Mihalek Alexandra J, Hall Matt, Russell Christopher J, Wu Susan
Hospitalist Division, Children's Hospital of Orange County, Orange, California.
Children's Hospital Association, Lenexa, Kansas.
Hosp Pediatr. 2021 Dec 1. doi: 10.1542/hpeds.2021-005924.
Many hospitalized children are underimmunized. We assessed the association between hospital immunization practices and tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal, human papillomavirus (HPV), and influenza vaccine delivery.
An electronic survey regarding hospital vaccine delivery practices was distributed via the Pediatric Health Information System (PHIS) and Pediatric Research in Inpatient Settings networks to PHIS hospitals. Number of vaccines delivered and total discharges in 2018 were obtained from the PHIS database to determine hospital vaccine delivery rates; patients 11 to 18 years old (adolescent vaccines) and 6 months to 18 years old (influenza vaccine) were included. Vaccine delivery rates were risk adjusted by using generalized linear mixed-effects modeling and compared with survey responses to determine associations between the number or presence of specific practices and vaccine delivery. Adjusted HPV and meningococcal vaccine delivery rates could not be calculated because of low delivery.
Twenty-nine hospitals completed a survey (57%). 152 499 and 423 046 patient encounters were included for the adolescent and influenza vaccines, respectively. Unadjusted inpatient vaccine delivery rates varied. After adjustment, the number of practices was associated only with influenza vaccine delivery (P = .02). Visual prompts (P = .02), nurse or pharmacist ordering (P = .003), and quality improvement projects (P = .048) were associated with increased influenza vaccine delivery; nurse or pharmacist ordering had the greatest impact. No practices were associated with Tdap vaccine delivery.
The number and presence of specific hospital practices may impact influenza vaccine delivery. Further research is needed to identify strategies to augment inpatient adolescent immunization.
许多住院儿童疫苗接种不足。我们评估了医院免疫接种实践与破伤风、白喉和无细胞百日咳（Tdap）疫苗、脑膜炎球菌疫苗、人乳头瘤病毒（HPV）疫苗及流感疫苗接种之间的关联。
一项关于医院疫苗接种实践的电子调查通过儿科健康信息系统（PHIS）和儿科住院患者研究网络分发给PHIS医院。从PHIS数据库获取2018年接种的疫苗数量和总出院人数，以确定医院疫苗接种率；纳入11至18岁的患者（青少年疫苗）和6个月至18岁的患者（流感疫苗）。通过广义线性混合效应模型对疫苗接种率进行风险调整，并与调查回复进行比较，以确定特定实践的数量或存在情况与疫苗接种之间的关联。由于接种率较低，无法计算经调整的HPV疫苗和脑膜炎球菌疫苗接种率。
29家医院完成了调查（57%）。青少年疫苗和流感疫苗分别纳入了152499例和423046例患者就诊情况。未调整的住院疫苗接种率各不相同。调整后，实践的数量仅与流感疫苗接种相关（P = 0.02）。视觉提示（P = 0.02）、护士或药剂师开医嘱（P = 0.003）以及质量改进项目（P = 0.048）与流感疫苗接种增加相关；护士或药剂师开医嘱的影响最大。没有实践与Tdap疫苗接种相关。
特定医院实践的数量和存在情况可能会影响流感疫苗接种。需要进一步研究以确定增强住院青少年免疫接种的策略。
