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.
Citations
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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.
5,334 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.
1,659 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)....
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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.
559 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)....
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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.
508 citations
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.
179 citations
References
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TL;DR: In addition to age and underlying medical condition, previous hospital care can help to define high-risk individuals for pneumococcal immunization and the results suggest that hospitals should assume a major role in the prevention of serious pneumococCal infections.
Abstract: • At the University of Chicago Hospitals and Clinics (UCHC), 60% of 126 patients who survived, and 70% of 40 patients who died with pneumococcal bacteremia had been discharged at least once within the previous five years. The experience of 39 patients with bacteremia at the Mary Imogene Bassett Hospital, Cooperstown, NY, was similar. There were 144 UCHC patients with high-risk conditions. In 69%, these conditions were evident on an earlier hospital admission. In contrast, only two of 22 UCHC patients without high-risk conditions had been previously discharged. In addition to age and underlying medical condition, previous hospital care can help to define high-risk individuals for pneumococcal immunization. The results also suggest that hospitals should assume a major role in the prevention of serious pneumococcal infections. ( Arch Intern Med 1983;143:885-889)
49 citations
"Hospital-based influenza and pneumo..." refers background or result in this paper
...In the US case study, 60% of 126 teaching hospital patients with pneumococcal bacteremia who survived and 70% of those who died had been discharged within the previous 5 years.(5) Similar rates were found among 39 bacteremia patients in the community hospital....
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...The epidemiological rationale for hospital-based pneumococcal vaccination also emerged in the early 1980s from a population-based study conducted in Oxfordshire in the United Kingdom(4) and a series of cases reported from a teaching and a community hospital in the United States.(5) In the Oxfordshire study, 39% of pneumonia (all-cause) patients who survived hospitalization and 49% of those who died were found to have been discharged from hospital within the previous 5 years (a 5year period was chosen because it was believed then, as now, that a substantial degree of protection persists for at least 5 years following pneumococcal vaccination)....
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TL;DR: A predischarge reminder is an inexpensive, effective method to improve physicians’ utilization of pneumococcal vaccine in high-risk patients and additional improvements in pneumococCal vaccine utilization will require selective components directed toward specific diagnoses or attending physician subspecialties.
Abstract: Objective:To evaluate the effectiveness of a computerized reminder for pneumococcal vaccination at hospital discharge and to determine patient and physician characteristics associated with increased use of the vaccine.
46 citations
TL;DR: A hospital-based pharmacy vaccination program that relied on simple chart reminders was significantly associated with increased vaccination rates among inpatients at risk for invasive pneumococcal disease.
Abstract: Background Current pneumococcal vaccination rates are well below national goals. Objective To determine whether pneumococcal vaccination rates could be increased with a hospital pharmacy-based program using simple chart reminders. Methods On a daily basis, inpatient records on general medicine and cardiology services at an academic medical center were reviewed to determine which patients were eligible to receive pneumococcal vaccine. Eligible inpatients were interviewed, and the percentage of nonvaccinated inpatients given vaccine during hospitalization was determined. During an intervention period, reminders were placed on charts after the interview requesting a vaccine when indicated. Results Of 447 inpatients, 224 (50.1%) had 1 or more indications for receiving pneumococcal vaccine. Only 64 (28.6%) had been previously vaccinated. One hundred fifty-eight (70.5%) of 224 vaccine-eligible patients had a prior hospitalization within the previous 5 years. Previous hospitalization was not significantly associated with having (48 [30.4] of 158) or not having (16 [24.2] of 66; P =.35) been vaccinated prior to admission. During the observational period, 0 of 80 vaccine-eligible, nonvaccinated inpatients were vaccinated before discharge. In comparison, 23 (28.8%) of 80 inpatients were vaccinated after a chart reminder ( P Conclusions A hospital-based pharmacy vaccination program that relied on simple chart reminders was significantly associated with increased vaccination rates among inpatients at risk for invasive pneumococcal disease.
45 citations
TL;DR: Pneumococcal vaccination at follow-up 8 weeks after treatment in the hospital for pneumonia seems to elicit an adequate antibody response without notable adverse reactions.
Abstract: Background: A substantial proportion of patients admitted to the hospital for pneumonia have been treated in a hospital during the preceding 4 to 5 years, and patients previously treated in a hospital for pneumonia seem to be at an especially high risk for another episode of pneumonia. Many cases of pneumococcal infection might therefore be prevented by immunizing admitted patients with pneumococcal vaccine at discharge or at follow-up. The aim of this study was to investigate the type-specific antibody response to pneumococcal vaccine in middle-aged and elderly patients at follow-up 8 weeks after hospital treatment for pneumonia. Methods: A total of 92 individuals, 50 to 85 years old, participated in the study. One group consisted of 65 individuals treated in the hospital for pneumonia 8 weeks before vaccination (mean age, 67 years), and another group consisted of 27 individuals who had not recently been treated for pneumonia (mean age, 67 years). All 92 individuals received a single dose of a 23-valent pneumococcal vaccine. The type-specific antibody responses to six pneumococcal capsular polysaccharide antigens included in the vaccine as well as antibodies against the 23-valent pneumococcal vaccine were measured before and 3 to 4 weeks after vaccination by use of an enzyme-linked immunosorbent assay. Results: The antibody concentrations before and after vaccination were comparable in the two groups, as were antibody fold increases from prevaccination to postvaccination serum. No serious adverse events were recorded. Conclusions: Pneumococcal vaccination at follow-up 8 weeks after treatment in the hospital for pneumonia seems to elicit an adequate antibody response without notable adverse reactions. (Arch Intern Med. 1994;154:1961-1965)
43 citations
"Hospital-based influenza and pneumo..." refers background in this paper
...Unfortunately, similar information has yet to be obtained for pneumococcal vaccine, although the vaccine is immunogenic when it is given to patients 1 to 2 months after hospital discharge for pneumonia.(66)...
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TL;DR: An outpatient "flu shot" program that emphasizes administrative and organizational elements can be successfully expanded to high-risk inpatients and the vaccination rates attained may not only achieve but exceed the national health objective for influenza vaccination.
42 citations