Immunization rates for healthcare workers in long-term care were at a meager 69% last flu season — and that was an improvement.

During the previous 2014-2015 flu season, 64% of healthcare workers in long-term care were immunized, according to the CDC.1

Though they work with vulnerable elderly residents, long-term care workers have historically been less likely to be vaccinated for flu as their counterparts in hospitals and other settings. Though a lagging indicator, flu vaccination rates in long-term care employees are improving over time just like other sectors of the healthcare continuum. Flu vaccination of long-term care workers has improved by 17% since the 2011-2012 season, the CDC reported. Still, a study2 published last year found that long-term care workers had lingering concerns about the safety of the vaccine, including the old myth that it could cause the flu.

“All the injectable vaccines are killed vaccines purified so that you cannot get flu,” said Wilbur Chen, MD, of the University of Maryland School of Medicine’s Center for Vaccine Development. “It is possible for you to get an adverse reaction, but it is really just mild injection site reactions and maybe some pain, swelling, and some muscle tenderness that really is very mild and lasts for a couple of days. But that’s really the extent of it, so it’s an extremely safe vaccine.”

Chen spoke at a recent press conference on seasonal flu immunization at the National Foundation for Infectious Diseases (NFID) in Washington, DC.

Moreover, several studies have linked low immunization rates in long-term care workers with increased mortality in residents.2-5 However, it must be noted that a 2013 Cochrane review concluded that there were “no accurate data” supporting the vaccination of healthcare workers to prevent laboratory-confirmed influenza in long-term care residents age 60 years and older.6

The problem in long-term care settings is compounded by the limited protective value of flu vaccine in elderly residents who may have a poor immune response, even after immunization. The elderly experience “immunosenescence,” a decline in the body’s ability to respond and fight off infection, Chen said. Similarly, they may not have a great post-vaccination bounce in immunity for flu, but the vaccine could lessen the severity of infections and prevent death.

“The impact of flu every year hits the elderly the hardest,” Chen said at the NFID meeting. “Seventy percent to 90% of influenza deaths every year occur in those 65 years and older. For hospitalizations, 50% to 70% due to flu occur in [this] population.”

There is a new option for those over 65 this flu season: a vaccine containing an adjuvant designed to boost the immune response, he says. The CDC and FDA approved the adjuvant vaccine based on safety and efficacy results in other countries. There is also a high-dose vaccine, which contains four times the antigen level in the regular flu shot, available for those age 65 and over. The CDC does not recommend one over the other.


  1. CDC Influenza Vaccination Coverage Among Health Care Personnel — United States, 2015–16 Influenza Season. MMWR 2016; 65(38):1026–1031.
  2. Daugherty JD, et al. Influenza vaccination rates and beliefs about vaccination among nursing home employees. Am J Infect Control 2015;43:100-106.
  3. Carman WF, Elder AG, Wallace LA, et al. Effects of influenza vaccination of healthcare workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000;355:93–97.
  4. Hayward AC, Harling R, Wetten S, et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomized controlled trial. BMJ 2006;333:1241.
  5. Lemaitre M, Meret T, Rothan-Tondeur M, et al. Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster randomized trial. J Am Geriatr Soc 2009;57:1580–1586.
  6. Thomas RE, Jefferson T, Lasserson TJ. Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions. Cochrane Database Syst Rev 2013;7(7):CD005187pmid:23881655.