BACKGROUND:
Influenza and pneumonia were ranked as the 4th leading causes of death among the people aged 65 years and older in Hawaii in 2002. The Hawaii Immunization Program (HIP) has conducted an annual immunization survey on the influenza and pneumococcal vaccination status at long-term care (LTC) facilities, including nursing facilities and adult residential care homes.

OBJECTIVE:
To observe trends for influenza and pneumococcal vaccination at LTC facilities and to evaluate the effect of policies on vaccination trends.

METHOD:
Data collected from HIP's annual survey over the past four influenza seasons, from 2000-2001 to 2003-2004, were reviewed. General linear models were used to evaluate whether policies, such as standing orders for residents and flu vaccination policy and offering free flu vaccines for staff, resulted in significantly higher vaccination rates.

RESULT:
Both influenza and pneumococcal vaccination rates among residents increased from 2000-2001 to 2003-2004 (87% to 89 % for influenza and 67% to 76% for pneumococcal vaccination). Influenza and Pneumococcal vaccine standing orders were significantly associated with higher influenza and pneumococcal vaccination rates in 2000-2001 (p= 0.01 & p=0.03, respectively). Staff influenza vaccinations have increased from 39% to 50% from 2000-2001 to 2003-2004.

CONCLUSION:
Influenza and pneumococcal standing orders seem to be associated with higher resident vaccination rates although not significantly in recent years. Strategies to encourage more LTC facilities to utilize standing orders may result in significant increases. Flu policy requiring staff vaccination seems to be associated with increased staff influenza vaccination rates although not significantly. Providing free flu vaccines to staff does not seem to be associated with increased vaccination rates.

LEARNING OBJECTIVES:
To evaluate the association between policies and vaccination rates at LTC facilities.