Publication Date
10-1-2023
Journal
Transplantation and Cellular Therapy
DOI
10.1016/j.jtct.2023.07.020
PMID
37517611
PMCID
PMC10592250
PubMedCentral® Posted Date
10-1-2024
PubMedCentral® Full Text Version
Author MSS
Published Open-Access
yes
Keywords
Humans, Hematopoietic Stem Cell Transplantation, Quality Improvement, Immunization, Secondary, Female, Child, Male, Cross-Sectional Studies, Child, Preschool, Time Factors, Infant, immunizations, immune reconstitution, quality improvement, pediatrics
Abstract
Background:
Revaccination after hematopoietic cell transplantation (HCT) is critical to prevent morbidity and mortality from vaccine preventable illnesses. While earlier re-vaccination after HCT is desirable, they may be ineffective if deployed before partial reconstitution of adaptive immunity. Increasingly, personalized approaches to re-vaccination after HCT have replaced time-based protocols in order to minimize unvaccinated time and enhance vaccine effectiveness. Furthermore, for revaccination to be maximally beneficial, compliance with, and timely delivery of the complete revaccination schedule is imperative, but rare, and there is little data on strategies to optimize vaccine delivery.
Objectives:
The global aim of our quality improvement initiative was to enhance timely, correct, and effective revaccination after pediatric HCT. The SMART aim of our project was to decrease median unvaccinated time by four months, by decreasing time to vaccine eligibility, time from eligibility to vaccine start and time to completion of vaccine series.
Quality improvement interventions:
A multidisciplinary group performed a cross-sectional quantitative and qualitative evaluation of revaccination practices at our institution, we identified factors associated with delayed, incorrect, or incomplete revaccination. Several plan-do-study-act interventions were implemented to address these drivers including revising immune readiness criteria, increased auditing of primary care administered immunizations and importantly, establishing a dedicated revaccination clinic within the HCT clinic at our center.
Results:
Time to vaccine eligibility decreased from 12.6 months to 10 months (20% decrease) and time to complete vaccine series decreased from 19.3 months to 15.7 months (19% decrease). The proportion of patients who started re-vaccination within 13 months from HCT increased from 55% to consistently greater than 90%.
Conclusions:
With a quality improvement initiative, we addressed the many causes of delayed or incomplete revaccination post-HCT and through a team-based approach successfully decreased time to vaccine start and vaccine completion at our center. We believe this initiative can similarly be implemented within HCT centers at peer institutions, in both pediatrics and adults, to improve revaccination after transplantation.
Graphical Abstract
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Diseases Commons, Influenza Humans Commons, Influenza Virus Vaccines Commons, Medical Sciences Commons, Medical Specialties Commons, Quality Improvement Commons
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