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Suboptimal Immunisations in Children With a Ventriculoperitoneal Shunt-Can We Do Better?
Emily Elliott1, Tamasine McGeown1, Sonya Stacey1,2
1Pharmacy Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.
Insights
Children with ventriculoperitoneal (VP) shunts have suboptimal immunisation rates, especially for pneumococcal vaccines. This increases their risk of vaccine-preventable infections, necessitating improved strategies for this vulnerable group.
Area of Science:
- Pediatric Neurology
- Immunology
- Public Health
Background:
- Children with ventriculoperitoneal (VP) shunts are considered at increased risk for infections.
- The Australian National Immunisation Program (NIP) provides a schedule of vaccinations, with additional recommendations for at-risk groups, including pneumococcal vaccines.
- Assessing immunisation coverage in this specific pediatric cohort is crucial for understanding their vulnerability to vaccine-preventable diseases.
Purpose of the Study:
- To evaluate the immunisation status of children with VP shunts against the Australian NIP schedule.
- To assess the uptake of additional recommended pneumococcal immunisations (13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine) in this cohort.
- To determine the prevalence of invasive pneumococcal disease (IPD) in children with VP shunts.
Main Methods:
- Children with VP shunts were identified using surgical codes from electronic medical records (EMR) over a 5-year period.
- Immunisation status and IPD prevalence were determined by accessing EMR and the Australian Immunisation Record as of June 2022.
- Data analysis focused on comparing vaccination rates to NIP recommendations and identifying IPD cases.
Main Results:
- Out of 207 children with VP shunts, 86% were up-to-date with standard NIP immunisations.
- Only 40% received an additional 13-valent pneumococcal conjugate vaccine (13vPCV), and uptake for 23-valent pneumococcal polysaccharide vaccine (23vPPV) was 55% for the first dose and 25% for the second.
- Overall, 25% received all eligible additional pneumococcal immunisations. Two cases of IPD were reported, both in immunocompromised children.
Conclusions:
- Immunisation coverage for routine vaccines in children with VP shunts is lower than national rates.
- Uptake of additional pneumococcal immunisations in this at-risk group is suboptimal, potentially increasing their susceptibility to infections.
- There is a need for targeted strategies to improve immunisation completeness in children with VP shunts to mitigate risks.
Aim:
To assess the immunisation status of children with a ventriculoperitoneal (VP) shunt as recommended per the Australian National Immunisation Program (NIP), including additional recommended pneumococcal immunisations. The secondary aim assessed the prevalence of invasive pneumococcal disease (IPD) in this cohort.
Methods:
Patients were identified via surgical codes utilising electronic medical records (EMR) over a 5-year period. Patients' EMR and Australian Immunisation Record were accessed to identify immunisation status and prevalence of IPD (as of 30 June 2022).
Results:
A total of 245 children were identified, and after exclusion criteria, 207 remained. Of the cohort (n = 207), 86% were up to date with standard NIP immunisations, however only 40% received an additional dose of 13-valent pneumococcal conjugate vaccine (13vPCV). For eligible children, 55% received the first dose of 23-valent pneumococcal polysaccharide vaccine (23vPPV), and only 25% received the second dose of 23vPPV. Overall, 25% of children received all eligible additional pneumococcal immunisations. Only two children were diagnosed with IPD, of which one received all eligible additional pneumococcal immunisations. Both were immunocompromised and neither strain was preventable with current immunisations.
Conclusion:
Coverage with routine immunisations in children with a VP shunt is suboptimal compared to Australian national immunisation rates. The rates of additional pneumococcal immunisation for at-risk children are less optimal, placing them at increased risk of vaccine-preventable infections. Strategies should be implemented to increase immunisation completeness in this cohort.
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