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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.
Abstract: Pneumonia 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.

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01 Jan 2017
TL;DR: National recommendations for inpatient vaccination against influenza and pneumococcal disease are not being followed for the vast majority of eligible Medicare patients admitted to the hospital.
Abstract: Results: Of the 104976 patients with a single hospitalization, 35 169 (33.5%; 95% confidence interval [CI], 33.2%-33.8%) received pneumococcal vaccination prior to admission, 444 (0.4%; 95% CI, 0.4%-0.5%) were vaccinated in the hospital, and 1076 (1.0%; 95% CI, 1.0%1.1%) were vaccinated within 30 days of discharge. In the subgroup of 40488 patients discharged from October through December, 12782 (31.6%; 95% CI, 31.1%32.0%) received influenza vaccination prior to admission, 755 (1.9%; 95% CI, 1.7%-2.0%) were vaccinated in the hospital, and 4302 (10.6%; 95% CI, 10.3%-10.9%) were vaccinated after discharge. Of patients who were unvaccinated prior to admission, 97.3% (95% CI, 97.1%97.5%) did not receive influenza vaccine and 99.4% (95% CI, 99.3%-99.4%) did not receive pneumococcal vaccine before hospital discharge. Conclusion: National recommendations for inpatient vaccination against influenza and pneumococcal disease are not being followed for the vast majority of eligible Medicare patients admitted to the hospital. Arch Intern Med. 2002;162:2349-2356
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01 Dec 2016
TL;DR: This project measures the influence of influenza vaccinations on Armenian Armed Forces personnel readiness and a cost-benefit analysis of the flu vaccination would assess whether conducting flu vaccination is expedient.
Abstract: : This project measures the influence of influenza vaccinations on Armenian Armed Forces personnel readiness. In the Republic of Armenia, neither the Ministry of Health nor the Military Medical Service of the Armed Forces conducts flu vaccinations. The flu is always highly prevalent in the Armenian Armed Forces personnel morbidity ranking. An analysis of flu morbidity data from 2006 to 2014 reveals how Armed Forces personnel readiness was affected. Preventive activities are likely beneficial in countries such as Armenia that have low economic development, where inpatient treatment costs are relatively low, where insurance companies and health care providers are still under development, and where population health care expenditures pose a heavy burden on the government. A cost-benefit analysis of the flu vaccination would assess whether conducting flu vaccination is expedient.
References
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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...

968 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.

765 citations

Journal ArticleDOI
TL;DR: In this paper, the authors present 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.

624 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

470 citations