Some states require long-term care facilities — nursing homes, skilled nursing facilities and others that give medical and personal care to people who can't live independently — to assess, offer or require pneumococcal vaccination. This CDC survey, one of a series on vaccination requirements in healthcare facilities, collected those laws from WestlawNext on October 19–27, 2016 (published September 11, 2017).
Why pneumococcal disease
- The germ: Streptococcus pneumoniae (pneumococcus) causes many illnesses, some life-threatening — invasive pneumococcal disease, meningitis, bloodstream infections, pneumonia and ear infections — and is one of the most common causes of severe pneumonia.
- The toll: an estimated 900,000 Americans get pneumococcal pneumonia each year, and about 5%–7% die. More than 95% of U.S. pneumococcal deaths are in adults, yet about 67 million adults at increased risk remain unvaccinated.
- In facilities: the bacteria spread between workers and patients through contact with respiratory secretions.
- Vaccines: very good at preventing severe disease, hospitalization and death — the safest, most effective protection.
| Vaccine (as described in the survey) | Recommended for |
|---|---|
| Conjugate | all children under 2; all adults 65 or older; ages 2–64 with certain conditions |
| Polysaccharide | all adults 65 or older; ages 2–64 at increased risk; adults 19–64 who smoke |
The page's summary now gives CDC's recommendation as adults 50 or older; its 2017 text says 65 or older. See CDC's pneumococcal vaccination and recommended adult vaccines.
What the laws can require
| Requirement | The facility must… |
|---|---|
| Assessment | check a worker's or resident's vaccination status |
| Offer | offer vaccination |
| Ensure | require proof of vaccination or immunity |
Exemptions may be medical, religious or philosophical; even without a stated exemption, people with a medical contraindication wouldn't be required to be vaccinated.
Headline results
29 states have requirements for residents; only six for workers — expected, since ACIP doesn't recommend pneumococcal vaccination for healthcare workers who don't meet the age or risk criteria.
| Group | States | Scope | Assess | Offer | Ensure | Exemptions |
|---|---|---|---|---|---|---|
| Workers | 6 | all workers 5; age- or risk-based 1 (D.C.) | 4 | 4 | 5 | medical 6, religious 5, philosophical 6 |
| Residents | 29 | all residents twenty-two; 65 or older nine; at-risk three | twenty-three | twenty-four | twenty-two | medical 27, religious fourteen, philosophical twenty-three |
Examples: workers
- New York: every long-term care facility must ask employees to be immunized against influenza and pneumococcal disease, require documentation, and require immunization — with exemptions for religious belief or an informed refusal.
- District of Columbia: nursing facilities must ensure each employee has been immunized or has refused; employees 65 or older, or younger with conditions such as chronic heart or lung disease, diabetes, alcoholism, chronic liver disease, or weakened immunity, must be immunized unless medically contraindicated.
- Kentucky: on hiring, facilities must assess immunization status and provide or arrange vaccination; religious objections are allowed.
- Utah: facilities must make pneumococcal immunization available every year to employees not immunized; those who refuse are exempt.
- Rhode Island: facilities must ask employees to be immunized, except where the vaccine is contraindicated.
- Pennsylvania: employees may refuse after being fully informed of the risks.
Examples: residents
- Kentucky, New York and North Carolina: facilities must require residents to be immunized.
- Arkansas: nursing homes require residents to be immunized as a condition of residency.
- Delaware: facilities must keep evidence of vaccination for residents older than 65.
- Texas: nursing homes must offer vaccination to residents 65 or older and to younger residents with chronic illness, and complete it unless it's contraindicated or refused.
- Florida: residents are assessed for eligibility within 5 business days of admission and vaccinated within 60 days if indicated, with religious exemptions.
- Georgia: nursing homes must offer the vaccine to all Medicare-eligible patients and private-pay patients 65 or older.
- Rhode Island: facilities must document each resident's immunization with the date and place.
- Illinois and Hawaii: vaccination unless medically contraindicated; Maryland allows religious objections; New Jersey allows residents to refuse.
About this survey
Developed by CDC's Public Health Law Program with CDC's National Center for Immunization and Respiratory Diseases. It is not legal advice; its findings are the authors' and not necessarily CDC's official views. State-by-state tables are in the appendices and a combined PDF.
Sources
Based on "Pneumococcal Vaccination Laws for State Long-Term Care Facilities," Public Health Law Program, 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
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