Herman Chmel

Influence of physician's recommendation on influenza immunization: perception and acceptance among a group of institutionalized elderly

Abstract Elderly residents (201, mostly male ≥ 65 years old) from the VA nursing home care unit (NHCU) in Florida were surveyed by a questionnaire as to whether they had been voluntarily accepting influenza vaccine in the past and what factors had affected their decision. These veterans had an average length of stay at the NHCU of 12 months and ≥ 70% suffered from chronic diseases with a past history of smoking. Physician recommendation concerning immunization was found to be the most significant factor for vaccine compliance. Over half of the residents immunized within the past year could recall a physician personally giving a recommendation for vaccination. Among those not immunized during the year, 22% did not have yearly physicians recommendation and cited reasons such as unawareness of vaccine need, 20% disliked or feared the side effects and 14% lacked general motivation. These data indicate that physician intervention plays a strong role in the acceptance of influenza vaccination among hospitalized elderly veterans and appears to be more effective than the usual standing NHCU practice of vaccine offered by the nursing staff. The data also suggest that educational intervention measures may be beneficial, yet, not as effective as physicians intervention.

Fungal Infections in the Immunocompromised Host

Fungal infections are a major cause of morbidity and mortality in the immunocompromised host. In the last 25 years, the frequency of invasive fungal infections has increased remarkably. Unbiased data concerning the true incidence and prevalence of invasive fungal infections in different patient populations is limited. Hart et al.1 reported 132 invasive fungal infections in normal and immunocompromised patients. Seventy infections occurred in immunocompromised patients, 81% caused by Candida spp., Aspergillus spp., and Zygomycete spp. and 12% by Cryptococcus spp. In contrast, 62 invasive fungal infections occurred in normal patients, and none were caused by Candida, Aspergillus, or Zygomycete spp. Muller et al. 2 reported the following incidence of opportunistic deep-seated mycosis, candidiasis 92.6%; aspergillosis 6.7%; cryptococcosis 0.35%, and zygomycosis 0.35%. Rose and Varkey,3 in a comprehensive review of invasive fungal infections, reported per 10,000 hospital discharges the following rates: Candida spp. 7.08, Aspergillus spp. 1.4, and Zygomycete spp. 0.23. Data from the National Nosocomial Infection Surveillance Program (CDC)4 representing 1984 rates showed Candida spp. accounted for 5.5% of all isolates and was the eighth most common nosocomial pathogen. The category listed as “other fungi” accounted for 1.7% of all isolates and ranked 11th. Although data from autopsies are limited and selective, the relative frequency of invasive fungal infections in transplant and oncologic patients can be inferred by their review. The observed frequency of invasive fungal infections is 20–30% in patients with acute leukemia, 10–15% in patients with lymphoma, and 5% in patients with other malignancies.5 The frequency in organ transplant recipients is 28–42% for liver, 10–35% for heart, 2–30% for bone marrow, and 0–20% for kidneys.6 Overall invasive candidiasis accounted for death in 10–40% of patients and invasive aspergillosis in 5–15%.7