Infectious Diseases Unit, Besancon University Hospital, Besancon, France.
Hematology Unit, Besancon University Hospital, Besancon, France.
Vaccine. 2021 Nov 26;39(48):7036-7043. doi: 10.1016/j.vaccine.2021.10.040. Epub 2021 Nov 2.
Immunocompromised patients are at high-risk for severe influenza and invasive pneumococcal diseases (IPD). Despite the French Public Health Council (FPHC) and the 7th European Conference on Infections in Leukaemia (ECIL7) recommendations, vaccination coverage remains insufficient. This study aimed to estimate the coverage and determinants of influenza, pneumococcal and diphtheria-tetanus-poliomyelitis (dTP) vaccinations in hematological patients underlying chemotherapy.
A survey was distributed to all patients of the hematology day hospital assessing vaccine uptakes and general opinion about vaccination. Vaccine uptakes were collected from medical and vaccination records; knowledge of and attitudes towards vaccinations in immunocompromised patients were evaluated for each general practitioner (GP) by phone call. Adequacy between vaccine uptakes and indication or not to vaccinate according to ECIL7 guidelines was assessed. Factors associated with vaccine uptakes were assessed by multivariate logistic regression.
Among 145 patients, 66 % were aged 65 years or older, 40 % were followed for lymphoma and 38 % for multiple myeloma, 39 % were treated with anti-CD20 antibodies. Vaccination coverage was suboptimal for influenza (45-56 %), dTP (44 %) and IPD (16-19 %) regardless of the guidelines followed, with a wide variation in rates by information source (19-76 %). Adequacy rate with ECIL7 recommendations were 63 % and 87 % for influenza and IPD respectively. Information of patients on specific vaccinations was positively associated with flu and IPD vaccinations, as well as favorable attitude toward vaccination and age ≥ 65 years for flu vaccination, and recommendation by hematologist for pneumococcal vaccination.
Despite vaccination opportunities, the complexity of these specific recommendations and the lack of communication between the health actors could explain the suboptimal vaccination coverage in this high-risk population. A proactive attitude of all actors in the city and hospital, including better patient information and a personalized and evolving vaccination schedule to help GPs to coordinate vaccination would allow to improve vaccine coverage.
免疫功能低下的患者患严重流感和侵袭性肺炎球菌病（IPD）的风险很高。尽管法国公共卫生理事会（FPHC）和第七届欧洲白血病感染会议（ECIL7）提出了建议，但疫苗接种覆盖率仍然不足。本研究旨在评估正在接受化疗的血液系统疾病患者的流感、肺炎球菌和白喉-破伤风-脊髓灰质炎（dTP）疫苗接种覆盖率及其决定因素。
向血液学日间医院的所有患者分发了一项调查，评估疫苗接种率和对疫苗接种的总体看法。从医疗和疫苗接种记录中收集疫苗接种率；通过电话评估每位全科医生（GP）对免疫功能低下患者疫苗接种的了解程度和态度。根据 ECIL7 指南，评估疫苗接种率与接种指征之间的一致性。通过多变量逻辑回归评估与疫苗接种率相关的因素。
在 145 名患者中，66%的患者年龄在 65 岁或以上，40%的患者患有淋巴瘤，38%的患者患有多发性骨髓瘤，39%的患者接受了抗 CD20 抗体治疗。无论遵循何种指南，流感（45-56%）、dTP（44%）和 IPD（16-19%）的疫苗接种覆盖率均不理想，且信息来源不同，接种率差异很大（19-76%）。根据 ECIL7 建议，流感和 IPD 的适当接种率分别为 63%和 87%。患者对特定疫苗的了解程度与流感和 IPD 疫苗接种呈正相关，此外，对疫苗接种的有利态度和年龄≥65 岁与流感疫苗接种有关，血液科医生对肺炎球菌疫苗接种的推荐也与流感疫苗接种有关。
尽管有疫苗接种机会，但这些特定建议的复杂性以及卫生保健人员之间缺乏沟通可能解释了高危人群中疫苗接种覆盖率不足的情况。城市和医院所有参与者采取积极主动的态度，包括更好地向患者提供信息，制定个性化和不断发展的疫苗接种计划，以帮助全科医生协调疫苗接种，这将有助于提高疫苗接种覆盖率。
