title: Underutilization of pneumococcal vaccine in nursing home in Washington State: report of a serotype-specific outbreak and a survey.
abstract: OBJECTIVE
  To describe an outbreak of pneumococcal disease in a Washington state nursing home and to report a survey of pneumococcal vaccine utilization in Washington nursing homes.
  
  
  METHODS
  Outbreak. Data were collected from nursing home residents' records. Nasopharyngeal cultures were obtained from residents and staff. Survey. Fifty-four randomly selected Washington nursing homes were surveyed about pneumococcal vaccine utilization and policies.
  
  
  RESULTS
  Outbreak. Three confirmed and 4 possible cases of pneumococcal disease occurred over 9 days among 94 residents; 5 patients (71%) died. Cases were identified among 6 of 42 residents on 1 wing, compared with 1 of 52 on the other 2 wings (relative risk 7.4, 95% confidence interval 1.0, 398.5). Streptococcus pneumoniae serotype 9V was cultured from the blood of 3 confirmed case-patients and the nasopharynx of 2 of 73 residents. Only 7% of residents had received pneumococcal vaccine, including one case-patient who had received 14-valent vaccine without serotype 9V. Survey. Only 22% of residents were reported to have received pneumococcal vaccine; vaccination status was unknown for 66%. Physician discretion determined pneumococcal vaccination in 49 (91%) nursing homes; 9 (17%) had a written policy. Two major barriers to pneumococcal vaccination were cited: low priority among physicians (43%) and difficulty in determining residents' vaccine history (37%).
  
  
  CONCLUSIONS
  A pneumococcal disease outbreak among undervaccinated nursing home residents probably resulted from person-to-person transmission. Pneumococcal vaccine appears to be underutilized in Washington state nursing homes.
authors.affiliation: Division of Field Epidemiology, Centers for Disease Control, Atlanta, Georgia.
authors.forename: R E
authors.initials: RE
authors.lastname: Quick
authors.forename: C W
authors.initials: CW
authors.lastname: Hoge
authors.forename: D J
authors.initials: DJ
authors.lastname: Hamilton
authors.forename: C J
authors.initials: CJ
authors.lastname: Whitney
authors.forename: M
authors.initials: M
authors.lastname: Borges
authors.forename: J M
authors.initials: JM
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D001428:Bacterial Vaccines / Q000008:administration & dosage*; D004196:Disease Outbreaks; D004363:Drug Utilization; D005260:Female; D005500:Follow-Up Studies; D006291:Health Policy; D006292:Health Priorities; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D008499:Medical Records; D009305:Nasopharynx / Q000382:microbiology; D009735:Nursing Homes; D010614:Pharynx / Q000382:microbiology; D011008:Pneumococcal Infections / Q000453:epidemiology*; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology*; D013296:Streptococcus pneumoniae / Q000145:classification / Q000276:immunology* / Q000302:isolation & purification; D014611:Vaccination / Q000706:statistics & numerical data; D014861:Washington / Q000453:epidemiology
chemical_list: D001428:Bacterial Vaccines; D007252:Influenza Vaccines