 |
The 130th Annual Meeting of APHA |
|
The 130th Annual Meeting of APHA |
Christina G. Tan, MD, Stanley Ostrawski, and Eddy A. Bresnitz, MD, MS. Division of Epidemiology, Environmental and Occupational Health, New Jersey Department of Health and Senior Services, 3635 Quakerbridge Road, Trenton, NJ 08625, 609-588-7516, tinatan92@yahoo.com
Invasive pneumococcal infection has a 30%-40% case-fatality rate among elderly persons but is largely preventable with pneumococcal polysaccharide vaccine (PPV). We investigated an outbreak of invasive pneumococcal infection among residents of a nursing home in April 2001 to characterize risk factors, determine why the outbreak may have occurred, and implement control efforts. We defined case-patients as nursing home residents hospitalized with febrile respiratory illness with radiographic findings consistent with pneumonia and sputum specimens positive for diplococci or blood cultures positive for Streptococcus pneumoniae. Blood culture isolates were serotyped. Two unmatched controls per case-patient were selected randomly from remaining residents without respiratory symptoms. To investigate compliance with state regulations requiring nursing homes to offer PPV to eligible residents, 853 long-term care facilities (LTCFs) statewide were surveyed. Nine case-patients were identified; median age was 86 years (range 78-100). Median age of controls was 86 years (range 58-95). No case-patients versus nine (50%) controls received PPV before the outbreak (OR=0; 95% CI=0, 0.7). Antibiotic use, pneumonia history, and physical functioning were not associated with illness. Attack rate among all nonvaccinated residents was 16% versus 0 among vaccinated residents. S. pneumoniae serotype 14, included in PPV, was isolated from blood cultures of seven case-patients. Of 361 (42%) LTCFs that replied to the survey, 28 (8%) did not comply with state immunization regulations. Outbreaks of pneumococcal infection occur in LTCFs with low vaccine coverage. Implementing standing orders programs, enforcing regulations, documenting vaccinations, and providing education may increase coverage.
Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.