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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Frail Nursing Home Residents at Flu Risk as Staff Vaccinations Lag

By Gary Evans, AHC Media Senior Staff Writer

Although overall healthcare influenza immunization rates continue to climb as mandated policies take effect in hospitals, 31% of workers in long term care settings still skip the seasonal vaccine -- even though the frail residents under their care are at increased risk of serious and fatal flu infections, the Centers for Disease Control and Prevention reports.

Mandatory vaccination policies are driving a trend that saw 91% of hospital workers immunized during the last flu season -- a far cry from the lagging levels of the voluntary flu shot era. However, as noted, immunization rates for healthcare workers in long-term care were at a meager 69% last flu season. On the plus side that represents a 5% improvement over the prior year.

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. Moreover, studies have linked low flu immunization rates in long term care workers with increased mortality in residents.1-3 In addition, a study4 published last year found that long-term care workers had lingering concerns about the safety of the vaccine, including the old myth that it can cause the flu. Fortunately, the literal needle is moving in the right direction, as flu vaccination of long-term care workers has improved by 17% since the 2011-2012 season, the CDC reported.

The problem in long-term care settings is compounded by “immune senescence,” a decline in the aging body’s ability to respond and fight off infection that also compromises vaccine response. There is a new option for those over 65 this flu season, a vaccine containing an adjuvant designed to boost the immune response. 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.

The cutting-edge vaccines won’t do much good if the elderly decline to be immunized. Historically about a third of those 65 and over ignore a standing recommendation to be vaccinated for seasonal flu that has been in place for decades. Thus many are at high risk of flu infections due to poor vaccination rates and the aforementioned immune competence issues. As a result it is estimated the 70% to 90% of influenza deaths every year occur in those 65 years and older, who also suffer 50% to 70% of flu hospitalizations.


  1. Carman WF, Elder AG, Wallace LA, et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000;355:93–97.
  2. 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 randomised controlled trial. BMJ 2006;333:1241.
  3. 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.
  4. Daugherty JD, et al. Influenza vaccination rates and beliefs about vaccination among nursing home employees. Am J Infect Control 2015;43:100-106.

For more on this story see the November 2016 issue of Hospital Infection Control & Prevention.