Vaccine-preventable diseases can lead to severe or prolonged illness, hospitalization, and death in older adults, particularly in those who have not received the appropriate vaccinations. The most common illnesses are influenza and pneumococcal disease, but older adults are at risk for other vaccine-preventable illnesses as well, including Herpes Zoster (shingles). Researchers estimate the cumulative costs of vaccine-preventable diseases in this population could be more than a trillion dollars over the next 30 years, and over a million deaths.
The flu is an acute respiratory illness caused primarily by one of two influenza viruses — Influenza A or B. Influenza epidemics typically occur during late fall through early spring, and most cases are due to Influenza A infection. People aged 65 and older are especially vulnerable to serious complications, and approximately 90 percent of all influenza-related deaths occur in this age group. People living in nursing facilities are at higher risk for complications because of chronic medical conditions, living in a closed environment and having less responsive immune systems.
Influenza is spread through close contact, droplet and sometimes air-borne transmission (e.g., sneezing, coughing and a runny nose). The incubation period is generally one to four days, but on average two days from the time of infection. People can be contagious up to 24 hours before symptoms begin, and for five to seven days after the onset of illness.
Immunization is the cornerstone of influenza control. Anyone living or working in a nursing facility should receive the flu vaccine each year, unless specifically contraindicated. Antiviral medications may be used to prevent infection and for treatment purposes; however, they are not a substitute for immunization.
Pneumonia is a common infection and a major cause of illness, hospitalization and death in people living in nursing facilities. It is especially common in winter and early spring when respiratory diseases are prevalent. The most common cause of bacterial pneumonia is streptococcus pneumoniae. Pneumococcal disease spreads from person to person by coughing, sneezing or close contact.
The pneumococcal vaccine should be administered routinely to anyone living in a nursing facility, regardless of age. People whose vaccination status is unknown should be vaccinated as well. Specific recommendations and the vaccine used will depend on the age of the person, and any underlying health conditions.
Herpes Zoster (Shingles)
Around one in three people in the US will develop shingles, in their lifetime. Anyone who has had chickenpox is at risk for developing shingles. Other risk factors include advanced age, a weakened immune system, and even stress. While most people will get shingles only once, it is possible for it to recur.
Shingles develops when the dormant chickenpox virus reactivates later in life. Pain, itching, and/or tingling are often the first symptoms, followed by a rash and blisters. Most cases resolve within three to five weeks, but some people experience long-term complications such as post-herpetic neuralgia - severe pain that can impact their daily lives.
The CDC recommends the shingles vaccine for all adults aged 50 and older. The shingles vaccine can reduce the risk of developing the disease by 50% to 90%. If someone develops shingles after being vaccinated, their risk of developing post-herpetic neuralgia is reduced and generally the course of the disease is less severe.
Tetanus, Diphtheria and Pertussis
The CDC recommends everyone be vaccinated against tetanus, diphtheria, and pertussis, including people living in nursing facilities. Adults who have not been vaccinated previously should receive:
- An initial dose of the Tdap
- A Tdap or Td booster every 10 years thereafter
Boostrix® is recommended for the booster vaccinations for people over the age of 65, but any available vaccine may be used.
Resources Created by HHS Quality Monitoring Program
Immunization Resources Handout (PDF) provides links to additional resources for immunization practices that will be helpful to nursing facility staff.
Sample centralized logs for tracking immunizations. Centralized immunization logs allow facilities to quickly respond to an outbreak, identify people who need anti-viral prophylaxis, or those who still need to be vaccinated. In addition, a centralized tracking system will allow staff to readily identify the vaccine serum lot numbers of the vaccines given in the event of a recall.
Centralized log for employee influenza vaccinations (Excel format)
Centralized log for influenza vaccinations (Excel format)
Centralized log for Pneumococcal vaccinations (Excel format)
Resources from the Centers for Disease Control and Prevention (CDC)
- Recommended Immunizations for Adults by Age (PDF) lists the current recommendations for adult immunizations by age and medical condition.
Vaccine Information Statements (VIS) provide information about the risks and benefits of vaccines. Vaccine providers are required to provide the appropriate VIS to anyone receiving certain vaccines or their legal representative before the vaccines are given, including the seasonal influenza vaccine.
Influenza (Flu) provides links to information about flu basics, the prevention and treatment of influenza, and a variety of educational resources for healthcare professionals and patients.
Free Resources includes a variety of educational materials, addressing current recommendations for preventing influenza.
Pneumococcal Vaccination provides information to healthcare professionals about pneumococcal disease and the pneumococcal vaccines that are current available.
Shingles Vaccination provides information to healthcare professionals about shingles and the available vaccines.
Diphtheria, Tetanus and Pertussis Vaccine Recommendations provides healthcare professionals with a summary of the recommendations for vaccination of all age groups.
Vaccine Adverse Event Reporting System (VAERS) is used to report adverse reactions following vaccination. Providers are required by federal law to report post-vaccination adverse events.
Hand Hygiene in Healthcare Settings provides healthcare professionals with a variety of resources about hand hygiene, including current recommendations from the CDC.
Resources from the Immunization Action Coalition (IAC)
Standing orders for Administering Vaccines This web page provides resources for developing standing orders and protocols for vaccine administration.
Standing Orders for Medical Management of Vaccine Reactions in Adults (PDF) provides guidance for managing adverse reactions related to vaccine administration, including the supplies and medications that may be needed.
- Declination of Flu Vaccine (PDF) can be used to ensure staff who decline vaccination have been informed of the risks associated with influenza and acknowledge receipt of that information.
- Vaccine Administration Record/Adults (PDF) provides a cumulative record of a person’s immunizations, and can help prevent accidental re-vaccination.
- Facts about Using Vaccine Information Statements (VISs) (PDF) outlines the federal requirements related to use of VISs, and when they should be provided.