Prevention of Pneumococcal Disease

 

Prevention of Pneumococcal Disease

I. Introduction

Recent outbreaks of pneumococcal pneumonia in long term care facilities in the United States, have reinforced the need for pneumococcal vaccination in populations at risk of complications of Streptococcus pneumoniae. Several points are worth noting:

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  S. pneumoniae infections are among the leading causes of illness and death for persons who have underlying debilitating medical conditions and the elderly.
• Because of their age and underlying health problems, nursing home residents are at high risk for developing serious complications or dying when they contract pneumococcal disease.
• Because residents in long term care facilities are in close proximity to one another, S. pneumoniae can be passed among residents and staff.
• Pneumococcal disease occurs most frequently during the winter months, both as a primary infection or as a secondary infection following an influenza infection.
• S. pneumoniae has become increasingly resistant to penicillin and other commonly used antibiotics. This makes infections caused by this organism increasingly hard to treat. 

Therefore, prevention through proper immunization with pneumococcal vaccine is critical. The Advisory Committee on Immunization Practices (ACIP) recommends that the vaccine be administered to all persons 65 years or older and to any individual at increased risk of getting pneumococcal disease. ACIP recommendations for the use of pneumococcal vaccine can be found in the MMWR, Volume 38, No. 5, p. 64-68, 1989.

12-1 Pneumococcal Disease

A. There is no control of a case or contacts.

B. Vaccination of an Individual at Risk.

• An individual at increased risk of pneumococcal disease includes an individual:

• With anatomic or functional asplenia;
• With sickle cell disease;
• With human immunodeficiency virus infection;
• With chronic heart, lung, liver, or renal disease;
• With diabetes mellitus;
• Who is 65 years old or older; or
• Who is a resident of a long-term care facility.

• A physician in attendance upon an individual at increased risk of pneumococcal disease shall:

• Educate that individual or the individual's legal guardian on the availability of pneumococcal vaccine; and
• Administer pneumococcal vaccine to a consenting individual who has no contraindications and who is at increased risk of pneumococcal disease, or refer the individual to a health care provider who has agreed to administer pneumococcal vaccine to an individual at increased risk of pneumococcal disease.

III. Recommendations 

• Assure vaccination with 23-valent pneumococcal vaccine of all residents of long term care facilities. If the vaccination status is unknown to the facility, vaccinate the resident after obtaining appropriate consent.
  • Survey your residents, their families or guardians, and/or their charts to assess which residents have had pneumococcal vaccine and which residents need vaccine
  • Obtain consent from those residents who are able to give consent. If the resident is unable to give consent, send a letter to family or guardian with information about pneumococcal disease, asking them for vaccine status, and request permission to administer pneumococcal vaccine. You could include an Important Information Statement (IIS) about pneumococcal disease and the vaccine. If there is no response from the family, the medical director should order the vaccination.

• Document in residents' chart the pneumococcal vaccine status, including the date administered (either date of past history of vaccination or the date when it is given at the facility), or declination for vaccination. 
• Assure that attending physicians comply with the Maryland regulation by establishing policies and procedures to accomplish pneumococcal vaccination on admission and on your current resident population.
• Determine the agent(s) responsible for causing pneumonia in residents of your facility. This may require contacting the hospital if the information from a resident's hospitalization does not come back to the facility (especially if the resident died). Clearly, agents such as Legionella, Mycobacterium tuberculosis, and S. pneumoniae have different implications for control in your facility.
• Report outbreaks of respiratory illness of any cause, with or without pneumonia to your local health department.

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