Recent outbreaks of pneumococcal pneumonia in long term care
facilities in the United States, including Maryland, have reinforced
the need for pneumococcal vaccination in populations at risk
of complications of Streptococcus pneumoniae. Several points
are worth noting:
-
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.
(Additional information about drug resistant Streptococcus
pneumoniae can be found in the Morbidity and Mortality Weekly
Report 1996; 45 No. RR-1: 1-20).
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 (Attachment 5).
II. Code of Maryland Regulations
Code of Maryland Regulations (COMAR) 10.06.01.12-1 Pneumococcal
Disease requires that residents of long term care facilities
be vaccinated with pneumococcal vaccine. Residents' physicians
shall educate the individual or the individual's legal guardian
on the availability of the vaccine and administer the vaccine
to a consenting individual who has no contraindications. The
physician may refer the individual to another health care provider
to administer the vaccine. Facilities are not the group that
must comply with this regulation; the regulation requires the
attending physician to educate and administer or refer the resident
for pneumococcal immunization.
(Top of Page)
Code of Maryland Regulations (COMAR) 10.06.01.12-1
Pneumococcal Disease requires the following: .
12-1 Pneumococcal Disease A. There is no control
of a case or contacts.
B. Vaccination of an Individual at Risk.
- 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 for Long
Term Care Facilities
- 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. (See Vaccine Administration Record,
Attachment 4).
- 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.
(Top of Page)
Maryland's local health departments, the Epidemiology
and Disease Control Program (410-767-6677) and the Licensing and
Certification Administration (410-764-2770) of the Department of
Health and Mental Hygiene are ready to provide consultation and
assistance as needed.
We hope that these recommendations and materials will
be helpful in your efforts to ensure that your attending physicians
comply with the requirements of Code of Maryland Regulations 10.06.01.12-1
or in establishing policies of your own.
Download
Attachment 2 in PDF format
Download
Sample letter
|
