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Published on: July 18, 2014
Immunisation deferral practices surrounding congenital heart surgery
Dana B Gal1,2, John D Cleveland2,3, Jeffrey E Vergales4
1Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Insights
Most pediatric centers delay routine childhood immunizations around congenital heart surgery, increasing risks for vulnerable children. Current practices vary widely and may not be necessary, warranting further research into perioperative immunization safety and efficacy.
Area of Science:
- Pediatric Cardiology
- Immunology
- Public Health
Background:
- Perioperative immunization administration around congenital heart surgery (CHD) is controversial.
- Delayed immunizations increase risks for vaccine-preventable illnesses in medically fragile children with CHD.
- Limited research suggests perioperative immunizations may be safe and effective.
Purpose of the Study:
- To survey current perioperative immunization practices in centers performing congenital heart surgery.
- To identify variations and trends in immunization deferral policies.
- To assess the potential risks associated with current practices.
Main Methods:
- Survey of member centers of the Pediatric Acute Care Cardiology Collaborative.
- Analysis of survey responses using descriptive statistics.
Main Results:
- 35/46 (76%) centers responded, revealing significant variation in practices.
- Most centers (66%) defer immunizations pre-surgery, and 89% defer post-surgery.
- Post-operative deferral is often linked to cardiopulmonary bypass, with variable durations and exceptions for specific vaccines.
Conclusions:
- The majority of centers defer routine childhood immunizations before and after congenital heart surgery.
- These varying deferral practices pose risks to patients and may be unwarranted.
- Further research is needed to understand the immunological impact and optimal timing of immunizations in this population.
Background:
Perioperative immunisation administration surrounding congenital heart surgery is controversial. Delayed immunisation administration results in children being at risk of vaccine-preventable illnesses and is associated with failure to complete immunisation schedules. Among children with CHD, many of whom are medically fragile, vaccine-preventable illnesses can be devastating. Limited research shows perioperative immunisation may be safe and effective.
Methods:
We surveyed Pediatric Acute Care Cardiology Collaborative member centres and explored perioperative immunisation practices. We analysed responses using descriptive statistics.
Results:
Complete responses were submitted by 35/46 (76%) centres. Immunisations were deferred for any period prior to surgery by 23 (66%) centres and after surgery by 31 (89%) centres. Among those who deferred post-operative immunisation, 20 (65%) required deferral only for patients whose operations required cardiopulmonary bypass. Duration of deferral in the pre- and post-operative periods was variable. Many centres included exceptions to their policy for specific vaccine-preventable illnesses. Almost all (34, 97%) centres administer routine childhood immunisation to patients who remain admitted for prolonged periods.
Conclusions:
Most centres defer routine childhood immunisation for some period before and after congenital heart surgery. Centre specific practices vary. Immunisation deferral confers risk to patients and may not be warranted in this population. Further research would be necessary to understand the immunologic impact of these practices.
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