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Kazi B, Talukdar Z, Schriefer J. Quality Improvement Interventions to Enhance Vaccine Uptake in Cancer Patients: A Systematic Review. J Healthc Qual 2024; 46:81-94. [PMID: 38421906 DOI: 10.1097/jhq.0000000000000422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Cancer patients, because of their compromised immune responses, face a higher risk of preventable infections, leading to increased morbidity and mortality. Despite this, vaccination rates among these patients are suboptimal, and research on effective interventions to improve vaccination rates is limited. METHODS We conducted a comprehensive search in PubMed and Cochrane Library for studies investigating quality improvement (QI) interventions targeting vaccine uptake in cancer patients. Two authors independently screened, extracted data, and analyzed studies, resolving any discrepancies through consensus. RESULTS Thirteen studies met the inclusion criteria, published between 2014 and 2022. Seven studies focused on the influenza vaccine, five on the pneumococcal vaccine, and one on both. Twelve studies used multiple interventions, whereas one used a single intervention. Most interventions aimed to enhance patient and family knowledge and identify eligible patients before their appointments. All studies demonstrated improved vaccine uptake after implementing the interventions. CONCLUSIONS A variety of QI interventions have effectively increased pneumococcal and influenza vaccine uptake among cancer patients. Future research should address roadblocks to implementation and explore the effect of these interventions on other vaccines.
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Yan AP, Archer NM, Arnold D, Hansbury E, Heeney MM, Johnson D, Lichtman E, McMullan H, Morrissey L, Ilowite M. Increasing COVID-19 Vaccination Rates for Children With Sickle Cell Disease. Pediatrics 2023; 152:e2022061011. [PMID: 37706252 DOI: 10.1542/peds.2022-061011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND The COVID-19 vaccine is important for children with sickle cell disease (SCD). This quality improvement project's objective was to increase the proportion of children with SCD receiving ≥2 COVID-19 vaccine doses to ≥70% by June 2022. METHODS We used the Model for Improvement framework. We assessed COVID-19 vaccination rates biweekly. Three plan-do-study-act cycles focusing on patient education, provider awareness, and access were performed. Process measures included the outcome of outreach calls and educational video views. Missed clinic appointments was our balancing measure. Line graphs and statistical process control charts were used to track changes. Interrupted time series was used to model implementation rates while accounting for preexisting trends. RESULTS A total of 243 patients were included. During the preintervention (September 2021-January 2022) and intervention periods (February 2022-June 2022), overall vaccination rates increased from 33% to 41% and 41% to 64%, respectively. Mean vaccination rate in eligible children in each 2-week period increased from 2.1% to 7.2%. The achieved vaccination rate was 11% greater than predicted for patients with SCD. For the general population the achieved vaccination rate was 23% lower than predicted. The proportion of missed visits did not change (9.0% vs. 9.6%). During outreach calls, 10 patients (13.5%) booked a vaccine. Forty percent of patients watched the promotional video. CONCLUSIONS A significant number of patients with SCD are not vaccinated against COVID-19. Targeting misinformation and improving vaccine access aided in increasing vaccination. Additional interventions are needed as a large number of patients remain unvaccinated.
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Affiliation(s)
- Adam P Yan
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Natasha M Archer
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - Eileen Hansbury
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Matthew M Heeney
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - David Johnson
- Boston Children's Hospital Program for Patient Safety and Quality, Boston, Massachusetts
| | | | - Heather McMullan
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lisa Morrissey
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Maya Ilowite
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Furlong E, Kotecha RS. Lessons learnt from influenza vaccination in immunocompromised children undergoing treatment for cancer. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:199-213. [PMID: 36706776 DOI: 10.1016/s2352-4642(22)00315-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 01/26/2023]
Abstract
Influenza infection contributes substantially to global morbidity and mortality, with children undergoing treatment for cancer among the most vulnerable due to immunosuppression associated with disease and treatment. However, influenza remains one of the most common vaccine-preventable diseases. Despite international guidelines recommending inactivated influenza vaccination on the basis of data supporting efficacy and an excellent safety profile in this population, uptake has often been suboptimal due to persisting hesitancy among both patients and oncologists regarding the ability of the vaccine to mount a sufficient immune response, the optimal vaccine schedule and timing, and the best method to assess response in immunocompromised populations. In this Review, we discuss the evidence regarding influenza vaccination in children with cancer, factors that influence response, and highlight strategies to optimise vaccination. Host immune factors play a substantial role, thus principles learnt from influenza vaccination can be broadly applied for the use of inactivated vaccines in children with cancer.
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Affiliation(s)
- Eliska Furlong
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia; Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Rishi S Kotecha
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia; Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; Curtin Medical School, Curtin University, Perth, WA, Australia.
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Yarnall JN, Mertens A, Yee M, Orenstein E, Lai KW, Wasilewski-Masker K. Influenza Vaccination Receipt in Pediatric Patients With Cancer or Sickle Cell Disease. J Pediatr Hematol Oncol 2023; 45:e228-e235. [PMID: 36219461 DOI: 10.1097/mph.0000000000002559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 07/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Influenza causes greater morbidity in children with cancer or sickle cell disease (SCD). Literature on influenza vaccination receipt for these populations is limited in low-vaccination states. Outpatient interventions improve vaccine receipt but isolated inpatient interventions remain unstudied. PROCEDURE We reviewed influenza vaccine receipt of children with cancer or SCD treated at Children's Healthcare of Atlanta during three influenza seasons. We implemented a clinical decision support intervention during an influenza season and compared influenza vaccine receipt preintervention and postintervention among admitted children. RESULTS The oncology cohort (N=1548, 60% to 62%) and the SCD cohort (N=2549, 61% to 65%) had similar-to-higher vaccination receipt to the United States (58% to 64%, P =0.01 to 0.79) and Georgia (51% to 56%, P <0.01). The intervention did not significantly improve vaccination receipt for admitted children with cancer (40% vs. 56%, P =0.05 to 0.88) or SCD (44% vs. 56%, P =0.01). Regression modeling also found no significant increase in vaccine receipt (hematologic malignancy: 0.8 [0.73 to 0.98], solid tumor: 0.9 [0.80 to 1.90], central nervous system tumor: 0.9 [0.71 to 1.14], SCD: 0.9 [0.85 to 0.99]). CONCLUSIONS Children with cancer and SCD have similar-to-greater influenza vaccination receipt compared with Georgia and the United States. An inpatient intervention did not significantly improve influenza vaccine receipt in these patient cohorts. Future studies are needed to identify alternative approaches to improving vaccine receipt in these cohorts.
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Affiliation(s)
- J Nathan Yarnall
- Department of Pediatrics, Emory University School of Medicine
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA
| | - Ann Mertens
- Department of Pediatrics, Emory University School of Medicine
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA
| | - Marianne Yee
- Department of Pediatrics, Emory University School of Medicine
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA
| | - Evan Orenstein
- Department of Pediatrics, Emory University School of Medicine
| | - Kristina W Lai
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA
| | - Karen Wasilewski-Masker
- Department of Pediatrics, Emory University School of Medicine
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA
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Blagden S, Newell K, Ghazarians N, Sulaiman S, Tunn L, Odumala M, Isba R, Edge R. Interventions delivered in secondary or tertiary medical care settings to improve routine vaccination uptake in children and young people: a scoping review. BMJ Open 2022; 12:e061749. [PMID: 35918116 PMCID: PMC9351315 DOI: 10.1136/bmjopen-2022-061749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To identify and analyse the interventions delivered opportunistically in secondary or tertiary medical settings, focused on improving routine vaccination uptake in children and young people. DESIGN Scoping review. SEARCH STRATEGY We searched CINAHL, Web of Science, Medline, Embase and Cochrane Database of Systematic Reviews for studies in English published between 1989 and 2021 detailing interventions delivered in secondary or tertiary care that aimed to improve childhood vaccination coverage. Title, abstract and full-text screening were performed by two independent reviewers. RESULTS After deduplication, the search returned 3456 titles. Following screening and discussion between reviewers, 53 studies were included in the review. Most papers were single-centre studies from high-income countries and varied considerably in terms of their study design, population, target vaccination, clinical setting and intervention delivered. To present and analyse the study findings, and to depict the complexity of vaccination interventions in hospital settings, findings were presented and described as a sequential pathway to opportunistic vaccination in secondary and tertiary care comprising the following stages: (1) identify patients eligible for vaccination; (2) take consent and offer immunisations; (3) order/prescribe vaccine; (4) dispense vaccine; (5) administer vaccine; (6) communicate with primary care; and (7) ongoing benefits of vaccination. CONCLUSIONS Most published studies report improved vaccination coverage associated with opportunistic vaccination interventions in secondary and tertiary care. Children attending hospital appear to have lower baseline vaccination coverage and are likely to benefit from vaccination interventions in these settings. Checking immunisation status is challenging, however, and electronic immunisation registers are required to enable this to be done quickly and accurately in hospital settings. Further research is required in this area, particularly multicentre studies and cost-effectiveness analysis of interventions.
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Affiliation(s)
- Sarah Blagden
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
- Health Education England North West Liverpool, Liverpool, UK
| | - Kathryn Newell
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
- Health Education England North West Liverpool, Liverpool, UK
| | - Nareh Ghazarians
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Sabrena Sulaiman
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Lucy Tunn
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Michael Odumala
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Rachel Isba
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Rhiannon Edge
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
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MacDonald SE, Palichuk A, Slater L, Tripp H, Reifferscheid L, Burton C. Gaps in knowledge about the vaccine coverage of immunocompromised children: a scoping review. Hum Vaccin Immunother 2021; 18:1-16. [PMID: 34270376 PMCID: PMC8920240 DOI: 10.1080/21645515.2021.1935169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Immunocompromised children are at increased risk of severe illness from vaccine-preventable infections. However, inadequate vaccine coverage remains a concern. This scoping review sought to determine the current state of knowledge regarding vaccine coverage of immunocompromised children. Bibliographic databases were searched for primary research from any year. Data were analyzed quantitatively and narratively. Ninety-seven studies met inclusion criteria. The most commonly studied vaccines were pneumococcal (n = 46), influenza (n = 44), diphtheria/tetanus/pertussis/poliomyelitis/Haemophilus influenzae type B/hepatitis B-containing (n = 36), and measles- and/or mumps- and/or rubella-containing (n = 29). Immunocompromising conditions studied included cancer/stem cell transplants (n = 24), solid organ transplants (n = 23), sickle cell disease (n = 21), immunosuppressive therapy (n = 14), human immunodeficiency virus (n = 12), splenectomy (n = 4), and primary immunodeficiency (n = 2). As more children are treated with immunosuppressive therapies, it is critical to identify whether they are being appropriately vaccinated for age and condition. We identified gaps in the current state of knowledge for specific vaccine types in specific immunocompromised populations.
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Affiliation(s)
| | | | - Linda Slater
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Hailey Tripp
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | | | - Catherine Burton
- Faculty of Medicine and Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Canada
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Norman DA, Barnes R, Pavlos R, Bhuiyan M, Alene KA, Danchin M, Seale H, Moore HC, Blyth CC. Improving Influenza Vaccination in Children With Comorbidities: A Systematic Review. Pediatrics 2021; 147:peds.2020-1433. [PMID: 33558309 DOI: 10.1542/peds.2020-1433] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Children with medical comorbidities are at greater risk for severe influenza and poorer clinical outcomes. Despite recommendations and funding, influenza vaccine coverage remains inadequate in these children. OBJECTIVE We aimed to systematically review literature assessing interventions targeting influenza vaccine coverage in children with comorbidities and assess the impact on influenza vaccine coverage. DATA SOURCES PubMed, Scopus, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, and Web of Science databases were searched. STUDY SELECTION Interventions targeting influenza vaccine coverage in children with medical comorbidities. DATA EXTRACTION Two reviewers independently screened articles, extracting studies' methods, interventions, settings, populations, and results. Four reviewers independently assessed risk of bias. RESULTS From 961 screened articles, 35 met inclusion criteria. Published studies revealed that influenza vaccine coverage was significantly improved through vaccination reminders and education directed at either patients' parents or providers, as well as by vaccination-related clinic process changes. Interventions improved influenza vaccine coverage by an average 60%, but no significant differences between intervention types were detected. Significant bias and study heterogeneity were also identified, limiting confidence in this effect estimate. LIMITATIONS A high risk of bias and overall low quality of evidence limited our capacity to assess intervention types and methods. CONCLUSIONS Interventions were shown to consistently improve influenza vaccine coverage; however, no significant differences in coverage between different intervention types were observed. Future well-designed studies evaluating the effectiveness of different intervention are required to inform future optimal interventions.
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Affiliation(s)
- Daniel A Norman
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia; .,School of Medicine, University of Western Australia, Western Australia, Australia
| | - Rosanne Barnes
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia
| | - Rebecca Pavlos
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia
| | - Mejbah Bhuiyan
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia
| | - Kefyalew Addis Alene
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia.,Faculty of Health Sciences, Curtin University, Western Australia, Australia
| | - Margie Danchin
- Department of General Medicine, The Royal Children's Hospital, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Victoria, Australia.,Vaccine Hesitancy, Murdoch Children's Research Institute, Victoria, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, New South Wales, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia.,School of Medicine, University of Western Australia, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Western Australia, Australia; and.,Department of Microbiology, PathWest Laboratory Medicine, Western Australia, Australia
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Price SA, Podczervinski S, MacLeod K, Helbert L, Pergam SA. Understanding influenza vaccination rates and reasons for refusal in caregivers and household contacts of cancer patients. Am J Infect Control 2019; 47:468-470. [PMID: 30522836 DOI: 10.1016/j.ajic.2018.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 11/24/2022]
Abstract
Cancer patients are at increased risk for morbidity and mortality from seasonal influenza but are known to respond poorly to influenza vaccination. This single-center survey suggests that approximately one-third of cancer patients and their caregivers and family did not receive the vaccine in the prior season. Patients felt strongly that caregiver vaccination was important, whereas caregivers' decisions did not appear to be affected by the patients' disease.
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