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

Background: Influenza and pneumococcal pneumonia are serious health problem s among elderly people and a major cause of death in long-term care facilit ies. We describe the results of serial surveys of vaccination coverage and influenza outbreak management in Canadian long-term care facilities over th e 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% am ong residents and 35% among staff, and the mean rate of pneumococcal vaccin ation among residents was 71%; all 3 rates were significantly higher than t hose in 1991. The rates were also higher in facilities with an infection co ntrol practitioner than in those without such an individual (88% v. 82% for influenza vaccination among residents [p < 0.001], 42% v. 35% for influenz a vaccination among staff [p = 0.008] and 75% v. 63% for pneumococcal vacci nation among residents [p < 0.001]). Obtaining consent for vaccination on a dmission to the facility was associated with higher influenza and pneumococ cal vaccination rates among residents (p = 0.04 and p < 0.001 respectively) . Facilities with higher influenza vaccination rates among residents and st aff reported lower rates of influenza outbreaks (p = 0.08 and 0.03 respecti vely). Despite recommendations from the National Advisory Committee on Immu nization, only 50% of the facilities had policies for amantadine prophylaxi s during influenza A outbreaks. Amantadine was judged effective in controll ing 76% of the influenza A outbreaks and was discontinued because of side e ffects in 3% of the residents. Interpretation: Influenza and pneumococcal vaccination rates among resident s and staff in Canadian long-term care facilities have increased over the l ast decade but remain suboptimal. Vaccination of residents and staff agains t influenza is associated with a reduced risk of influenza outbreaks. Amant adine is effective in controlling influenza outbreaks in long-term care fac ilities.