committee urges increased education for the elderly, for physicians and other health care workers, and for persons having close contact with the elderly regarding the safety and benefits of influenza vaccine. In short, the committee believes health policymakers should recognize the severe impact of influenza and its preventability.

Much research is needed to improve existing means of controlling influenza. There are currently several candidate live virus vaccines that are safe, easy to administer, and capable of longer-lasting protection. However, resources are required to conduct the necessary large-scale trials prior to licensure. In addition, better antiviral drugs are needed. Rimantadine,38 a derivative of amantadine that is safer for the elderly and easier to use, should be made available. An antiviral agent effective against influenza B virus is also needed.

Innovative means are required to make delivery of the current vaccines easier. Regardless of the delivery means or vehicle used, however, influenza vaccines should be required for all nursing home residents and personnel and should be given to any elderly person discharged from the hospital during the fall or winter.* Influenza and pneumococcal vaccines should be promoted together because unlike some combinations they are still safe and effective when given simultaneously. The promotion and marketing of such vaccines by the pharmaceutical industry would be helpful.

NOSOCOMIAL INFECTIONS

Nosocomial infections are infections of any type that are not present on admission to a hospital but develop after the third hospital day. They are unlike the previous risk factors discussed in this chapter in that they are not one specific infection; nevertheless, they constitute an important risk for the elderly. The incidence of nosocomial infections is greater in the elderly than in any other population groups; the elderly have the highest rates of nosocomial urinary tract infections, infected surgical wounds, and nosocomial pneumonia and bacteremia.17,23,25,46 In addition, the incidence rates for these infections increase with each day in the hospital.45 The costs resulting from nosocomial infections are also great because they prolong hospital stays and often require separate treatment.9,51 These infections cause severe morbidity and may result in death.21,22

Much progress has been made in preventing nosocomial infections,

*  

For elderly individuals living at home, vaccines also should be administered to their contacts (e.g., children, grandchildren, or household contacts who could expose the elderly person to influenza).



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