Having my say: Why best isn't enough

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William Schaffner, M.D., President, National Foundation for Infectious Diseases
William Schaffner, M.D., President, National Foundation for Infectious Diseases
Long-term care facilities are the best influenza vaccinators. Their residents have the highest vaccination rates of any group — usually around 70% annually. So congratulations on being the best!

But even being the best is just not good enough. We need to do even better.

Why? A 70% vaccination rate means three out of 10 residents are not vaccinated. That's not good because those three are very likely seniors — the population that accounts for nine of every 10 influenza-related deaths.

What's worse, they are living in a communal environment where influenza viruses can spread to them very easily. And compounding the issue: Many of the seven people around them who got the vaccine may still be able to pass influenza virus on to them.

Yes, it's true: Even though you vaccinate someone against influenza, he or she may not become immune to the virus, and this is especially true for people age 65 and older who may have a reduced ability to respond to the standard influenza vaccine.

While some use this information as a way to explain why it's acceptable to skip vaccination, the reality is it's a big reason why you need to make sure more of your residents get the vaccine.

Why bother?
“But,” you may ask, “if the vaccine doesn't always work in older folks, why do we give it?”

Earlier this year, the National Foundation for Infectious Diseases brought together a small panel, including myself, to discuss this issue and help the medical community better understand the challenges and opportunities in protecting older Americans from influenza.

You can read the full brief here.But the short answer is that the vaccine does work, if not always perfectly.

In addition, there are an increasing number of new strategies that offer the potential for greater protection against influenza, including the high-dose influenza vaccine for Americans age 65 and older that was approved last year.

Vaccines are not 100% effective, even when they're given to the healthiest, youngest people with the most robust immune systems.

The same is true for virtually every medical intervention, but for some reason, vaccine expectations are different.
Statin drugs reduce the risk but don't stop every heart attack, and anticoagulants reduce the risk of stroke but don't eliminate it. But here is a big difference: While statins and anticoagulants change an individual's personal risk, vaccines, if given to enough people, can lower the risk for the entire community.

In highly vaccinated populations, such as infants and toddlers, we get enough immunity to completely stop transmission of certain illnesses. This, as you probably know, is the herd effect. How much immunity a population needs to achieve the herd effect differs based on how easily the germ can be transmitted. Influenza, as it turns out, is very easily transmitted, so we need to vaccinate a large percentage of the community.

Still, the value of vaccination to individuals in your facilities cannot be disputed. The vaccine may not prevent infection altogether, but there is evidence that it will prevent severe illness, including exacerbations of underlying conditions, hospitalization and death.

Not just residents
One final point: Your vaccination efforts should not stop with your residents.

Hopefully, by now it's becoming common knowledge that the CDC recommends annual influenza vaccination for every man, woman and child in this country who is at least six months of age. Even before the universal recommendation there was a long-standing focus on healthcare workers. Each of us needs to be vaccinated every year to protect our patients, ourselves and our families.

It's in the best interest of the residents in LTC facilities that everyone around them gets vaccinated. Influenza vaccination is most effective in preventing influenza in the older population if everyone around them is vaccinated.

This includes caregivers, family, LTC staff and anyone else who comes within sneeze or coughing range of your residents.

If everyone gets vaccinated, outbreaks within facilities will decrease. Outbreaks cost money, cause unnecessary stress, raise concern among residents' families and pose serious health risks among your residents.

This coming flu season, I challenge you to beat the LTC facilities' “personal best” and close the vaccination gap, even further.

There is no good reason for anyone, even those three out of 10, to forego an annual influenza vaccination.

William Schaffner, M.D., is chairman of the Department of Preventive Medicine and Professor of Infectious Diseases in the Department of Medicine at the Vanderbilt University School of Medicine.
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