Immunization Adherence in Children With Sickle Cell Disease: A Single-Institution Experience

Abstract

OBJECTIVES The Advisory Committee on Immunization Practices (ACIP) recommends additional immunizations for people with asplenia or functional asplenia, such as children with sickle cell disease. Adherence rate to the recommended immunization schedule for functional asplenia remains low for children with sickle cell disease. The purpose of this study was to assess the immunization adherence for this population at a single institution in Kentucky and to evaluate the use of the Kentucky Immunization Registry (KYIR) by providers. METHODS A single-center retrospective chart review was conducted for 107 children with sickle cell disease ages 2 through 18 years. Immunization histories were obtained from the hospital EMRs, the sickle cell clinic EMR, the KYIR, and by requesting records from primary care physicians. Each patient was documented as either missing or having complete records in the KYIR. RESULTS The complete adherence rate to the ACIP-recommended immunization schedule for children with functional asplenia was 6% (6 of 107). Nearly all children were compliant with the Haemophilus influenzae type B vaccination, whereas the adherence rate for the meningococcal and pneumococcal vaccines ranged from 25% to 77%. The lowest immunization rate was observed in children eligible for the meningococcal B vaccine (25%). Only 3 patients had a complete immunization history documented in the KYIR. CONCLUSIONS Adherence to the ACIP-recommended immunization schedule for functionally asplenic patients is poor among children with sickle cell disease included in this study. Quality improvement measures should focus on increasing immunization adherence and improving documentation of immunization records in the KYIR for this patient population.

Immunization adherence among children with sickle cell disease and sickle cell trait: Results of a population‐based study

“…Studies have found that children with SCD have lower adherence to the immunization schedule for SCD‐specific vaccines than general vaccines 31,43 . This indicates a need for coordinated care between pediatricians and hematologists for children with SCD to help providers understand the importance of SCD‐specific vaccines and facilitate administration specifics on the supply and distribution of these vaccines 44 . Further, the introduction of new vaccines, such as the 15‐valent and 20‐valent pneumococcal conjugate vaccines, is expected to impact the UTD rates of pneumococcal vaccines 39 .…”

“…31,43 This indicates a need for coordinated care between pediatricians and hematologists for children with SCD to help providers understand the importance of SCD-specific vaccines and facilitate administration specifics on the supply and distribution of these vaccines. 44 Further, the introduction of new vaccines, such as the 15-valent and 20-valent pneumococcal conjugate vaccines, is expected to impact the UTD rates of pneumococcal vaccines. 39 Future research should explore the uptake and effects of these newly introduced vaccines on the population with SCD.…”

Influenza vaccination rates and hospitalizations among Medicaid enrollees with and without sickle cell disease, 2009–2015

“…However, US investigators have reported lower coverage estimates. A single‐center evaluation in Louisville, KY in 2017 indicated 52% of children with SCD adhered to influenza vaccination recommendations 35 . Similarly, an investigation among children with SCD referred to services in Indiana between 2009 and 2017 found that although 60% of children received at least one influenza vaccination, the annual proportion declined over time and was 33% by the end of the study period 36 .…”

Vaccination Rates in Pediatric Sickle Cell Patients in Louisiana

“…14 In Kentucky, A 2020 study showed that only 6% of children with functional asplenia due to sickle cell disease having complete adherence to ACIP guidelines. 15 While 1 study in Michigan found increased compliance to PPSV23 vaccination in sickle cell patients, their rates were lower than state and national compliance rates. 7 In Louisiana, similar results were observed, as 59% of children did not receive the second dose of the pneumococcal vaccine.…”