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January 2007

Influenza and Pneumococcal Pneumonia Vaccine-Preventable Diseases for the Geriatric Population

Many communicable diseases are not preventable by use of vaccines; however, two diseases that can be devastating to the geriatric population are vaccine-preventable. These diseases are influenza and pneumococcal pneumonia. The health care community has the responsibility of assisting public health in promoting and providing the immunizations against influenza and pneumococcal pneumonia.

INFLUENZA
Influenza (“flu”) is a serious disease that is caused by a virus that spreads from infected persons to the nose or throat of others. Influenza can cause fever, sore throat, chills, cough, headache and muscle aches. Influenza vaccination is the primary method for preventing influenza and its severe complications. Vaccination is associated with reductions in influenza-related respiratory illness and physician visits among all age groups, hospitalization and death among persons at high risk, otitis media among children and work absenteeism among adults. Influenza causes an average of 36,000 deaths each year in the U.S., mostly among the elderly. Influenza vaccine can prevent influenza. Inactivated (killed) influenza vaccine has been used in the United States for many years. Protection from vaccination develops about 2 weeks after getting the shot and may last up to a year.

People 6 months of age and older at risk for getting a serious case of influenza or influenza complications, and people in close contact with them (including all household members) should get the vaccine. In considering the geriatric population, an annual flu shot is recommended for:
• People 50 years of age or older.
• Residents of long-term care facilities housing persons with
   chronic medical conditions.
• People who have long-term health problems with:
  - heart disease
  - kidney disease
  - lung disease
  - metabolic disease, such as diabetes
  - asthma
  - anemia and other blood disorders
• People with a weakened immune system due to:
  - HIV/AIDS or another disease that affects the immune system
  - long-term treatment with drugs such as steroids
  - cancer treatment with x-rays or drugs.
Physicians, nurses, family members or anyone else coming in close contact with people at risk of serious influenza should also be immunized annually.

PNEUMOCOCCAL DISEASE
Pneumococcal disease is a serious disease that causes sickness and death. In fact, pneumococcal disease kills more people in the United States each year than all other vaccine-preventable diseases combined. Pneumococcal pneumonia is the leading cause of pneumonia in the elderly. People at greater risk from the disease include people 65 and older, the very young and people with special health problems such as alcoholism, heart or lung disease, kidney failure, diabetes, HIV infection or certain types of cancer. Pneumococcal disease can lead to serious infections such as pneumonia, bacteremia, and meningitis.
About 1 out of every 20 people who get pneumococcal pneumonia dies from it, as do about 2 people out of 10 who get bacteremia and 3 people out of 10 who get meningitis.

Prevention of the disease through vaccination is very important. In considering the geriatric population, the pneumococcal polysaccharide vaccine (PPV) should be given to all adults 65 years of age or older. Usually one dose of PPV is all that is needed. However, a second dose is recommended for those people aged 65 and older who got their first dose when they were under 65, if 5 or more years have passed since that dose.

• A second dose is also recommended for people who:
  - have a damaged spleen or no spleen
  - have sickle-cell disease
  - have HIV infection or AIDS
  - have cancer, leukemia, lymphoma or multiple myeloma
  - have kidney failure
  - have nephrotic syndrome
  - have had an organ or bone marrow transplant
  - are taking medication that lowers immunity (such as chemotherapy or
    long-term steroids).
Children 10 years old and younger may get this second dose 3 years after the first dose, and those older than 10 should get it 5 years after the first dose.

IMMUNIZATIONS IN LONG-TERM CARE FACILITIES
In recent years, many long term care facilities (LTCFs) have initiated giving flu vaccine and pneumococcal vaccine to their residents under standing orders rather than requiring specific consent. If a resident is allergic to the vaccine, or the resident or family otherwise refuses the vaccine, some facilities ask that a "refusal of care" form be signed. This practice has greatly increased the numbers of elderly that receive these important life-saving vaccines. Regarding the government’s efforts to promote these vaccines: in 2003, CMS announced that LTCFs may give the vaccines without a physician’s order. On August 15, 2005, CMS published in the Federal Register a proposed rule that would require Medicare and Medicaid participating LTCFs to offer each resident immunization against influenza annually, as well as lifetime immunization against pneumococcal disease.1 These advances in practice have the potential to save the lives of many of our elderly population.


1 Federal Register: August 15, 2005 (Volume 70, Number 156)

Ms. Bennett received her BSN from the Medical College of Georgia and her Master of Science in Adult Health Nursing from Georgia State University. She is Certified in Infection Control. She is currently the Executive Director of ICP Associates, an international consulting company for education and prevention of infections. Her contracts include over 259 healthcare facilities. Ms. Bennett is an active member of the Association for Professionals in Infection Control and Epidemiology and has served in the past on their national board of directors. She provides consultation and educational programs throughout the United States. www.icpassociates.com

Gail Bennett, RN, MSN, CIC
ICP Associates

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