Jun 3

Immunisation in Aged Care

Protecting Our Most Vulnerable

Aged care facilities are unique, where a high concentration of vulnerable individuals reside, making robust immunisation programs vital to not only protect residents but also the dedicated staff who care for them.

Introduction to Immunisation. What is it?

Immunisation, often referred to as vaccination, is a cornerstone of infection prevention in healthcare. Essentially, it boosts the body's natural defences to protect against infectious diseases. For older adults, who may have weaker immune systems and a higher susceptibility to severe illness, immunisation isn't just beneficial—it's critical. In communal living environments, such as aged care facilities, the risk of rapid disease transmission is significantly raised.

A vaccine contains a weakened, inactivated, or a small piece of a pathogen (virus or bacteria), called an antigen. It's enough for your immune system to recognise it, but not enough to cause the actual illness. Different types of vaccines use different forms:

  • Live-attenuated vaccines: These contain a weakened form of the living virus or bacteria (e.g., MMR, chickenpox). They often provide strong, long-lasting immunity with fewer doses.
  • Inactivated vaccines: These consist of killed versions of the pathogen (e.g., some flu vaccines). Because they can't replicate, they usually require multiple doses (boosters) to establish strong immunity.
  • Subunit, toxoid, or mRNA vaccines: Contain only specific parts of the pathogen (proteins or genetic material) that trigger an immune response (some COVID-19 vaccines).

Immune System Recognition and Response: The immune system produces antibodies to the antigen presented in the vaccine.

Antibody Production and Memory: Antibodies are highly specific molecules designed to bind to and neutralise the specific antigen they were trained against. They can block the pathogen from entering cells, have it destroyed by other immune cells, or neutralise the toxins it produces. Vitally, after fighting off this "imitation infection," the immune system creates "memory cells" which remain in the body for months, years, or even a lifetime.

Future Protection (The Real Benefit): If the vaccinated person is later exposed to the actual disease-causing pathogen, their memory cells quickly recognise it. They can then rapidly produce large numbers of the right antibodies and activate T-cells, often preventing the illness entirely or making the symptoms much milder and recovery faster. This rapid and robust response is why immunisation is so effective.

Herd Immunity: When a high percentage of residents and staff in an aged care facility are immunised, it creates herd immunity (or community immunity). This significantly reduces the spread of disease within a facility, protecting even those who cannot be vaccinated (e.g., due to medical reasons) or for whom the vaccine may be less effective.

Diseases Most Vaccinated Against in Aged Care

Residents and staff in aged care facilities are typically prioritised for vaccines against respiratory illnesses due to their high transmissibility and potential for severe outcomes in older adults. The most common vaccinations include:

  • Influenza (Flu): An annual flu shot is of high priority, as older adults are at a significantly higher risk of severe complications, hospitalisation, and death from influenza. Different strains circulate each year, hence annual boosters are recommended.
  • COVID-19: While the immediate crisis of the pandemic may have subsided, COVID-19 continues to pose a significant risk, especially to older adults with comorbidities. Staying up to date with booster shots is essential as protection wanes over time.
  • Pneumococcal Disease: This vaccine protects against serious infections like pneumonia, meningitis, and bloodstream infections caused by Streptococcus pneumoniae. Older adults are particularly susceptible.
  • Shingles (Herpes Zoster): Shingles is a painful rash caused by the reactivation of the chickenpox virus, which remains dormant in the body after the illness. Older adults have a weaker immune system, making them more prone to shingles and its debilitating complication, post-herpetic neuralgia.
  • Diphtheria, Tetanus, and Pertussis (Whooping Cough - dTpa): A booster for this combination vaccine is often recommended, especially for staff and those who will be around new babies (e.g., visiting grandchildren). Whooping cough can be severe in infants and contagious in older adults.

    Other vaccines that may be recommended based on individual health and risk factors include Hepatitis B, Measles, Mumps, Rubella (MMR), and Meningococcal vaccines.

Vaccine Refusal

Vaccine refusal, whether by residents or staff, can come about from a variety of interconnected factors:

Health Concerns:
  • Perceived Side Effects: Concerns about common, mild side effects (like soreness, fever, or fatigue) can be a deterrent, especially if they are seen as disrupting daily life or existing health conditions.
  • Fear of Adverse Reactions: While rare, serious adverse reactions are a significant fear for some.
  • Underlying Health Conditions: Some individuals may genuinely believe their specific health conditions make vaccination unsafe, even if medical advice suggests otherwise.
  • Waning Immunity/Perceived Ineffectiveness: For diseases like COVID-19 and influenza, where immunity can wane or new variants emerge, this can be perceived as being vaccinated is not worth the trouble.


Social Factors:
  • Misinformation and Disinformation: The spread of inaccurate or misleading information, particularly through social media, can significantly reduce trust in vaccines and public health authorities. Conspiracy theories can also play a role.
  • Peer Influence and Social Networks: Opinions of friends, family, and community groups can heavily influence the decision of an individual, creating social pressure to conform to the anti-vaccine sentiments of others.
  • Lack of Trust in Healthcare System/Authorities: Historical injustices or negative personal experiences can lead to a general distrust of medical institutions and government recommendations.
  • Loneliness and Anxiety: Studies suggest higher levels of social loneliness and anxiety can be associated with vaccine hesitancy among residents and staff in aged care.


Religious and Conscientious Objection:

  • Specific Religious Beliefs: Certain religious doctrines may hold objections to vaccines based on concerns about ingredients (e.g., animal-derived products, foetal cell lines in the production of a vaccine) or a belief that natural immunity is preferable.
  • Conscientious Objection/Personal Autonomy: Some individuals strongly believe in the right to bodily autonomy and view vaccine mandates as an infringement on personal freedom, regardless of specific health or religious reasons.

Fear:

  • Fear of Needles (Trypanophobia): A genuine and sometimes debilitating fear of injections can prevent individuals from being vaccinated.
  • General Anxiety: The unknown nature of a new vaccine or general health anxiety can contribute to refusal.


Logistical Barriers (for Residents):

  • Cognitive Impairment: Many aged care residents may have cognitive impairments, making it difficult to obtain informed consent directly. This requires careful discussion with legal guardians or next of kin.
  • Access Issues: While less common within a facility, external appointments or complex scheduling for boosters can be a barrier.

Consequences for the Aged Care Facility

Low vaccination rates among residents and staff can have severe consequences for an aged care facility:
  • Increased Outbreaks and Disease Transmission: This is the most immediate and critical risk. Unvaccinated individuals are more susceptible to infection and more likely to transmit diseases, leading to outbreaks that can spread rapidly within a close-knit aged care facility.
  • High Morbidity and Mortality: Aged care residents are highly vulnerable to severe illness, hospitalisation, and death from vaccine-preventable diseases. Outbreaks can result in significant loss of life and severe deterioration in health for many residents.
  • Staff Shortages and Burnout: Outbreaks necessitate isolation, increased personal protective equipment (PPE) usage, and often lead to staff illness or quarantine. This can cripple staffing levels, leading to increased workload and burnout for remaining staff, and potentially compromising care quality.
  • Reputational Damage and Loss of Trust: Facilities with recurring outbreaks or high rates of vaccine-preventable illnesses can suffer significant damage to their reputations, leading to reduced occupancy, difficulty attracting new residents, and a loss of trust from families of residents and the wider community.
  • Financial Strain: Managing outbreaks involves increased costs for PPE, testing, deep cleaning, staff overtime and temporary agency staff. Lower occupancy will also impact revenue.
  • Regulatory Scrutiny and Penalties: Health authorities and regulatory bodies are likely to investigate facilities with poor vaccination rates and high rates of infection, potentially leading to fines, sanctions, or even closure in severe cases.
  • Increased Burden on Healthcare System: Outbreaks in aged care facilities place a significant burden on local hospitals and emergency services, as residents may require acute care.

Should Staff in Aged Care Be Mandated for Vaccines?

The question of mandatory vaccination for aged care staff is a complex one, balancing public health decisions with individual rights.

Arguments for Mandating Vaccines for Aged Care Staff (Pros):

  • Protection of Vulnerable Residents: This is the strongest argument. Aged care residents are often frail, immunocompromised, and unable to protect themselves. Mandating vaccination for staff significantly reduces the risk of transmission to this highly vulnerable population, potentially saving lives and preventing severe illness.
  • Ethical Obligation (Fiduciary Duty): Healthcare workers, including aged care staff, have a professional and ethical responsibility to protect their patients. Vaccination is seen as a core component of this duty, demonstrating a commitment to patient safety.
  • Maintaining Workforce Resilience: High staff vaccination rates can reduce staff illness, absenteeism, and the need for isolation, contributing to a more stable and resilient workforce, especially during outbreaks.
  • Proven Effectiveness: Vaccine mandates have historically been effective in increasing vaccination rates and reducing disease spread in healthcare settings.
  • Reduced Burden on Healthcare System: By preventing outbreaks, mandates can reduce the pressure on hospitals and emergency services.

Arguments Against Mandating Vaccines for Aged Care Staff (Cons):
  • Violation of Individual Autonomy and Rights: Opponents argue that mandatory vaccination infringes on an individual's right to choose their medical treatment and make decisions about what to place in their own body.
  • Potential for Staff Shortages: Mandates can lead to some staff resignations or an inability to recruit new staff who refuse vaccination, heightening the existing workforce shortages in aged care.
  • Discrimination and Alienation: Mandates can be perceived as discriminatory, particularly if they disproportionately affect certain demographic groups or lead to the stigmatisation of unvaccinated individuals. It can erode trust and social cohesion.
  • Ethical Concerns about Coercion: While the intent is public health, the use of job security as a lever for vaccination can be seen as coercive.
  • Efficacy Against Transmission (especially for new variants): While vaccines are highly effective at preventing severe disease, their effectiveness in preventing transmission in the case of variants and the efficacy of the vaccine over time, which some argue will weaken the case for mandates solely on a transmission-prevention basis.


Conclusion on Mandates:

The decision to mandate vaccines for aged care staff is a policy choice that requires careful consideration of local context, disease prevalence, vaccine effectiveness, and ethical frameworks. Many jurisdictions have implemented such mandates, particularly during the height of the COVID-19 pandemic, citing the extreme vulnerability of aged care residents as the primary justification. However, it remains a contentious issue with ongoing debate about balancing public health needs with individual liberties. By highlighting these points, your blog post can provide a comprehensive and nuanced discussion on the critical role of immunisation in aged care facilities.

Conclusion

Immunisation in aged care is a dynamic and evolving area of practice. We must commit to understanding the science, addressing hesitancy with empathy, and advocating for robust vaccination programs. By doing so, we not only protect the physical health of our residents and colleagues but also uphold the highest standards of care, ensuring dignity, safety, and quality of life for those in our charge.


Read more on the science behind Immunisation. Fascinating stuff! For more information in general and other blogs, visit the IPS HUB. 

Our next blog will look at immunisation in the general population and why we are seeing the resurgence of the diseases thought to be dying out.

Take advantage of our expertise in IPC. See the HUB for policies, resources and courses relating to this very important subject. Ask EVE for a quick answer to your question.

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