"The 2011-2012 Flu Season Is Upon Us" (Emerging Infections, December 2011) was most informative and appreciated.

I'm affiliated with a very large retirement community where residents range in age from 60 to 102. Some are immunocompromised because of cancer treatments such as radiation, chemotherapy, and leuprolide and bicalutamide.

Is it really safe to administer flu or pneumonia vaccines to these patients? This year I've seen more adverse reactions to the flu vaccine.

Lois Lobdell, RN

Portland, OR

Author Betsy Todd responds: While the Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention prioritize the vaccination of high-risk patients, such as those with cancer, decisions about the benefits and risks of vaccinating are ultimately up to the patient's health care provider. Other measures can be taken to prevent the transmission of infection, regardless of whether an older person is vaccinated. Family and caregivers who are in regular contact with these patients should be vaccinated. Education on "standard precautions" for residents and family that emphasize hand hygiene (especially in public spaces) and cough etiquette can be effective. Environmental cleaning in any congregate living setting should be emphasized during the winter months, or whenever a resident exhibits influenza-like symptoms. Residents (when appropriate) and nurses should assist in this effort by using disinfectant wipes to wipe down tables, counters, handrails, doorknobs, and other "high touch" surfaces in common areas.