The 2nd COVID-19 Booster effectively prevents hospitalizations and deaths among nursing home residents. However, it is less effective in preventing severe infections.
A combination of factors causes low vaccination rates in nursing homes. The key drivers are vaccine hesitancy, lack of consent from relatives, and ineligibility for a booster because of receiving a last vaccine dose or monoclonal antibody.
Immune Responses
The effectiveness of the 2nd COVID-19 booster was assessed in a group of nursing home residents who had previously received the mRNA vaccine. This population is a high-risk group with a higher likelihood of experiencing breakthrough infections than other vaccinated populations.
Vaccine-induced immunity is critical in controlling disease severity and avoiding complications. However, few studies compare immunogenicity in a vulnerable group of older individuals with multiple comorbidities and frailty.
A cohort of nursing-home residents was evaluated at baseline and follow-up for SARS-CoV-2-specific immune responses to the mRNA vaccine. These patients were categorized as either SARS-CoV-2-naive or with documented prior SARS-CoV-2 infection.
Immune responses to the mRNA COVID-19 vaccine were comparable between naive and recovered nursing-home residents. SARS-CoV-2-reactive IFN-g CD8+ and CD4+ T cells were detected in a majority of both naive and recovered participants at baseline.
Infection Rates
Nursing home residents are disproportionately affected by COVID-19 and are at risk for severe outcomes, including death. Older age, comorbidities, and the congregate nature of nursing homes place nursing home residents at high risk for infection.
The 2nd COVID-19 Booster (Pfizer-BioNTech, Moderna, or Novavax) effectively reduces COVID-19 infections and severe outcomes among long-term nursing home residents, as demonstrated in a recent study by the VA. The study evaluated infection rates among nursing home residents who had received a primary monovalent vaccine series and either a monovalent booster dose within 2 months or the new bivalent booster.
The incidence rate ratio (IRR) for weekly COVID-19 cases was 1.3 to 1.5 for nursing home residents up-to-date with their vaccination status. These findings support the need to continue encouraging up-to-date vaccination among nursing home residents and encourage them to receive a bivalent booster dose as soon as possible.
Prevention
Infection is one of the leading causes of illness and death in nursing home residents. They are especially vulnerable to infection-related complications due to aging, chronic conditions, and other health factors.
Infected residents may spread germs to other patients, staff, and visitors. Infections can be prevented by placing infected residents in rooms with low-risk infection-spreading germs, using a cohort approach to place infected residents with other residents at lower risk of infection, and using contact isolation precautions when needed.
While the COVID-19 pandemic has focused on how vulnerable nursing homes are to infections, countless other infectious diseases pose similar risks to older people and people with severe health problems in these facilities. Researchers have been working for years to find ways to prevent infections in these settings.
Vaccination Recommendations
Vaccines have dramatically impacted COVID infections and deaths in nursing homes. Despite the initial concerns that they might not work in long-term care facilities, the vaccines appear to have reversed waning immunity.
Booster doses of the second COVID-19 mRNA vaccine have boosted resident and staff immune responses. Nevertheless, the vaccine is still lagging behind state expectations for vaccination rates among vaccinated individuals, especially older people.
As a result, states are now determining which groups should be prioritized for vaccination, even as they work out how to distribute the vaccine to the millions of nursing home residents and staff members who have been immunized thus far.
In this study, researchers followed the healthcare personnel and residents of 196 US community nursing homes for up to 12 weeks after the second COVID-19 mRNA booster to assess its effectiveness (VE). They found that the VE was significantly higher among vaccinated residents than unvaccinated ones.