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Stopping carers becoming carriers

It is worth investigating if there are compelling health and financial benefits from mandatory flu vaccinations for aged care staff, writes Robert Booy.

Residential aged care staff are a major potential source of infection, yet research shows that only about one in five get an annual flu shot. Ensuring more staff are vaccinated, and that health professionals intervene early when an outbreak occurs, may be the key to saving lives.

Healthy adults respond very well to vaccination but ageing reduces vaccine effectiveness so that in the elderly (over 80 years old) vaccines provide only about half the protection. This increased susceptibility of older people makes even more pressing the need to ensure that healthcare workers aren’t introducing flu infection.

Flu outbreaks in nursing homes are a serious matter and can lead to pneumonia, stroke and heart attacks among elderly residents.

Projected growth in care

The government’s Intergenerational Report 2007 forecast that in 40 years there will be a 350 per cent increase in healthcare costs in real terms and a huge 500 per cent increase in the cost of aged care. A huge annual deficit of $35 billion is expected. Taking account of recent justified concerns about dementia care, these figures are minimal estimates.

In 40 years, the proportion of Australians over 65 will double. Innovation in both commerce and medicine will be needed to prevent severe restrictions on essential medical and aged-care services.

Recent reports that aged-care facilities require more than 90 per cent bed occupancy to remain viable throws into sharp relief the dilemma facing the large tranche of baby boomers entering their third age. While they plan for a longer and better life, the stark truth is that this generation’s need for institutional care will rise inexorably over the next few decades.

Free immunisation or accreditation

The financial sustainability of nursing homes is threatened by considerable absences from work if staff are sick, with the resultant expense of procuring agency staff. Finances are further stretched by reduced bed occupancy from hospitalisations, deaths and even closure to new admissions.

Every year outbreaks of influenza in aged-care facilities create major disruption. Generally, both the elderly and high-risk chronically ill adults are told to get their flu shots and usually they comply.

And yet only about 10 per cent to 20 per cent of nursing home staff nationwide has an annual flu shot, an extraordinary and disappointing figure.

A randomised trial published in the British Medical Journal in 2006 showed that even being able to vaccinate half the staff can prevent half of all deaths during the flu season – a small outlay for a remarkable advantage.

Whether this can be achieved in Australia through mandating vaccinations for health workers, provision of a free immunisation service or linking to nursing home accreditation needs to be investigated. Mandatory vaccination of frontline healthcare workers against many infectious diseases, but not yet against influenza, is a NSW health policy.

Some argue that pneumonia from flu is the “old person’s friend” quickly carting off the frail who have poor quality of life. But we are talking about someone’s mother, uncle or sister and even if they are well prepared and ready for death, we need to remember that influenza is much more than a personal issue – it’s a transmissible infection that requires treatment to control outbreaks.

What’s more, research shows that with effective treatment, many elderly survivors of severe pneumonia can have five or more extra years of productive, high-quality life.

Benefits of early identification

Recent research in aged care facilities has shown that using novel ways to actively identify influenza outbreaks in nursing homes can save lives and reduce hospitalisations.

Active surveillance involved bedside tests to diagnose influenza on the spot and prompt immediate treatment with effective antiviral drugs. This enabled rapid control of outbreaks.

These vastly under-used antiviral drugs actually resulted from an Australian discovery. They work extremely well if given within one or two days of becoming unwell. But effective treatment requires very early recognition of an outbreak.

Influenza is an illness that often poleaxes those infected, confining them to bed for several days. It’s not the cold that some work-shy employees may describe as flu to get a sickie.

Having said that, treatment of influenza, within a day of falling ill, can reduce the illness period to as little as two days. Licensed antivirals need to be used intelligently to prevent development of viral resistance and to heighten their cost effectiveness.

The flu season in Australia usually lasts about six to eight weeks during winter so drug use is best restricted to this period. Most importantly, a combination of vaccinating staff and early detection measures could protect our elderly as well as ensure that nursing homes remain viable.

Professor Robert Booy is head of clinical research at the National Centre for Immunisation Research and Surveillance at the University of Sydney. This article was adapted from a piece first published in The Conversation.

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