Work

Development of Care Pathway to Ensure Timely and Appropriate Re-Vaccination in Pediatric Survivors of Stem Cell Transplant (SCT)

Year: 2017

Type: article

Abstract: Background: Patients undergoing hematopoietic stem cell transplants are known to have declining levels of antibodies to vaccine-preventable diseases. This is principally important in the pediatric population as exposure to vaccine-preventable diseases occur daily in daycare and school settings. For those eligible, re-vaccination provides a reprieve from use of IVIG and prophylactic antibiotics. However, in a community based setting, barriers to complete revaccination, such as, primary care providers' reluctance, lack of patient compliance and parental hesitancy to vaccinate in current cultural climate, are present. Using the CDC recommended re-vaccination schedule, we report a community-based model of re-vaccination utilizing the EPIC EMR and a case manager run database to deliver efficient population care management to address this care gap. Methods: We performed a retrospective review of re-vaccination efforts in pediatric post-BMT survivors. Inclusion criteria were patients must be 0-18 year old, currently living and at least 2 years post stem cell transplant. Exclusion criteria were patients on high dose immunosuppressants or active chemotherapy or patients with documented active graft-versus host disease. Patients with incomplete vaccine profiles were called by an MD, appropriately counseled, their electronic medical records updated to reflect the need for re-vaccination and vaccination status tracked using a centralized database. Results: Initial rate for complete revaccination for all transplant recipients was 5%. Of the 57 total patients at least 2 years post BMT, 16 were post-autologous BMT (0% completed revaccination) and 41 patients were post-allogeneic BMT (7% completed revaccination). However ~30% of patients could complete re-vaccination with 1 visit. Four months after presenting this data our regional transplant coordinator and various PCPs, rates of complete revaccination increased by three fold to ~14% and almost four fold ~18% if those refusing only HPV are included. Two patients initially included were excluded after one relapsed and one transferred care to another institution. Conclusions: We propose that by employing a case manager database to notify families of re-vaccination and amending EMR problem lists, we can analyze those eligible for re-vaccination, equip primary care providers with re-vaccination schedules and ultimately improve revaccination rates in this at-risk population. Our rates of re-vaccination for patients post-autologous BMT are likely due to our practice of checking titers to verify immunization status prior to proceeding with re-vaccination. A vast majority are found to be non-immune and highlights the need for all patients post-BMT to receive immunizations. At the time of this submission, we are in the process of addending EMR and contacting patients; full analysis of data to be completed in May of 2017.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2016.12.512

Authors: Jerry C. Cheng, Andrew Sy, Sylvia Reyes-Hatfield

Institutions: Kaiser Permanente, Los Angeles Medical Center

Language: English

Topic: Immunodeficiency and Autoimmune Disorders

Subfield: Immunology

Field: Immunology and Microbiology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,650