Shapiro Ben David Shirley, Goren Iris, Mourad Vered, Cahan Amos
Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
Vaccines (Basel). 2022 Oct 2;10(10):1654. doi: 10.3390/vaccines10101654.
Immune-compromised patients (IPs) are at high risk for infections, some of which are preventable by vaccines. Specific vaccines are recommended for IP; however, the vaccination rate is suboptimal. The aim of this study is to describe the development of an IP registry and to assess vaccination rates in this population. A population-based registry of IPs was developed using an automated extraction of patient electronic health-record data in Maccabi Healthcare Services (MHS), an Israeli health maintenance organization serving over 2.4 million members. Included in the registry were patients receiving immunosuppressive therapy (IT); patients living with HIV (PLWH); solid organ and bone marrow transplant recipients (TR); patients with advanced kidney disease (AKD), and asplenic patients. We evaluated the full schedule for each vaccine's uptake rates for influenza, pneumococcal, meningococcal, and hepatitis B. On 1 October 2019, 32,637 adult immune-compromised patients were identified by the registry. Of them, 1647 were PLWH; 2354 were asplenic; 5317 had AKD; 23,216 were on IT; and 1824 were TR. Their mean age was 57 and 52.4% were females. The crude rate of immune compromise among adult MHS members was 2%. Vaccine coverage rate was overall low for PCV13, with only 11.9% of all IPs in the registry having received one dose. Influenza and PPV23 vaccination rates were higher (45% and 39.4%, respectively). Only 5.3% of all IPs received all three vaccines. Overall, low vaccination coverage was found among IPs. Our registry can serve to identify target-patient populations for interventions and monitor their effectiveness.
免疫功能低下患者（IPs）感染风险很高，其中一些感染可通过疫苗预防。针对IPs推荐了特定疫苗；然而，疫苗接种率并不理想。本研究的目的是描述IPs登记系统的建立，并评估该人群的疫苗接种率。利用以色列一家为超过240万会员提供服务的健康维护组织——马卡比医疗服务公司（MHS）的患者电子健康记录数据自动提取功能，建立了一个基于人群的IPs登记系统。登记系统纳入的患者包括接受免疫抑制治疗（IT）的患者、艾滋病毒感染者（PLWH）、实体器官和骨髓移植受者（TR）、晚期肾病（AKD）患者以及无脾患者。我们评估了流感、肺炎球菌、脑膜炎球菌和乙肝疫苗每种疫苗的全程接种率。2019年10月1日，登记系统识别出32637名成年免疫功能低下患者。其中，1647名是PLWH；2354名是无脾患者；5317名患有AKD；23216名接受IT治疗；1824名是TR。他们的平均年龄为57岁，52.4%为女性。成年MHS会员中免疫功能低下的粗发病率为2%。13价肺炎球菌结合疫苗（PCV13）的疫苗覆盖率总体较低，登记系统中所有IPs中只有11.9%接种过一剂。流感疫苗和23价肺炎球菌多糖疫苗（PPV23）的接种率较高（分别为45%和39.4%）。所有IPs中只有5.3%接种了全部三种疫苗。总体而言，IPs的疫苗接种覆盖率较低。我们的登记系统可用于识别干预措施的目标患者群体并监测其有效性。
