Skip to main content Accessibility help
×
Home

Influenza Immunization in Nursing Homes: Who Does Not Get Immunized and Whose Status Is Unknown?

  • Jill A. Marsteller (a1), Ronald Tiggle (a1), Robin Remsburg (a1), Abigail Shefer (a2) and Barbara Bardenheier (a2)...

Abstract

Objective.

To identify nursing home resident and facility characteristics associated with patients not receiving influenza immunization and having unknown immunization status.

Design.

Secondary data analysis using multinomial logistic regression of data from the National Nursing Home Survey, a nationally representative establishment-based survey.

Setting.

A total of 1,423 nursing facilities of all ownerships and certifications systematically sampled with probability proportional to number of beds.

Patients.

A total of 7,350 randomly sampled people aged 65 years or older residing in nursing homes between July and December 1999 (approximately 6 per facility).

Main Outcome Measure.

Immunization status of residents.

Results.

Fifteen percent of residents were not immunized and 19% had unknown immunization status. In multivariate analysis, lack of immunization and unknown immunization status were each separately associated with being newly admitted, with no or unknown pneumococcal immunization, and with facility failures to screen for immunization and to record inoculation in the medical record. High-risk status and staff immunization requirements had no effect. Separate analyses showed that residents with unknown immunization status are statistically significantly different from both those vaccinated and those not vaccinated.

Conclusion.

This study indicates that both resident and facility characteristics are associated with failure to be immunized for influenza. Facilities should consider targeting younger, newly admitted, and residential care residents for influenza immunization, since they are more likely to be missed. Further research into the barriers to immunization specific to nursing home resident choice or opportunity may be warranted.

Copyright

Corresponding author

Division of Health Care Statistics, National Center Health Statistics, 3311 Toledo Road, Room 3312, Hyattsville, MD 20782 (ble2@cdc.gov)

References

Hide All
1.Public health and aging: influenza vaccination coverage among adults aged 50 years and pneumococcal vaccination among adults aged 65 years—United States, 2002. MMWR Morb Mortal Wkly Rep 2003; 52:987992.
2.Evans, MR, Wilkinson, EJ. How complete is influenza immunization coverage? A study in 75 nursing and residential homes for elderly people. Br J Gen Pract 1995; 45:419421.
3.Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2004; 53:130.
4.Patriarca, PA, Weber, JA, Parker, RA, et al. Efficacy of influenza vaccine in nursing homes: reduction in illness and complications during an influenza A (H3N2) epidemic. JAMA 1985;253:11361139.
5.Christenson, B, Lunderbergh, P. Comparison between cohorts vaccinated and unvaccinated against influenza and pneumococcal infection. Epidemiol Infect 2002; 129:515524.
6.Bardenheier, B, Shefer, A, McKibben, L, Roberts, H, Bratzler, D. Characteristics of long-term–care facility residents associated with receipt of influenza and pneumococcal vaccinations. Infect Control Hosp Epidemiol 2004; 25:946954.
7.Stevenson, CG, McArthur, MA, Naus, M, Abraham, E, McGeer, AJ. Prevention of influenza and pneumococcal pneumonia in Canadian long-term care facilities: how are we doing? CMAJ 2001; 164:14131419.
8.McArthur, MA, Simor, AE, Campbell, B, McGeer, A. Influenza vaccination in long-term care facilities: structuring programs for success. Infect Control Hosp Epidemiol 1999; 20:499503.
9.Russell, ML. Influenza vaccination in Alberta long-term care facilities. CMAJ 2001; 164:14231427.
10.Schluter, WW, Ralston, DL, Delaney, RJ, Sauaia, A, Dunn, TR. Increasing influenza and pneumococcal vaccination and tuberculosis screening among residents of Colorado long-term care facilities. Eval Health Prof 1999; 22:466483.
11.Nichol, KL, Grimm, MB, Peterson, DC. Immunizations in long-term care facilities: policies and practice. J Am Geriatr Soc 1996; 44:349355.
12.Arden, N, Monto, AS, Ohmit, SE. Vaccine use and the risk of outbreaks in a sample of nursing homes during an influenza epidemic. Am J Public Health 1995; 85:399401.
13.Nowalk, MP, Zimmerman, RK, Feghali, J. Missed opportunities for adult immunization in diverse primary care office settings. Vaccine 2004; 22:34573463.
14.Zimmerman, RK, Nowalk, MP, Bardella, IJ, et al. Physician and practice factors related to influenza vaccination among the elderly. Am J Prev Med 2004; 26:110.
15.Nowalk, MP, Zimmerman, RK, Shen, S, Jewell, IK, Raymund, M. Barriers to pneumococcal and influenza vaccination in older community-dwelling adults (2000-2001). J Am Geriatr Soc 2004; 52:2530.
16.Zimmerman, RK, Santibanez, TA, Janosky, JE, et al. What affects influenza vaccination rates among older patients? an analysis from inner-city, suburban, rural, and Veterans Affairs practices. Am J Med 2003; 114:3138.
17.Centers for Disease Control and Prevention. Notice to readers: facilitating influenza and pneumococcal vaccination through standing orders programs. MMWR Morb Mortal Wkly Rep 2003; 52:6869.
18.Jessop, AB, Hausman, AJ. Pneumococcal vaccination in Pennsylvania nursing homes: factors associated with vaccination level. J Am Med Dir Assoc 2002; 3:347351.
19.Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2001; 50:144.
20.Deguchi, Y, Tagasuki, Y. Efficacy of influenza vaccine in the elderly: reduction in risks of mortality and morbidity during an influenza A (H3N2) epidemic for the elderly in nursing homes. Int J Clin Lab Res 2000; 30:14.
21.Janssens, JP, Krause, KH. Pneumonia in the very old. Lancet Infect Dis 2004; 4:112124.
22.Marrie, TJ, Slayter, KL. Nursing home-acquired pneumonia: treatment options. Drugs Aging 1996; 8:338348.
23.Buikema, AR, Singleton, JA, Sneller, VP, Strikas, RA. Influenza and pneumococcal vaccination in nursing homes, U.S. 1995-1999 [abstract]. In: Program and abstracts of the 35th National Immunization Conference; Atlanta, Georgia; 2001.
24.US Department of Health and Human Services. With understanding and improving health and objectives for improving health, volume 1. In: Healthy People 2010. 2nd ed. Washington, DC: US Dept of Health and Human Services; November 2000.
25.Carroll, NV, Delafuente, JC, McCLure, KL, Weakley, DF, Khan, ZM, Cox, FM. Economic burden of influenza-like illness in long-term care facilities. Am J Health Syst Pharm 2001; 58:11331138.
26.Jones, A. The National Nursing Home Survey: 1999 summary. Vital Health Stat 13.> 2002; 152:1116.
27.NCHS National Nursing Home Survey. Available at http://www.cdc.gov/nchs/about/major/nnhsd/nnhsd.htm. Accessed November 28, 2003.
28.National Immunization Program. Adult Clinic Assessment Software Application (ACASA) User Tools, Department of Health and Human Services, Centers for Disease Control and Prevention, National Immunization Program, Immunization Services Division, Health Services Research and Evaluation Branch, November 5, 2003, pp. 2325. Available at http://www.cdc.gov/nip/casa/acasa/a_userguide/acasa_ usertools301.pdf. Accessed September 19, 2005.
29.SAS [computer program]. Version 8.02. Cary, NC: SAS Institute Inc; 2001.
30.Shah, BV. Software for Survey Data Analysis (SUDAAN) [computer program]. Version 8.0. Research Triangle Park, NC: Research Triangle Institute; 2001.
31.Long, JS. Regression Models for Categorical and Limited Dependent Variables. Thousand Oaks, CA: Sage Publications Inc; 1997:162163.
32.McArthur, MA, Simor, AE, Campbell, B, McGeer, A. Influenza and pneumococcal vaccination and tuberculin skin testing programs in long-term care facilities: where do we stand? Infect Control Hosp Epidemiol 1995; 16:1824.
33.Santibanez, TA, Nowalk, MP, Zimmerman, RK, et al. Knowledge and beliefs about influenza, pneumococcal disease, and immunizations among older people. J Am Geriatr Soc 2002; 50:17111716.
34.Zimmerman, RK, Silverman, M, Janosky, JE, et al. A comprehensive investigation of barriers to adult immunization: a methods paper. J Fam Pract 2001; 50:703.
35.Armstrong, K, Berlin, M, Schwartz, JS, Propert, K, Ubel, PA. Educational content and the effectiveness of influenza vaccination reminders. J Gen Intern Med 1999; 14:695698.
36.Dunn, MK, Misra, S, Habermann, R, Griffin, MR. Pneumococcal vaccination in nursing homes: does policy change practice? J Am Med Dir Assoc 2003;4:135138.
37.Stevenson, KB, McMahon, JW, Harris, J, Hillman, JR, Helgerson, SD. Increasing pneumococcal vaccination rates among residents of long-term–care facilities: provider-based improvement strategies implemented by peer-review organizations in four western states. Infect Control Hosp Epidemiol 2000; 21:705710.
38.Centers for Disease Control and Prevention. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 1997; 46:124.
39.Centers for Disease Control and Prevention. Immunization Registry Progress Report. MMWR Morb Mortal Wkly Rep 2002; 51:760762.

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed