Vaccination Guidelines for Patients with Advanced Dementia

Introduction to Vaccination Recommendations

Patients with advanced dementia should receive both influenza and pneumococcal vaccines to reduce morbidity and mortality from respiratory infections, as recommended by the American Diabetes Association 1
Annual influenza vaccination is strongly recommended for all patients with advanced dementia, with high-dose or adjuvanted influenza vaccine preferred over standard-dose vaccine for patients ≥65 years, according to the American College of Rheumatology 2
Pneumococcal vaccination is strongly indicated for patients with advanced dementia, with PCV13 (pneumococcal conjugate vaccine) administered first, followed by PPSV23 (pneumococcal polysaccharide vaccine) 6-12 months later, as recommended by the American Diabetes Association 1

Influenza vaccination can reduce hospitalization for pneumonia by 29-32% in older adults, as reported by the Infectious Diseases Society of America 3

Influenza vaccine should be administered ideally in September through November in North America, but vaccination is beneficial anytime during flu season, according to the Infectious Diseases Society of America 3
Vaccination can be administered in long-term care facilities, outpatient settings, or during hospital discharge, as recommended by the Infectious Diseases Society of America 3
Influenza and pneumococcal vaccines can be safely administered at the same time in different arms, as recommended by the Centers for Disease Control and Prevention and the Infectious Diseases Society of America 3, 4

Absolute contraindications for influenza vaccine include history of severe allergic reaction (anaphylaxis) to previous doses or vaccine components, and anaphylactic hypersensitivity to eggs or egg products, as reported by the American Diabetes Association 5
Precautions for influenza vaccine include history of Guillain-Barré syndrome within 6 weeks of previous influenza vaccination, as recommended by the Centers for Disease Control and Prevention 5 and 6
Severely immunocompromised individuals should receive inactivated vaccines rather than live attenuated vaccines, as recommended by the Centers for Disease Control and Prevention 7
For those with a history of Guillain-Barré syndrome (GBS) within 6 weeks of a previous influenza vaccination, vaccination should be approached with caution, as advised by the American Academy of Pediatrics and the Centers for Disease Control and Prevention 8, 4, 9

Patients with minor illnesses, including mild upper respiratory infections with or without fever, can safely receive influenza and pneumonia vaccines, but those with moderate to severe febrile illness should defer vaccination until symptoms resolve, as recommended by the Centers for Disease Control and Prevention 3, 8, 4
The presence of nasal congestion or runny nose alone is not a contraindication for vaccination, as stated by the American Academy of Pediatrics 8
For patients with moderate to severe febrile illness, vaccination should be deferred until resolution of the illness, as advised by the American Academy of Pediatrics 8

Use standing orders in long-term care facilities to ensure vaccination, and identify and label medical records of patients who should receive vaccination, as recommended by the Centers for Disease Control and Prevention 6
Document offer of vaccination and receipt or refusal in medical record, as recommended by the Centers for Disease Control and Prevention 6
Patients should be aware of potential side effects of vaccination during minor illnesses, including local reactions, low-grade fever, muscle aches, and fatigue, as stated by the American Academy of Pediatrics 8
The benefits of timely vaccination against influenza and pneumococcal disease generally outweigh the theoretical risks of vaccination during minor illness, as recommended by the Centers for Disease Control and Prevention and the Infectious Diseases Society of America 3, 4