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Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
A quality improvement study: Optimizing pneumococcal vaccination rates in children with cochlear implants
S Tay1, A C Bowen2, C C Blyth2
1Immunisation Service, Department of Infectious Diseases, Perth Children's Hospital, Western Australia, Australia.
Insights
Children with cochlear implants often miss recommended pneumococcal vaccines. Strategies like electronic reminders and dedicated clinics significantly improved vaccination rates, reducing the risk of invasive pneumococcal disease in this vulnerable group.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases
- Vaccinology
Background:
- Children with cochlear implants face a higher risk of invasive pneumococcal disease.
- Guidelines recommend additional pneumococcal vaccines for these children.
- Immunization status in this group is often suboptimal.
Purpose of the Study:
- To assess pneumococcal immunization status and invasive pneumococcal disease rates in children with cochlear implants.
- To evaluate the impact of vaccination reminders and a dedicated immunization clinic on vaccination rates.
- To identify strategies for improving vaccine uptake in medically-at-risk pediatric populations.
Main Methods:
- Quality improvement study over 12 years at a tertiary pediatric hospital.
- Included 200 children with cochlear implants.
- Assessed impact of electronic reminders and a nurse-led immunization clinic.
Main Results:
- 88% of children were not up-to-date with recommended pneumococcal vaccines.
- 2% of children developed invasive pneumococcal disease.
- Electronic reminders increased vaccine uptake from 12% to 49%.
- Dedicated clinic achieved 100% uptake for Prevenar13 and 81% for Pneumovax23.
Conclusions:
- A significant proportion of children with cochlear implants remain under-vaccinated against pneumococcal disease.
- Interventions like electronic reminders and dedicated clinics are effective in improving vaccine uptake.
- The demonstrated model can be expanded to other at-risk pediatric groups.
Abstract:
Children with cochlear implants are at increased risk of invasive pneumococcal disease, with national and international guidelines recommending additional pneumococcal vaccines for these children. This study aimed to examine the pneumococcal immunization status and rate of invasive pneumococcal disease in children with cochlear implants at a tertiary paediatric hospital over a 12-year period. Additionally, the impacts of vaccination reminders and a dedicated immunization clinic on pneumococcal vaccination rates were assessed. This quality improvement study included 200 children who had received a cochlear implant through the Children's Hearing Implant Program at a tertiary paediatric hospital servicing the state of Western Australia. The majority of children (88%) were not up to date with additionally recommended pneumococcal vaccinations. Over the 12-year study period, 2% of children developed invasive pneumococcal disease associated with cochlear implant infections. Generic and personalized electronic immunization reminders improved pneumococcal vaccine up-take in this paediatric cochlear implant setting from 12% (19/153) at baseline to 49% (75/153, p < 0.0001) post implementation. The value of a nurse-led dedicated immunization clinic was also demonstrated with all children (42/42, 100%) up to date with Prevenar13 and the majority (34/42, 81%) up to date with Pneumovax23 post initiation of this referral pathway. These data support the expansion of this model to other medically-at-risk paediatric groups that have been highlighted consistently to be under-vaccinated.
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