Improving Pneumococcal Vaccination in Pediatric Rheumatology Patients

Abstract

BACKGROUND AND OBJECTIVE: Many pediatric rheumatology patients are at increased risk of pneumococcal disease secondary to a deficient immune system and/or immunosuppressive medications. The goal of this study was to improve pneumococcal vaccination rates in this high-risk population.METHODS: Eligible patients included children at least 2 years old and adults with systemic lupus erythematosus and/or currently on immunosuppressive medication. Interventions included a presentation to rheumatology providers, creation of immunization algorithm, previsit planning, placing reminders on clinic forms, and sending reminder e-mails to providers. Chart reviews were performed, and control charts were established to portray change in immunization rates. RESULTS:The preintervention immunization rates for 90 patient visits compared with the immunization rates for the 53-week postintervention period with 1033 patient visits and 299 separate patients were all statistically significant. The 13-valent pneumococcal conjugate vaccine rate increased from 6.7% to 48.4% (x 2 = 58.3, P , .001), 23-valent pneumococcal polysaccharide vaccine rate increased from 8.9% to 28.4% (x 2 = 16.0, P , .001), and combined rate increased from 0% to 23.2% (x 2 = 25.2, P , .001). The improvement was sustained with shifts in the data for each vaccine and combined immunizations for final average rates of 60.9% for 13-valent pneumococcal conjugate vaccine, 39.2% for 23-valent pneumococcal polysaccharide vaccine, and 33.7% for combined.

Immunogenicity, safety and tolerability of anti-pneumococcal vaccination in systemic lupus erythematosus patients: An evidence-informed and PRISMA compliant systematic review and meta-analysis

“…Innovative approaches to improve the vaccine uptake have been developed and implemented, including, for example, the use of Electronic Health Record Best Practice Alert or pre-visit and counselling, especially among SLE paediatric patients (78,79). Further initiatives and techniques should be explored.…”

A quality improvement initiative to increase pneumococcal vaccination coverage among children after kidney transplant

“…Having a dedicated nephrology nurse, or vaccine champion, was critical to implement the interventions, as vaccination rates decreased in temporal association with the renal nurse no longer able to focus on this QI initiative. Along with identifying a local vaccine champion, we suggest that the most important additional interventions to increase vaccine rates include obtaining accurate vaccine records from primary care physicians, storing the actual vaccine in the clinic area, and providing at least monthly feedback to providers on the success of the intervention .…”

“…A 2015 study by Harris et al demonstrated an improvement in pneumococcal vaccination rates among pediatric rheumatology patients using an algorithm and QI process similar to ours. However, combined vaccination rates, defined as having received PCV13 and PPSV23, only increased to 23% by the end of their yearlong QI initiative, and missed opportunities at the visit level were not evaluated . The experience of QI projects focused on PPSV23 administration to high‐risk populations has also been reported.…”

Efficacy of Pneumococcal Polysaccharide Conjugate Vaccine (13-valent, Adsorbed) in Patients with Systemic Juvenile Idiopathic Arthritis Treated with Genetically Engineered Biologic Drugs (Tocilizumab or Canakinumab): Prospective Cohort Study

“…Пневмококковая вакцинация существенно снижает частоту инвазивных пневмококковых болезней [23]. Обобщая результаты международных исследований и рекомендаций, можно с уверенностью сделать вывод о положительном эффекте вакцинации против пневмококка у больных сЮИА [23].…”

“…Пневмококковая вакцинация существенно снижает частоту инвазивных пневмококковых болезней [23]. Обобщая результаты международных исследований и рекомендаций, можно с уверенностью сделать вывод о положительном эффекте вакцинации против пневмококка у больных сЮИА [23]. Однако сомнения врачей в безопасности вакцинации пациентов с аутоиммунными заболеваниями, равно как и других больных с иммунодефицитом или получающих иммунодепрессанты, а также отсутствие четкого алгоритма действия в подобных ситуациях приводят к тому, что медицинские работники часто отказываются от вакцинации «сложных» пациентов [24].…”