Nancy H. Arden

GUIDELINE FOR PREVENTION OF NOSOCOMIAL PNEUMONIA

This Z-part document updates and replaces the previously published Centers for Disease Control and Prevention Guideline for Prevention of Nosocomial Pneumonia ( Infect Control 1982;3:327-33, Respir Care 1983;28:221-32, and Am J Infect Control 1983;11:230-44). The revised guideline is designed to reduce the incidence of nosocomial pneumonia and intended for use by personnel who are responsible for surveillance and control of infections in acute-care hospitals. The guideline may not be applicable in long-term care facilities because of the unique characteristics of these settings. The revised guideline addresses common problems encountered by infection control practitioners regarding the prevention and control of nosocomial pneumonia in U.S. hospitals. Sections on the prevention of bacterial pneumonia in tnechanically ventilated and/or critically ill patients, care of respiratory-therapy devices, prevention of cross-contamination, and prevention of viral lower respiratory tract infections, such as respiratory syncytial virus (RSV) and influenza infections, have been expanded and updated. New sections on Legionnaires disease and pneumonia due to Aspergillus spp. have been added. Lower respiratory tract infection due to Mycobacterium tuberculosis is not addressed in this document: it is covered in separate guidelines.

Immunogenicity and efficacy of Russian live attenuated and US inactivated influenza vaccines used alone and in combination in nursing home residents

The immunogenicity and efficacy of Russian live attenuated and US inactivated trivalent influenza vaccines administered alone or in three different combinations were evaluated in a randomized, placebo-controlled, double-blinded study of 614 elderly or chronically ill nursing home residents in St. Petersburg, Russia during the 1996-97 influenza season. Postvaccination serum antibody responses were more frequent among individuals administered the combination vaccines than among those vaccinated with live or inactivated vaccine alone. Only individuals who received live vaccine, alone or in combination with inactivated vaccine, achieved significant postvaccination increases in virus-specific nasal IgA. Efficacy in preventing laboratory-confirmed influenza in vaccinated versus nonvaccinated individuals was 67% (95%CI, 36-81%) for recipients of a combination of the vaccines compared with 51% (95%CI, -17-79%) for recipients of live vaccine alone and 50% (95%CI, -26-80%) for recipients of inactivated vaccine alone. These results suggest that administration of a combination of influenza vaccines may provide a strategy for improved influenza vaccination of elderly people.

Effectiveness of Inactivated Influenza Vaccine Among Nursing Home Residents During an Influenza Type A (H3N2) Epidemic

OBJECTIVES: To evaluate the use of influenza vaccine in nursing homes and its effectiveness in reducing the likelihood of influenza‐like illness.

Control of influenza outbreaks in the nursing home: guidelines for diagnosis and management.

A well coordinated plan that includes a mechanism for surveillance, rapid antigen detection testing and viral culture, infection control techniques and chemoprophylaxis is effective for aborting outbreaks of influenza A in the nursing home. Amantadine has been better studied in this situation, and experience with rimantadine is limited. The safety and efficacy of our dose guidelines for nursing home residents need to be studied and directly compared with rimantadine dose guidelines. Except for chemoprophylaxis, these guidelines can be applied to outbreaks of influenza B as well.

Policies and outcomes for control of influenza among the elderly in the USA

For about 20 years official recommendations have been made to provide influenza vaccine to elderly persons in the USA because they are high risk of complications if infected during epidemics. Residents of homes for the aged (Nursing Homes) are of particular concern and we have studied this subgroup in greater detail than before. A prospectively organized surveillance programme of about 7000 residents of more than 65 homes in several states indicated that vaccination rates varied from about 9 to 98%, with the average about 60%. Biases in vaccinating residents according to age and medical condition were not detected. Vaccine use was greatest when the policy of the homes was to administer vaccine without requesting consent of relatives. In separate studies of influenza A(H3N2) outbreaks in homes for the elderly during 1982/83, influenza vaccine was found to reduce influenza-associated mortality by about 75% although febrile respiratory illness rates were reduced less than 50%. The frequency of outbreaks was lowest in homes having fewest residents, and highest vaccination rates. Professional Educational Programmes are no being developed to assist homes for the elderly to improve the organization of their influenza vaccination activities in an attempt to further reduce influenza mortality.

Decreased antibody response among nursing home residents who received recalled influenza vaccine and results of revaccination, 1996-97

In November 1996, 11 lots of one U.S. manufacturers 1996-97 trivalent influenza vaccine were voluntarily recalled because of decreasing potency of the A/Nanchang/933/95 (H3N2) component. Because the elderly are at high risk of developing influenza-related complications, we assessed the postvaccination antibody titers of nursing home residents who received recalled vaccine and assessed the antibody response to revaccination. Blood samples were collected 3 weeks after vaccination from 86 residents at three nursing homes who received recalled vaccine and 86 residents at three other nursing homes who received a different manufacturers vaccine. Medical records were reviewed. Residents of one nursing home were later revaccinated. Blood samples were collected on the day of revaccination and again in 3 weeks. Serum was tested by hemagglutination inhibition for antibody to all three components of the 1996-97 influenza vaccine. The geometric mean antibody titer (GMT) (33 vs 55; p=0.01) and the percentage of residents with an antibody titer > or = 1:40 (52 vs 67%; p=0.04) to the A/Nanchang/933/95 component were lower among residents who received recalled vaccine compared to those who received non-recalled vaccine, but had similar GMTs against the other two vaccine components. After revaccination, the GMT to A/Nanchang/933/95 increased from 24 on the day of revaccination to 39 (p=0.01) in residents from one nursing home. Therefore, vaccination with the recalled vaccine was associated with lower postvaccination antibody titers to A/Nanchang/933/95, but not against the other two vaccine components. Revaccination was moderately effective in increasing antibody titers. With annual changes in influenza vaccine strains, routine post-release stability testing of influenza vaccine should continue.