Nursing home residents are especially likely to catch — and to suffer severe complications from — COVID-19, influenza and respiratory syncytial virus (RSV). In 2023 the Food and Drug Administration approved the first two RSV vaccines for adults 60 and older, which made 2023–24 the first season in the United States with vaccines against all three viruses available at once.
CDC recommends an updated 2023–24 COVID-19 vaccine and a seasonal flu vaccine for everyone 6 months and older. For adults 60 and older, it recommends RSV vaccination through shared clinical decision-making between patient and provider — and living in a nursing home is an important risk factor to weigh.
How coverage is tracked
Since 2021, the Centers for Medicare & Medicaid Services (CMS) has required nursing homes to report residents’ COVID-19 vaccination each week to CDC’s National Healthcare Safety Network (NHSN). From October 21, 2023, they could also report flu and RSV vaccination voluntarily. For each vaccine, facilities count residents who received it, who had a medical reason not to (these are left out of the calculation), who declined, and whose status was unknown. CDC analyzed the data for the week of December 10, 2023.
COVID-19 data came from 14,646 nursing homes — 96.9% of those certified by CMS. Flu data came from 3,046 (20.2%) and RSV data from 2,939 (19.4%) of 15,113 facilities. Those voluntary reporters resembled all nursing homes in region, county social vulnerability and size.
What coverage looked like
| Vaccine | Residents vaccinated | Lowest regions | Highest region |
|---|---|---|---|
| Updated COVID-19 | 33.1% | 22.5% (Region 6) | 42.9% (Region 8) |
| Influenza | 72.0% | 64.3% (Region 10), 64.8% (Region 4) | 79.9% (Region 8) |
| RSV | 9.8% | 5.9% (Region 4), 7.1% (Region 2) | 24.8% (Region 8) |
Regions are those of the U.S. Department of Health and Human Services.
Nursing home residents’ vaccination coverage by state: A, COVID-19; B, influenza; C, RSV. Image from CDC’s page.
Region 8 led on all three, driven largely by North Dakota and South Dakota, where strong, persistent communication among nursing homes, health systems, health departments and pharmacies is credited.
Two other patterns held for every vaccine:
- Social vulnerability. Coverage was highest in the least socially vulnerable counties and lowest in the most vulnerable: 38.5% against 29.1% for COVID-19, 73.7% against 70.9% for flu, and 10.7% against 8.7% for RSV.
- Facility size. Small homes (58 or fewer residents) did best: 37.3% for COVID-19 against 32.3% in medium and 32.2% in large homes; 77.4% for flu against 72.2% and 69.8%; and 15.3% for RSV against 8.0% in large homes. Staff in small homes, with fewer residents each, may be better placed to build trust with residents and families.
Why coverage was low
Nursing home residents’ COVID-19 and RSV coverage fell below that of older adults generally, as measured by the National Immunization Survey (37.4% for COVID-19 among people 65 and older, 17.0% for RSV among people 60 and older), while their flu coverage was slightly higher (against 69.3%). The two sources use different methods, so the comparison is only a pointer.
Vaccine fatigue, inaccurate health information and vaccine hesitancy all weigh on demand, especially in socially vulnerable areas, where access and the cost and payment problems that followed the commercialization of COVID-19 vaccines may add to the gap.
RSV coverage may have been lowest because the recommendation was so new; because it meant a fourth respiratory vaccine on top of flu, COVID-19 and pneumococcal vaccines; because adding a vaccine takes time to put into practice; and because shared decision-making needs trained providers and new procedures. Staff may also know less about RSV outbreaks and severe disease among residents.
Flu shows what sustained effort achieves: annual flu vaccination has been recommended for everyone since the 2010–11 season, and CMS requires nursing homes to educate residents about and offer both flu and COVID-19 vaccines.
Limitations
- Flu and RSV reporting was voluntary and uncommon; reporters may be more likely to offer those vaccines.
- The data are facility totals, so coverage could not be broken down by age, race or ethnicity — and RSV coverage was calculated over all residents, not just the roughly 91% aged 60 or older, so the true figure among eligible residents is likely higher.
- NHSN does not record the outcome of shared decision-making or why residents declined.
What it means
The authors call it urgent to raise COVID-19 and flu vaccination among nursing home residents and to discuss RSV vaccination with those eligible. Providers should tell residents that vaccination is the most effective way to prevent severe COVID-19, flu and RSV, and offer the recommended vaccines. CDC was sharing the surveillance data with health departments and quality-improvement organizations to target outreach, learning from high-coverage homes, providing a provider toolkit, and working with CMS on reported billing barriers.
Sources
Based on Reses HE, Dubendris H, Haas L, et al., "Coverage with Influenza, Respiratory Syncytial Virus, and Updated COVID-19 Vaccines Among Nursing Home Residents — National Healthcare Safety Network, United States, December 2023," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
1
0
0
0
Comments
