Prevention of influenza and pneumococcal pneumonia in Canadian long-term care facilities: how are we doing?
BACKGROUND
Influenza and pneumococcal pneumonia are serious health problems among elderly people and a major cause of death in long-term care facilities. We describe the results of serial surveys of vaccination coverage and influenza outbreak management in Canadian long-term care facilities over the last decade.


METHODS
Cross-sectional surveys consisting of questionnaires mailed to all Canadian residential long-term care facilities for elderly people in 1991 and to a random sample of respondents in 1995 and 1999.


RESULTS
The response rates were 83% (430/515) in 1995 and 75% (380/506) in 1999. In 1999 the mean reported rates of influenza vaccination were 83% among residents and 35% among staff, and the mean rate of pneumococcal vaccination among residents was 71%; all 3 rates were significantly higher than those in 1991. The rates were also higher in facilities with an infection control practitioner than in those without such an individual (88% v. 82% for influenza vaccination among residents [p < 0.001], 42% v. 35% for influenza vaccination among staff [p = 0.008] and 75% v. 63% for pneumococcal vaccination among residents [p < 0.001]). Obtaining consent for vaccination on admission to the facility was associated with higher influenza and pneumococcal vaccination rates among residents (p = 0.04 and p < 0.001 respectively). Facilities with higher influenza vaccination rates among residents and staff reported lower rates of influenza outbreaks (p = 0.08 and 0.03 respectively). Despite recommendations from the National Advisory Committee on Immunization, only 50% of the facilities had policies for amantadine prophylaxis during influenza A outbreaks. Amantadine was judged effective in controlling 76% of the influenza A outbreaks and was discontinued because of side effects in 3% of the residents.


CONCLUSIONS
Influenza and pneumococcal vaccination rates among residents and staff in Canadian long-term care facilities have increased over the last decade but remain suboptimal. Vaccination of residents and staff against influenza is associated with a reduced risk of influenza outbreaks. Amantadine is effective in controlling influenza outbreaks in long-term care facilities.
Stevenson
C G
CG
Department of Microbiology, Mount Sinai Hospital, University of Toronto, Toronto, Ont.
McArthur
M A
MA
Naus
M
M
Abraham
E
E
McGeer
A J
AJ
D000368:Aged; D000547:Amantadine / Q000627:therapeutic use; D000704:Analysis of Variance; D000998:Antiviral Agents / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks / Q000517:prevention & control* / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data / Q000639:trends; D006282:Health Personnel / Q000706:statistics & numerical data; D006707:Homes for the Aged; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control*; D016015:Logistic Models; D016272:Occupational Health / Q000706:statistics & numerical data; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology* / Q000517:prevention & control*; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D012866:Skilled Nursing Facilities; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends
D000998:Antiviral Agents; D000547:Amantadine