Infanti Lisa M, Elder Joshua J, Franco Kyle, Simms Stephanie, Statler Victoria A, Raj Ashok
J Pediatr Pharmacol Ther. 2020 Jan-Feb;25(1):39-46. doi: 10.5863/1551-6776-25.1.39.
The Advisory Committee on Immunization Practices (ACIP) recommends additional immunizations for people with asplenia or functional asplenia, such as children with sickle cell disease. Adherence rate to the recommended immunization schedule for functional asplenia remains low for children with sickle cell disease. The purpose of this study was to assess the immunization adherence for this population at a single institution in Kentucky and to evaluate the use of the Kentucky Immunization Registry (KYIR) by providers.
A single-center retrospective chart review was conducted for 107 children with sickle cell disease ages 2 through 18 years. Immunization histories were obtained from the hospital EMRs, the sickle cell clinic EMR, the KYIR, and by requesting records from primary care physicians. Each patient was documented as either missing or having complete records in the KYIR.
The complete adherence rate to the ACIP-recommended immunization schedule for children with functional asplenia was 6% (6 of 107). Nearly all children were compliant with the Haemophilus influenzae type B vaccination, whereas the adherence rate for the meningococcal and pneumococcal vaccines ranged from 25% to 77%. The lowest immunization rate was observed in children eligible for the meningococcal B vaccine (25%). Only 3 patients had a complete immunization history documented in the KYIR.
Adherence to the ACIP-recommended immunization schedule for functionally asplenic patients is poor among children with sickle cell disease included in this study. Quality improvement measures should focus on increasing immunization adherence and improving documentation of immunization records in the KYIR for this patient population.
免疫实践咨询委员会（ACIP）建议为无脾或功能性无脾的人群，如镰状细胞病患儿，接种额外的疫苗。镰状细胞病患儿对功能性无脾推荐免疫接种计划的依从率仍然很低。本研究的目的是评估肯塔基州一家机构中该人群的疫苗接种依从性，并评估医疗服务提供者对肯塔基州免疫登记系统（KYIR）的使用情况。
对107名年龄在2至18岁的镰状细胞病患儿进行了单中心回顾性病历审查。从医院电子病历、镰状细胞病诊所电子病历、KYIR中获取免疫接种史，并向初级保健医生索要记录。记录每位患者在KYIR中是缺少记录还是有完整记录。
功能性无脾患儿对ACIP推荐免疫接种计划的完全依从率为6%（107例中的6例）。几乎所有儿童都接种了B型流感嗜血杆菌疫苗，而脑膜炎球菌和肺炎球菌疫苗的依从率在25%至77%之间。符合接种B型脑膜炎球菌疫苗条件的儿童免疫接种率最低（25%）。只有3例患者在KYIR中有完整的免疫接种史记录。
本研究纳入的镰状细胞病患儿对ACIP推荐的功能性无脾患者免疫接种计划的依从性较差。质量改进措施应侧重于提高免疫接种依从性，并改善该患者群体在KYIR中的免疫接种记录文档。
