scholarly journals Vaccine effectiveness of the first dose of ChAdOx1 nCoV-19 and BNT162b2 against SARS-CoV-2 infection in residents of Long-Term Care Facilities (VIVALDI study)

2021 ◽  
Author(s):  
Madhumita Shrotri ◽  
Maria Krutikov ◽  
Tom Palmer ◽  
Rebecca Giddings ◽  
Borscha Azmi ◽  
...  
Keyword(s):  
Long Term Care ◽  
Proportional Hazards ◽  
Vaccine Dose ◽  
Cox Proportional Hazards ◽  
Protective Effects ◽  
Term Care ◽  
Department Of Health ◽  
Health And Social Care ◽  
Care Facilities

Background The effectiveness of SARS-CoV-2 vaccines in frail older adults living in Long-Term Care Facilities (LTCFs) is uncertain. We estimated protective effects of the first dose of ChAdOx1 and BNT162b2 vaccines against infection in this population. Methods Cohort study comparing vaccinated and unvaccinated LTCF residents in England, undergoing routine asymptomatic testing (8 December 2020 - 15 March 2021). We estimated the relative hazard of PCR-positive infection using Cox proportional hazards regression, adjusting for age, sex, prior infection, local SARS-CoV-2 incidence, LTCF bed capacity, and clustering by LTCF. Results Of 10,412 residents (median age 86 years) from 310 LTCFs, 9,160 were vaccinated with either ChAdOx1 (6,138; 67%) or BNT162b2 (3,022; 33%) vaccines. A total of 670,628 person days and 1,335 PCR-positive infections were included. Adjusted hazard ratios (aHRs) for PCR-positive infection relative to unvaccinated residents declined from 28 days following the first vaccine dose to 0.44 (0.24, 0.81) at 28-34 days and 0.38 (0.19, 0.77) at 35-48 days. Similar effect sizes were seen for ChAdOx1 (aHR 0.32 [0.15-0.66] and BNT162b2 (aHR 0.35 [0.17, 0.71]) vaccines at 35-48 days. Mean PCR cycle threshold values were higher, implying lower infectivity, for infections 28 or more days post-vaccination compared with those prior to vaccination (31.3 vs 26.6, p<0.001). Interpretation The first dose of BNT162b2 and ChAdOx1 vaccines was associated with substantially reduced SARS-CoV-2 infection risk in LTCF residents from 4 weeks to at least 7 weeks. Funding UK Government Department of Health and Social Care.

Importance of Employee Vaccination against Influenza in Preventing Cases in Long-Term Care Facilities

2011 ◽  
Vol 32 (10) ◽  
pp. 990-997 ◽  
Author(s):  
Aaron M. Wendelboe ◽  
Catherine Avery ◽  
Bernardo Andrade ◽  
Joan Baumbach ◽  
Michael G. Landen
Keyword(s):  
New Mexico ◽  
Vaccination Coverage ◽  
Long Term Care ◽  
Direct Care ◽  
Term Care ◽  
Department Of Health ◽  
Laboratory Confirmation ◽  
Care Facilities ◽  
Influenza Outbreaks

Objective.Employees of long-term care facilities (LTCFs) who have contact with residents should be vaccinated against influenza annually to reduce influenza incidence among residents. This investigation estimated the magnitude of the benefit of this recommendation.Methods.The New Mexico Department of Health implemented active surveillance in all of its 75 LTCFs during influenza seasons 2006-2007 and 2007-2008. Information about the number of laboratory-confirmed cases of influenza and the proportion vaccinated of both residents and direct-care employees in each facility was collected monthly. LTCFs reporting at least 1 case of influenza (defined alternately by laboratory confirmation or symptoms of influenza-like illness [ILI]) among residents were compared with LTCFs reporting no cases of influenza. Regression modeling was used to obtain adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between employee vaccination coverage and the occurrence of influenza outbreaks. Covariates included vaccination coverage among residents, the staff-to-resident ratio, and the proportion of filled beds.Results.Seventeen influenza outbreaks were reported during this 2-year period of surveillance. Eleven of these were laboratory confirmed (n = 21 residents) and 6 were defined by ILI (n = 40 residents). Mean influenza vaccination coverage among direct-care employees was 51% in facilities reporting outbreaks and 60% in facilities not reporting outbreaks (P = .12). Increased vaccination coverage among direct-care employees was associated with fewer reported outbreaks of laboratory-confirmed influenza (aOR, 0.97 [95% CI, 0.95-0.99]) and ILI (aOR, 0.98 [95% CI, 0.96-1.00]).Conclusions.High vaccination coverage among direct-care employees helps to prevent influenza in LTCFs.

scholarly journals Hearing and Cognitive Impairments Increase the Risk of Long-term Care Admissions

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Nicole Williams ◽  
Natalie A Phillips ◽  
Walter Wittich ◽  
Jennifer L Campos ◽  
Paul Mick ◽  
...  
Keyword(s):  
Home Care ◽  
Long Term Care ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Assessment Instrument ◽  
Term Care ◽  
Data Set ◽  
Individual Level ◽  
The Individual

Abstract Background and Objectives The objective of the study was to understand how sensory impairments, alone or in combination with cognitive impairment (CI), relate to long-term care (LTC) admissions. Research Design and Methods This retrospective cohort study used existing information from two interRAI assessments; the Resident Assessment Instrument for Home Care (RAI-HC) and the Minimum Data Set 2.0 (MDS 2.0), which were linked at the individual level for 371,696 unique individuals aged 65+ years. The exposure variables of interest included hearing impairment (HI), vision impairment (VI) and dual sensory impairment (DSI) ascertained at participants’ most recent RAI-HC assessment. The main outcome was admission to LTC. Survival analysis, using Cox proportional hazards regression models and Kaplan–Meier curves, was used to identify risk factors associated with LTC admissions. Observations were censored if they remained in home care, died or were discharged somewhere other than to LTC. Results In this sample, 12.7% of clients were admitted to LTC, with a mean time to admission of 49.6 months (SE = 0.20). The main risk factor for LTC admission was a diagnosis of Alzheimer’s dementia (HR = 1.87; CI: 1.83, 1.90). A significant interaction between HI and CI was found, whereby individuals with HI but no CI had a slightly faster time to admission (40.5 months; HR = 1.14) versus clients with both HI and CI (44.9 months; HR = 2.11). Discussion and Implications Although CI increases the risk of LTC admission, HI is also important, making it is imperative to continue to screen for sensory issues among older home care clients.

scholarly journals Learning and improving in long-term care internationally: the International Prevalence Measurement of Care Quality (LPZ)

2021 ◽  
Vol 15 ◽  
Author(s):  
Irma H. J. Everink ◽  
Adam L. Gordon ◽  
Suzanne Rijcken ◽  
Selvedina Osmancevic ◽  
Jos M. G. A. Schols
Keyword(s):  
Quality Assurance ◽  
Long Term Care ◽  
Care Quality ◽  
Multidisciplinary Teams ◽  
Term Care ◽  
Regulatory Systems ◽  
Health And Social Care ◽  
Care Facilities ◽  
Care Systems

Long-term care (LTC) for older adults is an essential part of how health and social care systems respond to population ageing. Different long-term care systems in different countries have taken differing approaches to quality assurance, ranging from inspection-based regulatory systems to data and reporting-based regulatory systems. The significant variability in the ability of long-term care facilities to respond to the COVID-19 pandemic has led to increased recognition of the role of standardized data in informing structured approaches to quality assurance. The International Prevalence Measurement of Care Quality (in Dutch: Landelijke Prevalentiemeting Zorgkwaliteit – LPZ) was developed to guide continuous quality improvement in long-term care facilities. This special article describes the LPZ tool, developed to provide input for the learning and improvement cycle of multidisciplinary teams in the LTC sector and to help improve care quality.

scholarly journals Challenges of infection prevention and control in Scottish long-term care facilities

2020 ◽  
Vol 41 (8) ◽  
pp. 943-945
Author(s):  
Le K. N. Nguyen ◽  
Itamar Megiddo ◽  
Susan Howick
Keyword(s):  
Prevention And Control ◽  
Infection Prevention ◽  
Long Term Care ◽  
Healthcare Delivery ◽  
Infection Prevention And Control ◽  
Term Care ◽  
Health And Social Care ◽  
Care Facilities ◽  
And Control

AbstractResidents living in long-term care facilities (LTCFs) are at high risk of contracting healthcare-associated infections (HAIs). The unique operational and cultural characteristics of LTCFs and the currently evolving models of healthcare delivery in Scotland create great challenges for infection prevention and control (IPC). Existing literature that discusses the challenges of infection control in LTCFs focuses on operational factors within a facility and does not explore the challenges associated with higher levels of management and the lack of evidence to support IPC practices in this setting.1-7 Here, we provide a broader view of challenges faced by LTCFs in the context of the current health and social care models in Scotland. Many of these challenges are also faced in the rest of the United Kingdom and internationally.

scholarly journals Direct and indirect effectiveness of mRNA vaccination against SARS-CoV-2 infection in long-term care facilities in Spain

2021 ◽  
Author(s):  
Susana Monge ◽  
Carmen Olmedo ◽  
Belen Alejos ◽  
Marife Lapena ◽  
Maria Jose Sierra ◽  
...  
Keyword(s):  
Long Term Care ◽  
Cumulative Risk ◽  
Vaccine Dose ◽  
Reproductive Number ◽  
Term Care ◽  
Care Facilities ◽  
Previous Infection ◽  
Indirect Protection

Objectives: To estimate indirect and total (direct plus indirect) effects of COVID-19 vaccination in residents in long-term care facilities (LTCF). Design: Registries-based cohort study including all residents in LTCF 65 years or older offered vaccination between 27 December 2020 and 10 March 2021. Risk of SARS-CoV-2 infection following vaccination was compared with the risk in the same individuals in a period before vaccination. Risk in non-vaccinated was also compared to a period before the vaccination programme to estimate indirect protection. Standardized cumulative risk was computed adjusted by previous documented infection (before the start of follow-up) and daily-varying SARS-CoV-2 incidence and reproductive number. Participants: 573,533 records of 299,209 individuals in the National vaccination registry were selected; 99.0% had received at least 1 vaccine-dos, 99.8% was Pfizer/BioNTech (BNT162b2). Residents mean age was 85.9, 70.9% were females. A previous SARS-CoV-2 infection was found in around 25% and 13% of participants, respectively, at the time of vaccine offer and in the reference period. Main outcome measures: Documented SARS-CoV-2 infection identified in the National COVID-19 laboratory registry. Results: Total VE was 57.2% (95% Confidence Interval: 56.1%-58.3%), and was highest starting 28 days after the first vaccine-dose (proxy of more than 7 days after the second dose) and for individuals naive to SARS-CoV-2 [81.8% (81.0%-82.7%)] compared to those with previous infection [56.8% (47.1%-67.7%)]. Vaccination prevented up to 9.6 (9.3-9.9) cases per 10.000 vaccinated per day; 11.6 (11.3-11.9) if naive vs. 0.8 (0.5-1.0) if previous infection. Indirect protection in the non-vaccinated could only be estimated for naive individuals, at 81.4% (73.3%-90.3%) and up to 12.8 (9.4-16.2) infections prevented per 10.000 indirectly protected per day. Conclusions: Our results confirm the effectiveness of mRNA vaccination in institutionalized elderly population, endorse the policy of universal vaccination in this setting, including in people with previous infection, and suggest that even non-vaccinated individuals benefit from indirect protection.

scholarly journals Weak humoral immune reactivity among residents of long-term care facilities following one dose of the BNT162b2 mRNA COVID-19 vaccine

2021 ◽  
Author(s):  
Mark A Brockman ◽  
Francis Mwimanzi ◽  
Yurous Sang ◽  
Kurtis Ng ◽  
Olga Agafitei ◽  
...  
Keyword(s):  
Long Term Care ◽  
Vaccine Coverage ◽  
Vaccine Dose ◽  
The Elderly ◽  
Antibody Activity ◽  
Immune Reactivity ◽  
Term Care ◽  
Live Virus ◽  
Care Facilities

Background. Several Canadian provinces are extending the interval between COVID-19 vaccine doses to increase population vaccine coverage more rapidly. However, immunogenicity of these vaccines after one dose is incompletely characterized, particularly among the elderly, who are at greatest risk of severe COVID-19. Methods. We assessed SARS-CoV-2 humoral responses pre-vaccine and one month following the first dose of BNT162b2 mRNA vaccine, in 12 COVID-19 seronegative residents of long-term care facilities (median age, 82 years), 18 seronegative healthcare workers (HCW; median age, 36 years) and 4 convalescent HCW. Total antibody responses to SARS-CoV-2 nucleocapsid (N) and spike protein receptor binding domain (S/RBD) were assessed using commercial immunoassays. We quantified IgG and IgM responses to S/RBD and determined the ability of antibodies to block S/RBD binding to ACE2 receptor using ELISA. Neutralizing antibody activity was also assessed using pseudovirus and live SARS-CoV-2. Results. After one vaccine dose, binding antibodies against S/RBD were ~4-fold lower in residents compared to HCW (p<0.001). Inhibition of ACE2 binding was 3-fold lower in residents compared to HCW (p=0.01) and pseudovirus neutralizing activity was 2-fold lower (p=0.003). While six (33%) seronegative HCW neutralized live SARS-CoV-2, only one (8%) resident did (p=0.19). In contrast, convalescent HCW displayed 7- to 20-fold higher levels of binding antibodies and substantial ability to neutralize live virus after one dose. Interpretation. Extending the interval between COVID-19 vaccine doses may pose a risk to the elderly due to lower vaccine immunogenicity in this group. We recommend that second doses not be delayed in elderly individuals.

scholarly journals Breathing Uneasy: Fit-Tested N95 Respirator Access in Washington State Long-Term Care Facilities

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 158-159
Author(s):  
Carolyn Ham ◽  
Mikiko Nakamura
Keyword(s):  
Assisted Living ◽  
Long Term Care ◽  
Washington State ◽  
Term Care ◽  
Department Of Health ◽  
Care Facilities ◽  
Facility Type ◽  
Fit Testing ◽  
N95 Respirators

Abstract Long-term care facilities (LTCF) have been disproportionately impacted by illness and death from COVID-19. Shortages of respirators for staff, especially Particulate Filtering Facepiece Respirators (N95), have limited LTCFs ability to follow public health recommendations for preventing COVID-19 transmission. Use of N95 respirators was infrequent in Washington State (WA) LTCFs prior to May 2020. N95 respirators must be individually fit tested to provide intended protection; a fit test is a procedure that tests the seal between the N95 respirator and the wearer’s face. The WA Department of Health (WA DOH), collaborated with stakeholders to survey LTCFs in November 2020 regarding needs for fit tested respirators and analyzed responses (n=384). Responses by facility type: 8.3% nursing homes, 17.7% assisted living, 62.8% adult family home, 11.2% other. In WA, adult family homes (AFH) are licensed for six or fewer residents. 23.70% of LTCFs indicated they did not have any N95 respirators in stock at their facility; 96.7% of these were AFH. In August 2020 WA DOH surveyed AFH owners and received 110 responses; 9.76% reported having at least one staff member fit tested for respirators. Smaller facilities may experience increased burden in accessing N95 respirators and fit testing due to lack of established relationships with suppliers and small volumes being purchased. WA DOH used federal COVID funding to contract with mobile fit testing providers and prioritized AFHs for this service. Between December 1, 2020-February 28, 2021, staff at 290 LTCFs were fit tested. The project will continue throughout 2021.

scholarly journals High vaccine effectiveness against COVID-19 infection and severe disease among residents and staff of long-term care facilities in Norway, November - June 2021

2021 ◽  
Author(s):  
Jostein Starrfelt ◽  
Anders S Danielsen ◽  
Oliver Kacelnik ◽  
Anita Wang Borseth ◽  
Elina Seppala ◽  
...  
Keyword(s):  
Health Care Workers ◽  
Long Term Care ◽  
Severe Disease ◽  
Vaccine Dose ◽  
Vaccine Effectiveness ◽  
High Morbidity ◽  
Term Care ◽  
Care Workers ◽  
Care Facilities

COVID-19 has caused high morbidity and mortality in long-term care facilities (LTCFs) worldwide. We estimated vaccine effectiveness (VE) among residents and health care workers (HCWs) in LTCFs using Cox regressions. The VE against SARS-CoV-2 infection was 81.5 (95%CI: 75.3-86.1 82.7%) and 81.4% (95%CI: 74.5-86.4%) 7 days or more after 2nd vaccine dose among residents and staff respectively. The VE against COVID-19 associated death was 93.1% among residents, no hospitalisations occurred among HCW 7 days or more after 2nd dose.

scholarly journals The VA’s Long-Term Care Strike Team Supporting Florida’s Nursing Homes Workforce

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 383-383
Author(s):  
Adam Golden
Keyword(s):  
Long Term Care ◽  
Nursing Home Care ◽  
Direct Patient Care ◽  
Term Care ◽  
Prevention Education ◽  
Department Of Health ◽  
Florida Department ◽  
Care Facilities ◽  
To Come

Abstract In coordination with the Florida Department of Health, the VA Sunshine Healthcare Network (VISN 8) established Long-Term Care Strike Teams to provide services to the LTC facilities most affected by the COVID-19 pandemic across the state of Florida. Between April 2020 through September 2020, the Strike Teams provided direct patient care to community residents, infection control/ prevention education, and patient/staff COVID-19 swabbing. We encountered facilities with large numbers of staff infected with COVID-19 and agency staff that were refusing to come to “COVID-infected” facilities. Remaining staff, including the administrators, were under much psychological distress. However, our experience supporting the long-term care facilities also had a major impact on our own perceptions of nursing home care. The bravery, dedication, and caring that we witnessed reinforced that the health care workers in long-term care facilities are true heroes.

Sign in / Sign up

Export Citation Format

Share Document