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To: Zvi Yammer who wrote (1314)	7/31/1998 7:21:00 PM
From: Zvi Yammer	Respond to of 2742

A bit of interesting information ... Flu shots ... BETHESDA, Md.--(BW HealthWire)--July 9, 1998--New Jersey has now become the third state to take preventive action against deadly outbreaks of pneumococcal disease in elder care facilities. New Jersey announced it has joined Delaware and South Dakota in requiring that pneumococcal and influenza vaccines be offered to residents and users of elder care facilities. The state mandates are increasingly important in light of the June 25 issue of the New England Journal of Medicine, which reported on a study of a 1996 outbreak of antibiotic-resistant pneumococcal disease in an Oklahoma nursing home. The authors concluded that wider use of pneumococcal vaccine can help prevent institutional outbreaks of the disease, which can infect the lungs (pneumonia), bloodstream (bacteremia) or brain lining (meningitis). Older adults are particularly vulnerable, with a death rate for bacteremia of 30 to 40 percent. The importance of vaccination is further highlighted by the declining effectiveness of antibiotics to treat pneumococcal disease. The Centers for Disease Control and Prevention (CDC) recommends that pneumococcal vaccine be given to everyone over 65 and to people two years of age and older with certain underlying medical conditions, including weakened immune systems. Pneumococcal vaccination is usually given only once in a lifetime and is Medicare Part B-reimbursable. Yet, despite recommendations by virtually all major medical and public health organizations, only about 35 percent of those over 65 have received pneumococcal vaccine. Rates are even lower for minorities. Flu Vaccine Also Recommended for Elderly The CDC recommends the influenza vaccination annually for all persons 65 and older and all persons in high-risk groups, including those who are immunocompromised; have chronic heart or lung conditions, including asthma; are residents of elder care facilities; and women who will be in the second or third trimester of pregnancy during flu season. The vaccination is also recommended for healthcare workers and employees of eldercare facilities who have any contact with patients or residents. "Pneumococcal disease and influenza together are the sixth leading cause of death in the United States each year, claiming nearly as many lives as AIDS and breast cancer combined," according to Greg Poland, M.D., Chairman of the National Coalition for Adult Immunization (NCAI) and head of vaccine research at the Mayo Clinic. NCAI is an umbrella organization of more than 100 medical, voluntary, government and corporate healthcare organizations committed to improving the immunization status of adults. "New Jersey has taken an important step and we hope other states will follow suit. New Jersey's action signifies a growing recognition that pneumococcal and flu vaccination are essential to protecting the health and well-being of our older citizens," Poland said. The National Nursing Home Survey of organized pneumococcal vaccination programs and immunization rates reports that less than half (only 42 percent) of nursing home residents were vaccinated against pneumococcal disease, according to the National Center for Health Statistics. These rates compare to the goal of 80 percent for pneumococcal and flu immunization among institutionalized chronically ill or older people established by the U.S. Public Health Service "Healthy People 2000" initiative. Three States Set Pace for Others The New Jersey regulations, published in the New Jersey Register on May 18, 1998, are designed to close the gap. The new regulations require that elder care facilities document evidence of vaccination against pneumococcal disease for each resident over 65, in accordance with the recommendations of the Advisory Committee on Immunization Practices (ACIP) of the CDC. If the vaccine is contraindicated or the patient refuses, that must be noted in the chart. In addition, pneumococcal vaccination must be offered to patients prior to or upon admission. Facilities are also required to document evidence of annual influenza vaccination in accordance with ACIP recommendations. Facilities affected are long-term care, assisted living facilities, personal care homes, assisted living programs, residential health care facilities, adult day care centers and alternate family care sponsor agencies. "The fact that pneumococcal vaccine is 100 percent reimbursable through Medicare Part B makes it even more logical -- from both a health and budgetary perspective -- for states to focus their efforts on those most at risk for pneumococcal disease, older people in institutionalized settings," Poland said. South Dakota adopted similar provisions for pneumococcal vaccine in 1995 and has had regulations in place to ensure influenza vaccination in nursing facilities and assisted living centers since 1987. Influenza outbreaks in the 1970s spurred the initiative. Health care workers at these facilities are also strongly encouraged to obtain vaccinations. In 1990, Delaware adopted regulations requiring that influenza and pneumococcal vaccination be offered to residents in elder care facilities. Poland noted that other states may be expected to follow suit as the health and economic benefits of adult vaccination become more widely recognized. He also predicted that efforts such as Pneumonia/Flu 2000, a major national initiative to promote influenza and pneumococcal vaccinations for people on Medicare, will improve low vaccination rates. The initiative is a joint project of the NCAI, CDC and the U.S. Health Care Financing Administration (HCFA).