Abstract

Each year, an estimated 35,000 older Americans die of pneumonia and influenza-like illness.¹ These figures have remained constant over the past several decades, despite the availability of vaccines to prevent both influenza and Streptococcus pneumoniae infections. Following reports of deaths due to influenza or pneumonia among older, previously hospitalized patients during their last year of life (ie, among those hospitalized in the prior year, but without vaccination for influenza and pneumococcus), initiatives to vaccinate hospitalized, older patients against influenza and pneumococcus were reported as early as 1983. Fedson and Kessler² reported that only 2 out of 112 older patients admitted for influenza, pneumonia, or chronic pulmonary diseases had been immunized against influenza or Streptococcus pneumoniae during hospitalizations in the previous 12 months. Subsequently, in 1986, the Centers for Disease Control and Prevention recommended that hospitals provide immunizations for influenza, and for Streptococcus pneumoniae in 1989, prior to discharge.^3,4 While physicians agreed in principle to the concept, this was a departure from the historical practice of the physician’s office serving as the primary vaccination site for most patients.