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Immunization Adherence in Children With Sickle Cell Disease: A Single-Institution Experience
Insights
Immunization adherence is poor for children with sickle cell disease, especially for meningococcal B vaccines. Improving vaccination rates and Kentucky Immunization Registry (KYIR) documentation is crucial for these functionally asplenic patients.
Area of Science:
- Pediatric Hematology
- Immunology
- Public Health
Background:
- Advisory Committee on Immunization Practices (ACIP) recommends specific immunizations for individuals with functional asplenia.
- Children with sickle cell disease, a common cause of functional asplenia, exhibit low adherence to these recommended vaccines.
- Assessing adherence and registry use is vital for improving preventive care in this vulnerable population.
Purpose of the Study:
- To evaluate immunization adherence to ACIP guidelines for children with sickle cell disease.
- To assess the utilization of the Kentucky Immunization Registry (KYIR) by healthcare providers for this patient group.
- To identify specific vaccines with low adherence rates in functionally asplenic children.
Main Methods:
- Retrospective chart review of 107 children (ages 2-18) with sickle cell disease at a single institution.
- Immunization histories were compiled from electronic medical records (EMRs), the KYIR, and primary care physician records.
- Patients were categorized based on the completeness of their immunization history in the KYIR.
Main Results:
- Overall adherence to the ACIP-recommended immunization schedule was low at 6%.
- High compliance was observed for Haemophilus influenzae type B vaccine, but rates for meningococcal and pneumococcal vaccines varied (25%-77%).
- Meningococcal B vaccine showed the lowest adherence rate (25%), and only 3 patients had complete immunization histories in the KYIR.
Conclusions:
- Children with sickle cell disease demonstrate poor adherence to recommended immunizations for functional asplenia.
- Quality improvement initiatives are needed to enhance vaccination rates and improve the documentation of immunization records in the KYIR.
- Targeted interventions may be necessary to address low adherence for specific vaccines like meningococcal B.
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.
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