scispace - formally typeset

Journal ArticleDOI

Hospital-based influenza and pneumococcal vaccination: Sutton's Law applied to prevention.

01 Nov 2000-Infection Control and Hospital Epidemiology (Infect Control Hosp Epidemiol)-Vol. 21, Iss: 11, pp 692-699

TL;DR: This commentary will address the following six issues: the epidemiological rationale for hospitalbased influenza and pneumococcal vaccination; the translation of these epidemiological findings into clinical and public policy; changes in the scientific understanding of the benefits of influenza and pneumoniae vaccination; experience in implementing hospitalbased programs for vaccination; practical issues for hospital-based vaccination; and an enhanced role for infection control practitioners in ensuring that Sutton’s Law for influenza and lung cancer vaccination is followed.

AbstractPneumonia and influenza continue to be two of the major causes of hospitalization and death throughout the world. It is fitting that this issue of the Journal is devoted to addressing these important topics. Many of these cases are caused by influenza virus and Streptococcus pneumoniae and could be prevented if the delivery of influenza and pneumococcal vaccines were more effectively targeted to those individuals who are otherwise destined to be hospitalized or to die due to one of these diseases. That persons with vaccine-preventable influenza and pneumococcal infections are still admitted to our hospitals is a sobering reminder that there still is important work to do. Early in their education, virtually all medical students are taught the importance of following Sutton’s Law in formulating a differential diagnosis. Sutton’s Law is based on the remark made by the notorious bank robber, Willie Sutton. When asked why he robbed banks, he replied, “That’s where the money is.” In formulating a differential diagnosis, the student is advised to think first of common problems, not rare diseases. More often than not, diagnosing a common problem is “where the money is.” Sutton’s Law also can be applied to the prevention of influenza and pneumococcal infections. In this instance, the question asked is, “What is the best vaccination strategy for reaching people who, if not vaccinated, will have the greatest likelihood of being hospitalized or dying of these two diseases?” The answer is patients who are being discharged from the hospital. Hospital-based influenza and pneumococcal vaccination is “where the money is.” In this commentary, we will address the following six issues: (1) the epidemiological rationale for hospitalbased influenza and pneumococcal vaccination; (2) the translation of these epidemiological findings into clinical and public policy; (3) changes in the scientific understanding of the benefits of influenza and pneumococcal vaccination; (4) experience in implementing hospitalbased programs for vaccination; (5) practical issues for hospital-based vaccination; and (6) an enhanced role for infection control practitioners in ensuring that Sutton’s Law for influenza and pneumococcal vaccination is followed.

Topics: Sutton's law (54%), Vaccination (51%)

...read more

Content maybe subject to copyright    Report

Citations
More filters

Journal Article
TL;DR: This report updates the 2000 recommendations by the Advisory Committee on Immunization Practices on the use of influenza vaccine and antiviral agents with new or updated information regarding the cost-effectiveness of influenza vaccination and the 2001-2002 trivalent vaccine virus strains.
Abstract: This report updates the 2002 recommendations by the Advisory Committee on Immunization Practices (ACIP) on the use of influenza vaccine and antiviral agents (CDC. Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2002;51 [No. RR-3]:1-31). The 2003 recommendations include new or updated information regarding 1) the timing of influenza vaccination by age and risk group; 2) influenza vaccine for children aged 6-23 months; 3) the 2003-2004 trivalent inactivated vaccine virus strains: A/Moscow/10/99 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like, and B/Hong Kong/330/2001-like antigens (for the A/Moscow/10/99 [H3N2]-like antigen, manufacturers will use the antigenically equivalent A/Panama/2007/99 [H3N2] virus, and for the B/Hong Kong/330/2001-like antigen, manufacturers will use either B/Hong Kong/330/2001 or the antigenically equivalent B/Hong Kong/1434/2002); 4) availability of certain influenza vaccine doses with reduced thimerosal content, including single 0.25 mL-dose syringes; and 5) manufacturers of influenza vaccine for the U.S. market. Although the optimal time to vaccinate against influenza is October and November, vaccination in December and later continues to be strongly recommended A link to this report and other information regarding influenza can be accessed at http://www.cdc.gov/ncidod/diseases/flu/fluvirus.htm.

5,294 citations


Journal Article
TL;DR: This report updates the 2008 recommendations by CDC's Advisory Committee on Immunization Practices regarding the use of influenza vaccine for the prevention and control of seasonal influenza and includes a summary of safety data for U.S. licensed influenza vaccines.
Abstract: This report updates the 2009 recommendations by CDC's Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine for the prevention and control of influenza (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2009;58[No. RR-8] and CDC. Use of influenza A (H1N1) 2009 monovalent vaccine---recommendations of the Advisory Committee on Immunization Practices [ACIP], 2009. MMWR 2009;58:[No. RR-10]). The 2010 influenza recommendations include new and updated information. Highlights of the 2010 recommendations include 1) a recommendation that annual vaccination be administered to all persons aged >or=6 months for the 2010-11 influenza season; 2) a recommendation that children aged 6 months--8 years whose vaccination status is unknown or who have never received seasonal influenza vaccine before (or who received seasonal vaccine for the first time in 2009-10 but received only 1 dose in their first year of vaccination) as well as children who did not receive at least 1 dose of an influenza A (H1N1) 2009 monovalent vaccine regardless of previous influenza vaccine history should receive 2 doses of a 2010-11 seasonal influenza vaccine (minimum interval: 4 weeks) during the 2010--11 season; 3) a recommendation that vaccines containing the 2010-11 trivalent vaccine virus strains A/California/7/2009 (H1N1)-like (the same strain as was used for 2009 H1N1 monovalent vaccines), A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens be used; 4) information about Fluzone High-Dose, a newly approved vaccine for persons aged >or=65 years; and 5) information about other standard-dose newly approved influenza vaccines and previously approved vaccines with expanded age indications. Vaccination efforts should begin as soon as the 2010-11 seasonal influenza vaccine is available and continue through the influenza season. These recommendations also include a summary of safety data for U.S.-licensed influenza vaccines. These recommendations and other information are available at CDC's influenza website (http://www.cdc.gov/flu); any updates or supplements that might be required during the 2010-11 influenza season also will be available at this website. Recommendations for influenza diagnosis and antiviral use will be published before the start of the 2010-11 influenza season. Vaccination and health-care providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information.

1,629 citations


Cites background from "Hospital-based influenza and pneumo..."

  • ...0 per child, 55% of all visits during the final year of the study still represented a missed vaccination opportunity (342)....

    [...]


Journal Article
TL;DR: This report summarizes recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP) concerning influenza vaccination of health-care personnel (HCP) in the United States.
Abstract: This report summarizes recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP) concerning influenza vaccination of health-care personnel (HCP) in the United States. These recommendations apply to HCP in acute care hospitals, nursing homes, skilled nursing facilities, physician's offices, urgent care centers, and outpatient clinics, and to persons who provide home health care and emergency medical services. The recommendations are targeted at health-care facility administrators, infection-control professionals, and occupational health professionals responsible for influenza vaccination programs and influenza infection-control programs in their institutions. HICPAC and ACIP recommend that all HCP be vaccinated annually against influenza. Facilities that employ HCP are strongly encouraged to provide vaccine to their staff by using evidence-based approaches that maximize vaccination rates.

550 citations


Cites background from "Hospital-based influenza and pneumo..."

  • ...Vaccination of senior medical staff or opinion leaders has been associated with higher vaccination acceptance among staff members under their leadership (55,69,72,73)....

    [...]


Journal ArticleDOI
26 Aug 2016
TL;DR: In light of concerns regarding low effectiveness against influenza A(H1N1)pdm09 in the United States during the 2013-14 and 2015-16 seasons, ACIP makes the interim recommendation that live attenuated influenza vaccine (LAIV4) should not be used.
Abstract: This report updates the 2015-16 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines (Grohskopf LA, Sokolow LZ, Olsen SJ, Bresee JS, Broder KR, Karron RA. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices, United States, 2015-16 influenza season. MMWR Morb Mortal Wkly Rep 2015;64:818-25). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. For the 2016-17 influenza season, inactivated influenza vaccines (IIVs) will be available in both trivalent (IIV3) and quadrivalent (IIV4) formulations. Recombinant influenza vaccine (RIV) will be available in a trivalent formulation (RIV3). In light of concerns regarding low effectiveness against influenza A(H1N1)pdm09 in the United States during the 2013-14 and 2015-16 seasons, for the 2016-17 season, ACIP makes the interim recommendation that live attenuated influenza vaccine (LAIV4) should not be used. Vaccine virus strains included in the 2016-17 U.S. trivalent influenza vaccines will be an A/California/7/2009 (H1N1)-like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008-like virus (Victoria lineage). Quadrivalent vaccines will include an additional influenza B virus strain, a B/Phuket/3073/2013-like virus (Yamagata lineage).Recommendations for use of different vaccine types and specific populations are discussed. A licensed, age-appropriate vaccine should be used. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended product is otherwise appropriate. This information is intended for vaccination providers, immunization program personnel, and public health personnel. Information in this report reflects discussions during public meetings of ACIP held on October 21, 2015; February 24, 2016; and June 22, 2016. These recommendations apply to all licensed influenza vaccines used within Food and Drug Administration-licensed indications, including those licensed after the publication date of this report. Updates and other information are available at CDC's influenza website (http://www.cdc.gov/flu). Vaccination and health care providers should check CDC's influenza website periodically for additional information.

476 citations


Journal ArticleDOI
25 Mar 2008-Vaccine
TL;DR: A concerted effort to increase provider adoption of standards for adult immunization, public awareness, and stable vaccine supplies is needed to improve influenza vaccination rates among recommended groups, and to reduce racial and ethnic disparities.
Abstract: Summary Objective To assess influenza vaccination coverage among recommended adult populations in the United States. Methods Data from the 1989 to 2005 National Health Interview Surveys (NHISs), weighted to reflect the civilian, non-institutionalized U.S. population, were analyzed to determine self-reported levels of influenza vaccination among persons aged ≥65 years, persons with high-risk conditions, health care workers (HCW), pregnant women, and persons living in households with at least one identified person at high risk of complications from influenza infection. We stratified data by race/ethnicity to identify racial/ethnic disparities. Results Vaccination coverage levels among all recommended adult populations peaked in 2004, then declined in 2005 in association with the 2004–2005 vaccine shortage. Coverage for adults ≥65 years of age increased from 30.1% (95% confidence interval [CI]: 28.8–31.3) in 1989 to 70.0% (68.0–71.5) in 2004. In 2004, coverage was 40.7% (39.0–42.5) for all adults 50–64 years, 27.2% (24.6–29.9) for adults aged 18–49 years with high-risk conditions, 43.2% (39.9–46.6) for health care workers, 21.1% (19.1–23.4) for non-high-risk adults aged 18–64 years with a high-risk household member, and 14.4% (8.8–22.9) for pregnant women. Among each of the recommended adult sub-groups, vaccination coverage was higher for non-Hispanic whites compared to minority groups. Conclusions By 1997, influenza vaccination coverage had exceeded the national 2000 objective of 60% among persons aged ≥65 years, but by 2004 still remains well below the national 2010 target of 90%. Coverage levels for other groups targeted for influenza vaccination also are far short of the Healthy People 2000 and 2010 goals of 60% for persons aged 18–64 years with high-risk conditions, health care workers, and pregnant women. A concerted effort to increase provider adoption of standards for adult immunization, public awareness, and stable vaccine supplies are needed to improve influenza vaccination rates among recommended groups, and to reduce racial and ethnic disparities.

176 citations


References
More filters

Journal ArticleDOI
TL;DR: For elderly citizens living in the community, vaccination against influenza is associated with reductions in the rate of hospitalization and in deaths from influenza and its complications, as compared with the rates in unvaccinated elderly persons, and vaccination produces direct dollar savings.
Abstract: Background Despite recommendations for annual vaccination against influenza, more than half of elderly Americans do not receive this vaccine. In a serial cohort study, we assessed the efficacy and cost effectiveness of influenza vaccine administered to older persons living in the community. Methods Using administrative data bases, we studied men and women over 64 years of age who were enrolled in a large health maintenance organization in the Minneapolis-St. Paul area. We examined the rate of vaccination and the occurrence of influenza and its complications in each of three seasons: 1990-1991, 1991-1992, and 1992-1993. Outcomes were adjusted for age, sex, diagnoses indicating a high risk, use of medications, and previous use of health care services. Results Each cohort included more than 25,000 persons 65 years of age or older. Immunization rates ranged from 45 percent to 58 percent. Although the vaccine recipients had more coexisting illnesses at base line than those who did not receive the vaccine, duri...

957 citations


Book
01 Jan 1997
TL;DR: The role of the hospital epidemiologist in protecting the environment laboratory-acquired infections infectious biohazards associated with laboratory animal research nosocomial infections related to patient care support and protection from blood and blood products.
Abstract: Section 1 Perspectives: the control of infections in hospitals - 1750-1950 cost-effectiveness and cost-benefit analysis in infection control the modern infection control practitioner heath care reform and the hospital epidemiologist in the US. Section 2 Management: regulatory, accreditation, and professional agencies influencing infection control programs controversies in isolation policies and practices organizing for infection control with limited resources microbiology: the role of the clinical laboratory health psychology. Section 3 Epidemiology methods: surveillance, reporting and use of computers what to do about high endemic rates of infection epidemics: identification and management design and analytical issues in studies of infectious diseases statistics in infection control studies. Section 4 Special locations: outpatient/out of hospital care issues infection contra issues in same-day surgery extended care facilities. Section 5 Special problems: the threat of antibiotic resistance optimal use of antibiotics multidrug resistant enterococci and the threat of vancomycin-resistant staphylococcus aurous epidemiology of nosocomial tuberculosis. Section 6 Protecting employees: protecting employees from injury and infection management of exposures to infections. Section 7 Environmental issues: hospital environment for high-risk patients environment issues and nosocomial infections the operating theatre: a special environment area disinfection, sterilization and waste disposal the hospital and pollution: role of the hospital epidemiologist in protecting the environment laboratory-acquired infections infectious biohazards associated with laboratory animal research nosocomial infections related to patient care support. Section 8 Preventing specific infections: handwashing, hand disinfestation, and skin disinfestation nosocomial blood stream infections IV-related infections nosocomial pneumonia urinary tract infections surgical infections including burns perioperative antibiotic prophylaxis infection in implantable prosthetic devices nosocomial gastrointestinal infections uncommon infections of the eye prevention and control of nosocomial infections in obstetrics and gynaecology. Section 9 Special patients: infection in the newborn the paediatric patient the elderly solid-organ transplant patients bone marrow transplant patients the AIDS patient protecting recipients from blood and blood products.

763 citations


Journal ArticleDOI
Abstract: Background: This paper presents the results of systematic reviews of the effectiveness, applicability, other effects, economic impact, and barriers to use of selected population-based interventions intended to improve vaccination coverage. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis for recommendations by the Task Force on Community Preventive Services (the Task Force) regarding the use of these selected interventions. The Task Force recommendations are presented on pp. 92–96 of this issue.

608 citations


Journal ArticleDOI

559 citations


Journal ArticleDOI
TL;DR: It is confirmed that healthy senior citizens as well as senior citizens with underlying medical conditions are at risk for the serious complications of influenza and benefit from vaccination.
Abstract: Background: Vaccination rates for healthy senior citizens are lower than those for senior citizens with underlying medical conditions such as chronic heart or lung disease. Uncertainty about the benefits of influenza vaccination for healthy senior citizens may contribute to lower rates of utilization in this group. Objective: To clarify the benefits of influenza vaccination among low-risk senior citizens while concurrently assessing the benefits for intermediate- and high-risk senior citizens. Methods: All elderly members of a large health maintenance organization were included in each of 6 consecutive study cohorts. Subjects were grouped according to risk status: high risk (having heart or lung disease), intermediate risk (having diabetes, renal disease, stroke and/or dementia, or rheumatologic disease), and low risk. Outcomes were compared between vaccinated and unvaccinated subjects after controlling for baseline demographic and health characteristics. Results: There were more than 20 000 subjects in each of the 6 cohorts who provided 147 551 person-periods of observation. The pooled vaccination rate was 60%. There were 101 619 person-periods of observation for low-risk subjects, 15 482 for intermediate-risk, and 30 450 for highrisk subjects. Vaccination over the 6 seasons was associated with an overall reduction of 39% for pneumonia hospitalizations (P,.001), a 32% decrease in hospitalizations for all respiratory conditions (P,.001), and a 27% decrease in hospitalizations for congestive heart failure (P,.001). Immunization was also associated with a 50% reduction in all-cause mortality (P,.001). Within the risk subgroups, vaccine effectiveness was 29%, 32%, and 49% for high-, intermediate-, and low-risk senior citizens for reducing hospitalizations for pneumonia and influenza (for high and low risk, P#.002; for intermediate risk, P = .11). Effectiveness was 19%, 39%, and 33% (for each, P#.008), respectively, for reducing hospitalizations for all respiratory conditions and 49%, 64%, and 55% for reducing deaths from all causes (for each, P,.001). Vaccination was also associated with direct medical care cost savings of $73 per individual vaccinated for all subjects combined (P = .002). Estimates of cost savings within each risk group suggest that vaccination would be cost saving for each subgroup (range of cost savings of $171 per individual vaccinated for high risk to $7 for low risk), although within the subgroups these findings did not reach statistical significance (for each, P$.05). Conclusions: This study confirms that healthy senior citizens as well as senior citizens with underlying medical conditions are at risk for the serious complications of influenza and benefit from vaccination. All individuals 65 years or older should be immunized with this vaccine. Arch Intern Med. 1998;158:1769-1776

458 citations