Achieving optimal vaccine administration in a pediatric cochlear implant program after implementation of a Quality Improvement Project

OBJECTIVES

To maximize vaccination compliance in children undergoing cochlear implantation and thus minimize meningitis-related complications. To present a Quality Improvement (QI) Project for 23-valent pneumococcal polysaccharide vaccine (PPSV-23) administration within a pediatric cochlear implant program.

METHODS

We identified children from birth through 21 years of age with cochlear implants or cochlear implant candidates who were seen at Children's Health Medical Center/UT Southwestern Medical Center, Dallas between 12/2018 and 01/2020. Protocols were developed for physicians and nurses using electronic medical record (EMR) smart phrases with prompts to review and document vaccine status and plan. Charts were reviewed for six consecutive cycles of 6-12 weeks for vaccine documentation and plan compliance. Regular feedback was provided to physicians and nurses. A cochlear implant EMR registry was developed for increased surveillance of vaccine administration.

RESULTS

Physicians and nurses showed an improvement in vaccine documentation from the start of the project to the first data cycle review (61%-90% and 20%-91% for physicians and nurses respectively). This was followed by a regression in the third to fourth review cycles (decrease to 67% and 80% compliance). Vaccine documentation compliance improved after subsequent review and feedback, and peaked during the final cycle of the review (83% and 100% compliance). During the year-long QI project, one child with a cochlear implant missed the PPSV-23 vaccine but was identified during cycle review and vaccinated. This occurred during the third cycle, and for the remaining three cycles there were no missed vaccinations. On completion of the QI project, a formal vaccination oversight program was introduced with a physician/nurse team that reviews the cochlear implant EMR registry monthly for children who have not been vaccinated. In the 13 months since the completion of the QI project there has been 100% compliance with no children who missed vaccination.

CONCLUSION

We present a vaccination program with oversight to address missed vaccinations. Implementation of a QI project followed by transition to a formal vaccination oversight program eliminated missed PPSV-23 vaccinations in children with cochlear implants. We recommend that cochlear implant programs use similar approaches to ultimately minimize potential meningitis-related complications in patients with cochlear implants.

Adverse events following quadrivalent meningococcal CRM-conjugate vaccine (Menveo®) reported to the Vaccine Adverse Event Reporting system (VAERS), 2010-2015

BACKGROUND

Limited data are available describing the post-licensure safety of meningococcal vaccines, including Menveo®. We reviewed reports of adverse events (AEs) to the Vaccine Adverse Event Reporting System (VAERS) to assess safety in all age groups.

METHODS

VAERS is a national spontaneous vaccine safety surveillance system co-administered by the Centers for Disease Control and Prevention and the US Food and Drug Administration. We searched the VAERS database for US reports of adverse events in persons who received Menveo from 1 January 2010 through 31 December 2015. We clinically reviewed reports and available medical records for serious AEs, selected pre-specified outcomes, and vaccination during pregnancy. We used empirical Bayesian data mining to identify AEs that were disproportionately reported after receipt of Menveo.

RESULTS

During the study period, VAERS received 2614 US reports after receipt of Menveo. Of these, 67 were classified as serious, including 1 report of death. Adolescents (aged 11-18years) accounted for 74% of reports. Most of the reported AEs were non-serious and described AEs consistent with data from pre-licensure studies. Anaphylaxis and syncope were the two most common events in the serious reports. We did not identify any new safety concerns after review of AEs that exceeded the data mining threshold, although we did observe disproportionate reporting for terms that were not associated with an adverse event (e.g., "incorrect drug dosage form administered", "wrong technique in drug usage process"). Although reports were limited, we did not find any evidence for concern regarding the use of Menveo during pregnancy.

CONCLUSIONS

In our review of VAERS reports, findings of AEs were consistent with the data from pre-licensure studies. Vaccine providers should continue to emphasize and adhere to proper administration of the vaccine.

Vaccines safety; effect of supervision or SMS on reporting rates of adverse events following immunization (AEFI) with meningitis vaccine (MenAfriVac™): a randomized controlled trial

BACKGROUND

To ensure vaccines safety, given the weaknesses of the national pharmacovigilance system in Cameroon, there is a need to identify effective interventions that can contribute to improving AEFI reporting.

OBJECTIVE

To assess the effect of: (i) sending weekly SMS, or (ii) weekly supervisory visits on AEFI reporting rate during a meningitis immunization campaign conducted in Cameroon in 2012 using the meningitis A conjugate vaccine (MenAfriVac™).

METHODS

Health facilities that met the inclusion criteria were randomly assigned to receive: (i) a weekly standardized SMS, (ii) a weekly standardized supervisory visits or (iii) no intervention. The primary outcome was the reported AEFI incidence rate from week 5 to 8 after the immunization campaign. Poisson regression model was used to estimate the effect of interventions after adjusting for health region, type of health facility, type and position of health workers as well as the cumulative number of AEFI reported from weeks 1 to 4.

RESULTS

A total of 348 (77.2%) of 451 health facility were included, and 116 assigned to each of three groups. The incidence rate of reported AEFI per 100 health facility per week was 20.0 (15.9-24.1) in the SMS group, 40.2 (34.4-46.0) in supervision group and 13.6 (10.1-16.9) in the control group. Supervision led to a significant increase of AEFI reporting rate compared to SMS [adjusted RR=2.1 (1.6-2.7); p<0.001] and control [RR=2.8(2.1-3.7); p<0.001)] groups. The effect of SMS led to some increase in AEFI reporting rate compared to the control group, but the difference was not statistically significant [RR=1.4(0.8-1.6); p=0.07)].

CONCLUSION

Supervision was more effective than SMS or routine surveillance in improving AEFI reporting rate. It should be part of any AEFI surveillance system. SMS could be useful in improving AEFI reporting rates but strategies need to be found to improve its effectiveness, and thus maximize its benefits.