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Issue Number 83
May 26, 1999
UNPROTECTED PEOPLE: Stories of
people who have suffered or died from vaccine-preventable diseases
TWO DEATHS IN A NURSING HOME IGNITE PNEUMOCOCCAL
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Editors' note: Pneumococcal disease causes
approximately 40,000 deaths, 500,000 cases of pneumonia, and 50,000 cases of bacteremia
each year in the United States. A 1997 CDC survey indicated that only 45% of adults 65
years of age and older have received their recommended dose of pneumococcal vaccine (MMWR,
October 2, 1998, vol. 47, no.38).
The following article originally appeared in the Texas Department of Health's newsletter,
"Accent on Health," on March 10, 1997, and was reprinted with permission in the
spring/summer 1999 issue of NEEDLE TIPS.
According to Devora Goodnight, it wasn't just luck that only two people died in a recent
outbreak of deadly pneumococcal disease where she works at the Houston County Nursing Home
in Crockett. What undoubtedly saved lives when the outbreak began was a combination of the
nursing home staff's recognizing the seriousness of the outbreak and their getting an
immediate response from experts at the Texas Department of Health (TDH). But perhaps
the most decisive single factor was the quick immunization of all potential patients with
a vaccine which often is overlooked by physicians and patients alike.
After two patients died of streptococcal pneumonia infections and one other was stricken,
Goodnight said, "We knew we had a situation that might cost many of our residents'
lives if it got further out of hand. We had never had anything like this happen before and
didn't even know what to expect if we called TDH for help. But we knew we would most
likely lose more of our `family' if we didn't."
At TDH's Infectious Disease Control and Surveillance Division, epidemiologist Beverly Ray
said that Goodnight and the home's nursing director Debbie Hargrove showed "the
highest standard of concern for their residents."
Ray explained that although outbreaks of pneumococcal disease caused by the Streptococcus
pneumoniae bacteria are rare, the bacteria spread rapidly among unimmunized people whose
health may already be compromised. People in good health with normal immune systems are
not as likely to develop infections, but ill people, such as elderly nursing home
residents with existing problems, are especially at risk of developing pneumonia after
exposure to the bacteria.
According to Ray, Streptococcus pneumoniae causes about half a million individual cases of
pneumonia, some 3,000 cases of meningitis and about seven million ear infections in the
United States every year. The most susceptible people are the elderly and ill, such as
those at the Crockett nursing home, infants and toddlers, people with chronic health
conditions such as diabetes or emphysema, and people without spleens or with weakened
immune systems. Outbreaks of the disease occur most commonly during the winter months,
among nursing home patients, jail or prison inmates, and other groups who share close
living quarters and often breathe the same air.
The U.S. Centers for Disease Control and Prevention recommends that all people 65 years of
age or older receive one dose of pneumococcal vaccine. Those at greatest risk for serious
complications from pneumococcal disease need to receive a second dose five years later.
The vaccine is effective against at least 23 different strains of streptococcal bacteria
and is fast acting. However, Ray said that in a recent survey of Texans 65 and older, only
42 percent said they had been vaccinated against bacterial pneumonia.
Ray said, "This vaccine is one of the most effective, fastest-acting vaccines we have
for averting outbreaks among such groups as nursing home residents, yet it is unbelievably
underused. We hope that physicians will offer the vaccine more often to their own patients
who may be at risk, and that more patients or family members will remember to ask for the
vaccine if they have not already had it."
After TDH received the Crockett nursing home's call for help on Jan. 23, Ray and a team of
other epidemiology staff drove directly to Crockett to begin taking blood samples from
about 90 nursing home residents and staff and obtaining permission to begin vaccinating as
many of the residents as possible. Only 14 of 88 residents had previously been immunized.
Vaccinations began the following morning, Jan. 24.
According to Hargrove, she and others on the nursing home staff "were amazed at how
quickly TDH brought the outbreak under control."
Although two patients out of the first three diagnosed with pneumococcal disease died, the
remaining victim of the outbreak survived and has recovered. The vaccines which the other
residents received have begun protecting the home's residents from further infections. For
a few days after the residents were vaccinated, some of their visiting friends and family
members were advised to take antibiotics as an additional precaution against more
pneumococcal infections, but no other cases occurred.
Goodnight said that the loss of the two residents who died from pneumococcal disease has
been hard on the other residents and the staff alike. "They were part of our family.
We always try to operate as one big family here, and a death is personal to all of us. We
are just very, very grateful that help was there when we needed it to prevent even more
tragedies," she said.