Vaccines In The ED

Vaccination in the ED is usually limited to tetanus and rabies post-exposure prophylaxis. The elderly are less likely to have protective titers for tetanus, even if they have received the vaccine in the past.¹⁸ While the elderly are the group most at risk for tetanus (they represent almost 50% of all tetanus cases), they are least likely to receive a booster.^16,65

Although the pneumococcal vaccine is indicated for all persons 65 and older, only 19-28% of those eligible receive the vaccine.^104,105 Pneumococcal vaccine in the elderly is costeffective and saves lives.¹⁰⁷ More recently, a retrospective analysis demonstrated that an ED-based pneumococcal vaccine program could decrease morbidity, mortality, and hospital costs.¹⁰⁸ Equally important, it is logistically feasible in the ED.¹⁰⁹ Other vaccines may expand the role of the ED in providing preventative medical care.¹¹⁰

Influenza

While influenza is not necessarily more common in the elderly, the morbidity and mortality are much greater.³⁸ The elderly are 20 times more likely to be hospitalized and 10 times more likely to develop bacterial pneumonia after a bout of influenza.¹¹¹ Although vaccination can reduce mortality by up to 60%, many patients remain unimmunized.¹¹² The diagnosis of influenza is clinical; however, rapid detection methods are becoming more readily available.^113,114

Currently there are two drugs used for the treatment of influenza A (not influenza B)?amantadine and
rimantadine. Both have pronounced CNS side effects in the elderly. More treatments for both influenza A and B are expected to be available in the near future.^115,116 Rapid laboratory diagnosis and additional treatment options will dramatically impact the way emergency physicians manage influenza.