Immunization against Influenza and Pneumococcal Disease in Residents of Long Term Care Facilities

Immunization against influenza and pneumococcal disease in residents of long term care facilities I mmunization's contribution to the prevention, control and , occasionally, eradication of communicable diseases, such as smallpox globally and poliomyelitis in the western hemisphere, is beyond question. A recent meta-analysis of 20 cohort studies on the efficacy of the influenza vaccine in elderly, mostly institutionalized individuals came to a similar conclusion concerning the value of influenza vaccine (1 ). The studies demonstrated that vaccination prevented hospitalization for pneumonia (33% to 45% vaccine efficacy), hospital deaths from pneumonia and influenza (31 % to 65%) and hospital death from all respiratory conditions (43% to 50%). Nevertheless , despite the impressive accumulated evidence of influenza vaccine efficacy, many individuals who are at high risk for influenzaand pneumococcal-related morbidity and mortality are not immunized. As a result, improving influenza and pneumococcal vaccine uptake has emerged as one of the most important challenges we face in contemporary adult immunization. Although influenza immunization coverage rates of Canadians at high risk for influenza morbidity or mortality are still lower than proclaimed target levels, immunization against this recurring epidemic in Canada has increased progressively, and impressively: from 1980 to 1992 influenza vaccine distribution increased from 32 to 140 doses per 1000 population (2). This rate was only exceeded in the United States and France where 145 and 175 doses per 1000 population, respectively, were distributed. In 1991 and 1992, the Canadian Omnibus Survey, a door-to-door survey of a modified probability sample of the general population, determined that 11% (95% CI 10 to 13) of the population 18 years of age or older stated they received influenza vaccine (3). This yields a calculated vaccine uptake rate of 110 (100 to 130) doses per 1000, a figure similar to Fedson 's estimate of 140 doses per 1000 (1). Among noninstitutionalized persons, the survey determined that 43% of individuals 65 years of age or older reported receiving influenza vaccine in the preceding year. This , however, is still substan-