Nursing Home Residents Under-Vaccinated Against COVID-19, Flu and RSV, November 2024

Nursing home residents face some of the highest risks of severe illness from COVID-19, influenza and respiratory syncytial virus (RSV), and vaccines lower those risks. Yet early in the 2024–25 respiratory season, most residents weren't fully protected.

What's recommended

• The Advisory Committee on Immunization Practices (ACIP) recommends a 2024–2025 COVID-19 vaccine and a yearly flu vaccine for everyone 6 months and older.
• Since June 2024, ACIP has recommended one dose of RSV vaccine for all nursing home residents 60 and older. Among people 60+ hospitalized with RSV in July 2022–June 2023, 17% lived in long-term care.

Since 2021, the Centers for Medicare & Medicaid Services has required nursing homes to report residents' COVID-19 vaccination weekly to CDC's National Healthcare Safety Network (NHSN); since October 2023 they may voluntarily report flu and RSV vaccination too.

Coverage as of November 10, 2024

Vaccination coverage among nursing home residents by jurisdiction and HHS region, November 2024. Image from CDC's report

HHS Region 8 — Colorado, Montana, North Dakota, South Dakota, Utah and Wyoming — led on COVID-19 and RSV and came second on flu; within it, South Dakota led on COVID-19 and RSV and North Dakota on flu. Coverage for all three vaccines was highest in small facilities and in the least socially vulnerable counties, and lowest in large facilities.

Compared with last year and with older adults

The surveys use different methods and can't be compared directly, but the pattern — residents behind on COVID-19 and RSV — matches the previous season.

Why it matters

• In each week of October 2024, about 5,500 residents were diagnosed with COVID-19 and 360 were hospitalized after testing positive.
• In 2023–24, adults 65 and older accounted for 70% of COVID-19 hospitalizations, and about one in six adults hospitalized with COVID-19 lived in a nursing home. Residents' peak hospitalization rate — 7.1 per 10,000 — was about eight times that of all adults 70 and older.

Why coverage is low

• Low demand, as in the wider population: mistrust, and worries about safety, effectiveness, speed of development and mRNA technology for COVID-19 vaccines; misinformation affects others.
• Cost and billing: RSV and COVID-19 vaccines cost more than flu vaccine, and RSV vaccines are billed to Medicare Part D, which some nursing homes aren't set up to bill — likely hitting low-resource homes hardest.

A strong recommendation from facility clinicians and leaders helps. Small homes' higher coverage suggests staff there may build trust more easily, and North and South Dakota's results suggest strong state partnerships work.

What's being done

• a CDC–CMS fact sheet on billing Medicare for respiratory vaccines
• NHSN data shared with health departments and quality improvement organizations to reach low-coverage homes
• CDC webinars, a respiratory pathogens toolkit for nursing homes, and a "Why Get Vaccinated" counseling sheet
• the HHS-funded "Risk Less. Do More." vaccine confidence campaign for older adults

Limits

Flu and RSV reporting is voluntary — though reporting homes resemble all homes — and far more homes reported this year than last, which limits comparison. Data aren't broken down by age, so RSV coverage counts residents of all ages, not just the roughly 91% who are 60 or older; coverage among those eligible was likely higher.

Sources

Based on Hannah E. Reses, George Segovia, Heather Dubendris and colleagues, "Coverage with Influenza, Respiratory Syncytial Virus, and COVID-19 Vaccines Among Nursing Home Residents — National Healthcare Safety Network, United States, November 2024," MMWR, volume 73, Centers for Disease Control and Prevention; a work of the United States government in the public domain.