practices, and on outbreaks during three influenza seasons (1995-1998). RESULTS: The survey response rate was 78%. Influenza vaccine was offered to residents and staff by 99% and 86%, respectively, of nursing homes. Among nursing homes offering the influenza vaccine, the average vaccination rate was 83% for residents and 46% for staff. Sixty-seven percent of the nursing homes reported having access to laboratories with rapid antigen testing capabilities, and 19% reported having a written policy for the use of influenza antiviral medications for outbreak control. Nursing homes from New York, where organized education programs on influenza detection and control have been conducted for many years, were more likely to have reported a suspected or laboratory-confirmed influenza outbreak (51% vs 10%, P = .01), to have access to rapid antigen testing for influenza (92% vs 63%, P = .01), and to use antivirals for prophylaxis and treatment of influenza A for their nursing home residents (94% vs 55%, P = .01) compared with nursing homes from the other eight states. CONCLUSIONS: Influenza outbreaks among nursing home residents can lead to substantial morbidity and mortality when prevention measures are not rapidly instituted. However, many nursing homes in this survey were neither prepared to detect nor to control influenza A outbreaks. Targeted, sustained educational efforts can improve the detection and control of outbreaks in nursing homes.     

An outbreak of influenza A (H3N2) in a well immunized nursing home population.

OBJECTIVE: To describe the epidemiologic features of an outbreak of influenza A that occurred in a skilled nursing home although over 90 percent of the resident population had previously received influenza vaccine. DESIGN: Retrospective cohort study. SETTING: Skilled nursing home facility in western New York State. PATIENTS: Nursing home residents and patient-care staff. MAIN OUTCOME MEASURE: Incidence of influenza-like illness among vaccinated versus unvaccinated nursing home residents and staff. RESULTS: Thirty-seven of 124 residents (attack rate = 30%) and 18 of 146 staff (attack rate = 12%) had an influenza-like illness. Staff illness began 16 days prior to onset among residents. Six cases of pneumonia and three influenza-related deaths occurred, all among the vaccinated residents. Ninety percent of the nursing home residents and 10% of the staff received the influenza vaccine prior to the outbreak. The calculated vaccine efficacies were minus 21% and plus 45% for residents and staff, respectively. CONCLUSION: While antigenic drift of the circulating influenza virus was the major factor in the apparent vaccine failure, the observed poor staff immunization rate (10%) and absence of surveillance which precluded the use of amantadine chemoprophylaxis suggest that the use of these strategies may be of importance in controlling influenza outbreaks in nursing homes.     

Do Vaccination Strategies Implemented by Nursing Homes Narrow the Racial Gap in Receipt of Influenza Vaccination in the United States?

OBJECTIVES: To determine whether the racial inequity between African Americans and Caucasians in receipt of influenza vaccine is narrower in residents of nursing homes with facility‐wide vaccination strategies than in residents of facilities without vaccination strategies. DESIGN: Secondary data analysis using the National Nursing Home Survey 2004, a nationally representative survey. SETTING: One thousand one hundred seventy‐four participating nursing homes sampled systematically with probability proportional to bed size. PARTICIPANTS: Thirteen thousand five hundred seven randomly sampled residents of nursing homes between August and December 2004. MEASUREMENTS: Receipt of influenza vaccine within the last year. Logistic regression was used to examine the relationship between facility‐level influenza immunization strategy and racial inequity in receipt of vaccination, adjusted for characteristics at the resident, facility, state, and regional levels. RESULTS: Overall in the Untied States, vaccination coverage was higher for Caucasian and African‐American residents; the racial vaccination gaps were smaller (<6 percentage points) and nonsignificant in residents of homes with standing orders for influenza vaccinations (P=.14), verbal consent allowed for vaccinations(P=.39), and routine review of facility‐wide vaccination rates (P=.61) than for residents of homes without these strategies. The racial vaccination gap in residents of homes without these strategies were two to three times as high (P=.009, P=.002, and P=.002, respectively). CONCLUSION: The presence of several immunization strategies in nursing homes is associated with higher vaccination coverage for Caucasian and African‐American residents, narrowing the national vaccination racial gap.     

Effect of Influenza Vaccination of Nursing Home Staff on Mortality of Residents: A Cluster-Randomized Trial

OBJECTIVES: To evaluate the effect of staff influenza vaccination on all-cause mortality in nursing home residents.
DESIGN: Pair-matched cluster-randomized trial.
SETTING: Forty nursing homes matched for size, staff vaccination coverage during the previous season, and resident disability index.
PARTICIPANTS: All persons aged 60 and older residing in the nursing homes.
INTERVENTION: Influenza vaccine was administered to volunteer staff after a face-to-face interview. No intervention took place in control nursing homes.
MEASUREMENTS: The primary endpoint was total mortality rate in residents from 2 weeks before to 2 weeks after the influenza epidemic in the community. Secondary endpoints were rates of hospitalization and influenza-like illness (ILI) in residents and sick leave from work in staff.
RESULTS: Staff influenza vaccination rates were 69.9% in the vaccination arm versus 31.8% in the control arm. Primary unadjusted analysis did not show significantly lower mortality in residents in the vaccination arm (odds ratio=0.86, P =.08), although multivariate-adjusted analysis showed 20% lower mortality ( P =.02), and a strong correlation was observed between staff vaccination coverage and all-cause mortality in residents (correlation coefficient=−0.42, P =.007). In the vaccination arm, significantly lower resident hospitalization rates were not observed, but ILI in residents was 31% lower ( P =.007), and sick leave from work in staff was 42% lower ( P =.03).
CONCLUSION: These results support influenza vaccination of staff caring for institutionalized elderly people.     

Hip fracture incidence in the elderly in Austria: An epidemiological study covering the years 1994 to 2006

Background

Previous studies have shown influenza vaccine uptake in UK nursing home residents to be low. Very little information exists regarding the uptake of pneumococcal vaccine in this population. The formulation of policies relating to the vaccination of residents has been proposed as a simple step that may help improve vaccine uptake in care homes.

Methods

A postal questionnaire was sent to matrons of all care homes with nursing within the Greater Nottingham area in January 2006. Non respondents were followed up with up to 3 phone calls.

Results

30% (16/53) of respondents reported having a policy addressing influenza vaccination and 15% (8/53) had a policy addressing pneumococcal vaccination. Seasonal influenza vaccine coverage in care homes with a vaccination policy was 87% compared with 84% in care homes without a policy (p = 0.47). The uptake of pneumococcal vaccination was found to be low, particularly in care homes with no vaccination policy. Coverage was 60% and 32% in care homes with and without a vaccination policy respectively (p = 0.06). This result was found to be statistically significant on multivariate analysis (p = 0.03, R = 0.46)

Conclusion

The uptake of influenza vaccine among care home residents in the Nottingham region is relatively high, although pneumococcal vaccine uptake is low. This study shows that there is an association between pneumococcal vaccine uptake and the existence of a vaccination policy in care homes, and highlights that few care homes have vaccination policies in place.     

Influenza virus vaccination and booster in B-cell chronic lymphocytic leukaemia patients

Background: Influenza vaccination is recommended for patients with B-cell chronic lymphocytic leukaemia (CLL). Because response rates are often low, we decided to evaluate antibody response to single and booster vaccinations with influenza A and B virus vaccine in these patients. Methods: Twenty patients with B-CLL received two subunit virus vaccine injections 21 days apart. Antibody titres were determined before and 21 days after the single and booster vaccinations. The serological response was expressed using the following criteria: (1) response rate, i.e. the proportion of subjects with at least a 4-fold titre increase; (2) the protection rate, i.e. the proportion of subjects exceeding the threshold of 100 (influenza A) or 200 (influenza B); and (3) the mean fold increase (MFI), i.e. the difference between the log-adjusted geometric mean titres of pre- and post-vaccination sera. Results: Response rates were 5% for influenza A and 15% for B after the single vaccination and 15% for A and 30% for B after the booster vaccination. Protection rates were 0% for influenza A and 25% for B after the single vaccination; they were 5% (H1N1) and 10% (H3N2) for influenza A and 30% for B after the booster. The MFI+/-S.D. (range) after the booster vaccination was 0.26+/-0.33 (0-1.00), 0.17+/-0.34 (0-1.00) and 0.35+/-0.34 (0-1.20) for H1N1, H3N2 and influenza B, respectively. Conclusion: In this study with B-CLL patients, immune response to influenza vaccination was poor. Thus, single and booster vaccinations with influenza virus vaccine do not appear to be of great value to patients with B-cell CLL.     

Protective efficacy of combined live intranasal and inactivated influenza A virus vaccines in the elderly.

OBJECTIVE: To evaluate the efficacy of adding intranasal live attenuated cold-adapted influenza A vaccine to inactivated influenza vaccine to prevent influenza A in elderly residents of long-term-care institutions. DESIGN: Randomized, double-blind, placebo-controlled study conducted over 3 years. SETTING: Three large nursing homes. PARTICIPANTS: A total of 523 residents of nursing homes (mean age, 84.2 years). INTERVENTIONS: All participants received trivalent inactivated influenza vaccine parenterally and were randomly assigned to receive either live attenuated influenza A (H3N2) virus vaccine or placebo intranasally. MEASUREMENTS: Laboratory-documented influenza A was defined as a respiratory illness plus isolation of influenza A virus from nasal secretions, significant serologic response, or both. Participants were considered to have been exposed to influenza A if they resided in an institution in which cases of influenza A were documented. Outbreak-associated illnesses were defined as those occurring between the first and last isolation of influenza virus from within the institution, +/- 3 days. RESULTS: Participants who received intranasal vaccine and were subsequently exposed to influenza A had significantly lower rates of laboratory-documented influenza A (9 of 162 vaccine recipients compared with 24 of 169 placebo recipients; vaccine protective efficacy, 60.6%; 95% CI, 18% to 82%), outbreak-associated respiratory illnesses (13 of 162 vaccine recipients compared with 34 of 169 placebo recipients; vaccine protective efficacy, 56.8%; CI 23% to 76%), and outbreak-associated influenza-like illnesses (6 of 162 vaccine recipients compared with 18 of 169 placebo recipients; vaccine protective efficacy, 65.0%; CI 17% to 86%). CONCLUSIONS: Intranasal immunization with live attenuated influenza A virus vaccine provided additional protection against influenza A when added to parenteral trivalent inactivated influenza vaccine among elderly nursing home residents.     

Influenza Vaccination is Associated with Lower Risk of Acute Coronary Syndrome in Elderly Patients with Chronic Kidney Disease

Elderly patients with chronic kidney disease (CKD) are at a higher risk of hospitalization for cardiovascular diseases (CVD). Previous studies have showed that influenza vaccination could reduce the risk of recurrent major cardiovascular events in patients with CVD. However, the effects of influenza vaccination on the reduction of first hospitalizations for acute coronary syndrome (ACS) in elderly patients with CKD remain unknown.We conducted a cohort study using data from the Taiwan Longitudinal Health Insurance Database 1997 to 2008. This cohort study comprised elderly patients (ages ≥55 years) with a recorded diagnosis of CKD (n = 4406) between January 1, 1999, and December 31, 2007. Each patient was followed up until the end of 2008. To minimize the selection bias of vaccine therapy, a propensity score adjustment was applied. The hazard ratio (HR) and 95% confidence interval (CI) for the association between the influenza vaccination and the occurrence of first hospitalization for ACS was evaluated by Cox proportional hazards regression. We further categorized the patients into 4 groups according to their vaccination status (unvaccinated, and total number of vaccinations: 1, 2–3, and ≥4).We found that elderly CKD patients without prior CVD history receiving influenza vaccination exhibited a lower risk of hospitalization for ACS (adjusted HR = 0.35, 95% CI 0.30–0.42; P < 0.001). We observed consistent protective effects regardless of age groups (55–64, 65–74, and ≥75), gender, and seasonality of influenza. When the patients were stratified according to the total number of vaccinations, the adjusted HRs for first ACS hospitalization were 0.62 (95% CI 0.52–0.81), 0.35 (95% CI 0.28–0.45), and 0.13 (95% CI 0.09–0.19) for patients who received 1, 2 to 3, and ≥4 vaccinations. There was a significant trend of decreasing risk of ACS hospitalization with an increasing number of vaccinations.The results of our observational study could strengthen the annual vaccination policy and physicians should be aware of missed opportunities to vaccinate elderly patients with CKD against influenza. The potential public health impact of influenza vaccination, particularly in the elderly CKD patients without a history of CVD, who are at risk for ACS, should be further explored.     

Use of influenza vaccine in nursing homes

The organization and outcome of influenza immunization programs were studied in 67 randomly or systematically selected nursing homes (8354 residents) in six states during the autumn of 1982 and/or 1983. In each home, influenza vaccine was usually offered to all residents on a voluntary basis, independent of their age, level of required nursing care, or underlying medical conditions. However, the proportion of residents who were vaccinated ranged from 8 to 98% (mean, 62% overall), with significantly lower rates in homes that also required consent from relatives (usually by return mail) than in homes that did not (P less than .00001; median, 57 versus 90%, respectively). These observations suggest that distribution of educational materials about the risks and benefits of influenza vaccine and systematic follow-up of relatives who fail to return the consent form may be useful strategies to further increase the number of nursing home residents who are immunized.     

Nursing home resident and facility characteristics associated with pneumococcal vaccination: national nursing home survey, 1995-1999

Objectives: To assess Advisory Committee for Immunization Practices recommendations for the pneumococcal vaccine in nursing home residents using national surveys to examine factors associated with vaccination. Design: Cross‐sectional national sample surveys of nursing homes and nursing home residents with a two‐stage probability design, stratified on size and Medicare and Medicaid certification status. Setting: U.S. nursing homes during 1995, 1997, and 1999. Participants: Six current residents were randomly selected from each facility (n=approximately 8,000 each year). Measurements: Residents' pneumococcal vaccination status was obtained by asking the facility respondent for each resident: “Has [the resident] EVER had a pneumococcal vaccine, that is a pneumonia vaccination?” Vaccination status was coded as yes, no, and unknown. Results: The proportion of residents aged 65 and older that received pneumococcal vaccination increased significantly, from 23.6% in 1995 to 28.2% in 1997 to 37.4% in 1999 (P<.001). The proportion of residents in homes with pneumococcal immunization programs increased significantly, from 65.2% in 1995 to 88.9% in 1999. Conclusion: The proportion of nursing home residents aged 65 and older receiving the pneumococcal vaccine increased significantly from 1995 to 1999. Residents living in nursing homes with programs for pneumococcal immunizations were significantly more likely to be vaccinated.     

Influenza vaccine adverse event and effect on acceptability in pediatric residents

Despite the demonstrated benefits of influenza vaccinations, the coverage is lower than expected among health-care personnel (HCP). In this study we surveyed the attitudes of pediatric residents regarding influenza immunization and adverse reactions. Forty-five female and 35 male pediatric residents with ages ranging from 24 to 28 years were vaccinated with an influenza vaccine on 2 days in the 3rd week of September 2005 by the same nurse. Among our resident, 27 (33.7%) thought the vaccine unnecessary; their vaccine coverage was only 12% in the previous year. Thirteen residents (16%) had soreness at the vaccination site; 7 (8%) had other local reactions that did not interfere with everyday activities, and 16 (20%) had any systemic side effects. The overall rate of side effects from the vaccination was 36.5% (n=29). Twenty of the 29 vaccinees who experienced side effects stated they did not want to receive the vaccine the following year because of the side effects, while 13% in the group without side effects stated the same thing, mainly because of the cost of vaccination. We would like to recommend an influenza vaccination campaign for HCP by employers, but first we must plan to take steps to improve the acceptability of the influenza vaccine among HCP.     

Studies of influenza vaccination among elderly nursing home residents

We conducted a questionnaire survey of influenza vaccination among elderly nursing home residents, and investigated the actual condition and the view of vaccination of elderly people. There was 272 elderly residents in Nagoya-shi, Kouseiin Medical Welfare Center, they were classified into the bed ridden group; 195cases (71.7%) according to the independence in activities of daily living, and 132cases (48.5%) were evaluated as the disturbance of community ability group. The number of vaccination in 2002/2003 was 163 residents (59.9%). When the vaccination group (163cases) was compared with the non-vaccination group (109cases), it becomes clear that the later has much bedridden or dementia. The reply of questionnaire was obtained from 139 cases (51.1%) among 272 residents. As a reason of the residents who received vaccine, a prevention was 70.2%, mostly over whelmingly. The following were 17.0% of a custom of annual vaccination, and the recommendation by doctor and family were 5.3% and 3.2%, respectively. The main reasons for having not received a vaccine was inability of recoganization 22.2%. The afraid of adverse reaction or allergy, the ache of a injection was following 17.8%, respectively. In order to raise the rate of the vaccination in elderly nursing home residents, we should make into consideration that the educational campaign of the safety of vaccine and how to develop motivation for vaccination to the elderly with cognitive decline.     

Introducing a pneumococcal vaccine to an existing influenza immunization program: vaccination rates and predictors of noncompliance.

PURPOSE: Influenza vaccination has been recommended for all elderly people in The Netherlands since 1996, with greater than 80% compliance. It is unknown, however, if the addition of another vaccine to this immunization program will affect compliance. SUBJECTS AND METHODS: General practitioners offered a pneumococcal vaccine together with the yearly influenza vaccination to 3365 patients aged 65 years and older. A questionnaire was then mailed to a stratified sample (n = 972) of these patients. Factors associated with noncompliance with vaccination were assessed using polytomous logistic regression. RESULTS: A total of 2529 patients (75%) received the pneumococcal vaccine and 2812 (84%) received the influenza vaccine. Predictors of noncompliance with the pneumococcal vaccine were perceived lack of recommendation by the general practitioner (odds ratio [OR] = 4.6; 95% confidence interval [CI], 2.6 to 8.3) and fear of local side effects (OR = 2.8; 95% CI, 1.6 to 4.6). Predictors of noncompliance with both vaccinations also included unwillingness to comply with the doctor's advice (OR = 6.1; 95% CI, 2.4 to 15.4), the belief that vaccinations weaken one's natural defenses (OR = 2.7; 95% CI, 1.4 to 5.3) or that influenza is not dangerous (OR = 2.9; 95% CI, 1.5 to 5.4), and the fear of becoming sick from pneumococcal vaccination (OR = 2.9; 95% CI, 1.1 to 7.9). People who felt healthy, found it difficult to visit the doctor's office, had private medical insurance, or were younger than 75 years of age also had a greater risk of not being vaccinated. CONCLUSION: Introducing a pneumococcal vaccine to an existing influenza immunization program resulted in high pneumococcal and influenza vaccination rates. A wider diversity of patient characteristics and attitudes was present when neither vaccination was received.     

The health and economic benefits associated with pneumococcal vaccination of elderly persons with chronic lung disease

BACKGROUND: More than 50% of the elderly population has not received pneumococcal vaccination. Uncertainty regarding the benefits of immunization, particularly for noninvasive disease, may contribute to the underuse of pneumococcal vaccine. OBJECTIVE: To assess the health and economic benefits associated with pneumococcal vaccination. METHODS: We conducted a 2-year retrospective cohort study among all elderly members of a staff-model managed care organization who had a baseline diagnosis of chronic lung disease. The study outcomes were assessed over 2 years, from November 15, 1993, through November 14, 1995, and included hospitalizations for pneumonia and influenza, death, and hospitalization costs. Using administrative data, we compared these outcomes for vaccinated and unvaccinated subjects using multivariate models to control for subjects' baseline demographic and health characteristics. The additive benefits of combined influenza and pneumococcal vaccination were also assessed for the 2 influenza seasons included in the study. RESULTS: There were 1898 subjects. Pneumococcal vaccination was associated with significantly lower risks for pneumonia hospitalizations (adjusted risk ratio [RR], 0.57; 95% confidence interval [CI], 0.38-0.84; P=.005) and for death (adjusted RR, 0.71; 95% CI, 0.56-0.91; P = .008). For the control outcome of all nonpneumonia hospitalizations, rates did not differ significantly between the 2 groups (adjusted RR, 0.91; 95% CI, 0.77-1.07; P= .24). During the influenza seasons included in the study, the benefits of pneumococcal and influenza vaccinations were additive, with an adjusted RR of 0.28 (95% CI, 0.14-0.58; P<.001) for the number of hospitalizations for pneumonia and influenza among persons who had received both vaccinations compared with those who had received neither and an adjusted odds ratio of 0.18 (95% CI, 0.11-0.31; P<.001) for death. Over the 2-year outcome period, pneumococcal vaccination was also associated with direct medical care cost savings. CONCLUSIONS: Pneumococcal vaccination of elderly persons with chronic lung disease was associated with fewer hospitalizations for pneumonia, fewer deaths, and direct medical care cost savings.     

Influenza season triggers pneumococcal vaccination

OBJECTIVES: To investigate the frequency with which influenza and pneumococcal vaccines are administered alone and together. DESIGN: Retrospective review. SETTING: Marshall University internal medicine practice, Huntington, West Virginia. PARTICIPANTS: All patients aged 65 and older seen in the practice from 1999 through 2005 who received pneumococcal or influenza vaccine. MEASUREMENTS: Billing records were reviewed for administration of pneumococcal and influenza vaccines to Medicare beneficiaries, and rates of administration of these vaccines given alone and together were calculated. RESULTS: Nine hundred sixty-nine doses of pneumococcal vaccine were administered. Of these, 796 (82%) were administered during the fall and winter. Three hundred fifty-six (45%) pneumococcal vaccinees received it together with influenza vaccine. During 2001 and 2005, when influenza vaccine supply was limited, the rate of pneumococcal vaccine administered together with influenza vaccine declined sharply. Nonetheless, the rate of pneumococcal vaccination remained relatively stable because of an increase in the rate of vaccine administered alone. CONCLUSION: Four-fifths of pneumococcal vaccine was administered in the fall and winter, and approximately half was given together with influenza vaccine. When influenza vaccine was in limited supply, physicians continued to vaccinate with pneumococcal vaccine alone. These findings suggest that the imminent influenza season provides the trigger for physicians to prescribe pneumococcal vaccine. Physicians should be reminded that pneumococcal vaccine can be administered any time of year.     

Enhanced Estimates of the Influenza Vaccination Effect in Preventing Mortality: A Prospective Cohort Study

Mortality is a major end-point in the evaluation of influenza vaccine effectiveness. However, this effect is not well known, since most previous studies failed to show good control of biases. We aimed to estimate the effectiveness of influenza vaccination in preventing all-cause mortality in community-dwelling seniors.Since 2009, a population-based cohort study using healthcare databases has been conducted in Navarra, Spain. In 2 late influenza seasons, 2011/2012 and 2012/2013, all-cause mortality in the period January to May was compared between seniors (65 years or over) who received the trivalent influenza vaccine and those who were unvaccinated, adjusting for demographics, major chronic conditions, dependence, previous hospitalization, and pneumococcal vaccination.The cohort included 103,156 seniors in the 2011/2012 season and 105,140 in the 2012/2013 season (58% vaccinated). Seniors vaccinated in the previous season who discontinued vaccination (6% of the total) had excess mortality and were excluded to prevent frailty bias. The final analysis included 80,730 person-years and 2778 deaths. Vaccinated seniors had 16% less all-cause mortality than those unvaccinated (adjusted rate ratio [RR] = 0.84; 95% confidence interval 0.76–0.93). This association disappeared in the post-influenza period (adjusted RR = 0.96; 95% confidence interval 0.85–1.09). A similar comparison did not find an association in January to May of the 2009/2010 pandemic season (adjusted RR = 0.98; 95% confidence interval 0.84–1.14), when no effect of the seasonal vaccine was expected. On average, 1 death was prevented for every 328 seniors vaccinated: 1 for every 649 in the 65 to 74 year age group and 1 for every 251 among those aged 75 and over.These results suggest a moderate preventive effect and a high potential impact of the seasonal influenza vaccine against all-cause mortality. This reinforces the recommendation of annual influenza vaccination in seniors.     

Epidemiological study on the effects of influenza virus vaccines--based on the state of absence examined in elementary school children as a whole and in children with a history of disease

The effects of commercially available HA influenza vaccines, produced in 1988, was investigated in pupils in elementary schools located in six cities in Saitama Prefecture during the prevalence of influenza from 1988 to 1989. The state of absence in the children as a whole and in those with a history of disease was examined statistically, by dividing them into three groups in terms of the number of vaccinations given. The following results were obtained. 1) The proportion of children who had received no vaccination (71.2%) was significantly higher than that of children who had received one (9.6%) or two (19.3%) vaccinations. 2) A history of disease was found in 1,048 (3.3%) of the 31,941 children. The percentage of children having such a history was 3.6%, 2.7% and 2.5% among those who had received 0, 1 and 2 vaccinations, respectively; those who had no such history accounted for more than 96.0% in each group of children. 3) There were no differences between the three groups of children with regard to the proportion of those who had a history of respiratory or circulatory symptoms. 4) The rate of absenteeism and the overall rate of absenteeism were found to be significantly higher in children without any vaccination than those with two vaccinations, regardless of whether all subjects were considered or only those who had a history of disease were considered. 5) Both among all subjects and among those who had a history of disease, the mean number of days of absence was significantly high in children without any vaccination than those with 2 vaccinations.(ABSTRACT TRUNCATED AT 250 WORDS)     

Impfungen im Alter

The aging immune system, so-called immunosenescence, is well documented as being the cause of increased infection rates and severe, often complicated courses of infections in the elderly with increased morbidity and mortality rates. Furthermore, it can lead to decreased efficacy of vaccinations. The administration of stronger immunogenic vaccines can be beneficial in the elderly. Implementing vaccination recommendations for the elderly by the Ständige Impfkommission (STIKO, Standing Vaccination Committee) can reduce the burden of infectious diseases by prevention of infections or reduction of the severity of infections. The following vaccinations are recommended by STIKO for all persons aged 60 years and above: annual influenza vaccination (additionally all nursing home residents independent of age), once only pneumococcal polysaccharide vaccination, completion of incomplete tetanus and diphtheria vaccinations (Td) as well as regular revaccination. All adults should be vaccinated once only against pertussis with the combined Td and acellular pertussis (Tdap) vaccine. Meanwhile, pneumococcal conjugate vaccine is authorized for administration in adults but is not yet recommended by the STIKO which also applies to the vaccine for prevention of herpes zoster and postherpetic neuralgia. A lifelong course of vaccination may help to attenuate the effect of immunosenescence.     

Influenza Vaccination Compliance Among Health Care Workers in a German University Hospital

Abstract Background:   Since 1988, the Standing Committee on Vaccination (STIKO) at the Robert Koch-Institute, Berlin, has explicitly recommended that health-care workers (HCWs) should be vaccinated against seasonal influenza. However, acceptance of the influenza vaccination by medical personnel is low. Methods:   This study analyzes factors associated with the compliance of HCWs with the seasonal influenza vaccination on the basis of three different anonymized questionnaires during two consecutive influenza seasons: 2006/2007 and 2007/2008. The questionnaires covered details of demographics, frequency of previous vaccinations, reasons for accepting or declining the vaccination, and the HCW’s knowledge of the influenza vaccine and influenza itself. Results:   Our study showed that physicians were significantly more likely to have been vaccinated than nurses (38.8% vs 17.4%; p < 0.0001). The main reasons for noncompliance included: supposition of a low risk of infection, fear of side effects, the belief that the influenza vaccine might trigger the influenza virus infection, and scepticism about the effectiveness of the influenza vaccination. Conclusion:   Our findings confirm the importance of a comprehensive approach to the vaccination, ensuring that HCWs are correctly informed about the vaccine and that it is convenient to receive it.     

Influenza vaccination in hematopoietic SCT recipients

Influenza is a potentially serious infection after hematopoietic SCT (HSCT). Vaccination is the main prophylactic approach in individuals at an increased risk for severe influenza disease or post-influenza complications. No controlled study on the efficacy of influenza vaccination has been performed in HSCT recipients and also studies evaluating the antibody response are limited by their small sizes and by that vaccinations have been performed at varying times after HSCT. The reports show that serological response rates are lower in HSCT patients than in healthy individuals. However, patients receiving influenza vaccine at 6 months or later after HSCT have a lower risk for virological confirmed influenza. The documentation for efficacy if patients are vaccinated earlier than 6 months after HSCT is mostly lacking but it has been shown that T-cell responses can be elicited after vaccination. Therefore, currently available recommendations suggest starting earlier when the risk for influenza is high, especially during ongoing community outbreaks. Two vaccine doses are recommended in children below the age of 9 years, who have not been previously vaccinated against influenza. Vaccination of family members, close contacts and health-care workers is recommended.