Prevention of influenza and pneumococcal pneumonia in Canadian long-term care facilities: how are we doing?

Abstract

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.

Interpretation: 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.

Fig. 1: Influenza and pneumococcal vaccination rates among residents and staff in Canadian long-term care facilities reported in 1991, 1995 and 1999. Quantitative data on pneumococcal vaccination rates and staff influenza vaccination rates were not collected in 1991.

Fig. 2: Influenza (black bars) and pneumococcal (dark and light grey bars) vaccination rates among residents reported in 1999, by province. Dark grey bars = provinces with publicly funded pneumococcal vaccination programs for residents of long-term care facilities introduced before 1998; light grey bars = provinces with programs introduced in 1998 or later.

Fig. 3: Influenza vaccination rates among staff in long-term care facilities for the 1998/99 influenza season, by province.

Fig. 4: Proportion of long-term care facilities reporting an influenza outbreak in the 1998/99 influenza season, by vaccination rates among residents and by size of facility.

Fig. 5: Proportion of long-term care facilities reporting an influenza outbreak in the 1998/99 influenza season, by staff vaccination rates and by size of facility.