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Compliance with Pneumovax 23 vaccination poor among high-risk patients

WASHINGTON — High-risk patients demonstrated poor overall compliance rates with Pneumovax 23 vaccination, varying widely across diagnoses, suggesting that providers may not be aware of the indications for administering this vaccine, according to data presented at the 2015 AAP National Conference and Exhibition.

“Our review showed that only 24% of the high-risk patients in our study population had documentation indicating that they received this vaccine,” Ramzan Shahid, MD, division director of general pediatrics at Loyola University Medical Center, told Infectious Diseases in Children. “It may be that the general pediatricians are assuming the subspecialists will give the vaccine, while the subspecialists are assuming the general pediatrician will give the vaccine, yet neither one is giving it to the patient.”

As the leading cause of serious bacterial infections in children, Streptococcus pneumoniae accounts for significant morbidity and mortality in the United States. Both the AAP and CDC have endorsed routine immunization against S. pneumoniae, with pediatric patients at highest risk recommended to receive added vaccination with Pneumovax 23 (23-valent pneumococcal polysaccharide vaccine, Merck; PPSV23) that covers 11 additional serotypes.

To evaluate the compliance rate of PPSV23 vaccination among high-risk pediatric populations and the most common setting of administration, Shahid and colleagues performed a retrospective chart review of patients (n = 308) aged 2 to 19 years with high-risk diagnoses, including:

• chronic heart disease;
• chronic liver disease;
• chronic renal failure;
• nephrotic syndrome;
• diabetes mellitus;
• cochlear implants; and
• sickle cell disease.

The review showed that 24% of high-risk patients were compliant with PPSV23 vaccination. When the researchers compared vaccination rates across patient groups, a significant difference between diagnosis and vaccination status was detected (P < .0001).

Shahid and colleagues observed that 48% of patients with sickle cell disease compared with 27% of patients with diabetes mellitus and only 9% of those with chronic heart disease were vaccinated.

“The hem-onc subspecialists do a much better job of providing the vaccine in their outpatient subspecialty clinics because S. pneumoniae is a known pathogen that can cause significant morbidity and mortality in sickle cell patients,” Shahid said. “The other subspecialists such as, cardiologists, endocrinologists, and nephrologists might not be aware of the risk of invasive pneumococcal disease in their high-risk patient populations and, therefore, do not offer the vaccine to these patients.”

In addition, the researchers observed that the location of administration was statistically significant across diagnoses. They wrote that patients with sickle cell disease were 28 times more likely to receive the vaccine in a subspecialty clinic when compared with other high-risk diagnoses whereas patients with diabetes mellitus were five times more likely to receive PPSV23 during inpatient hospitalization.

“There clearly needs to be better communication between the pediatrician and the subspecialist as they co-manage these high-risk patients regarding the indication for the PPSV23 vaccine and which provider will administer it,” Shahid said. “In general, most pediatric offices vs. subspecialty offices have this vaccine available and should be able to provide the vaccine.” – by Bob Stott

Reference:

Downing A, et al. Abstract 31401. Presented at: AAP National Conference and Exhibition; Oct. 24-27, 2015; Washington, D.C. 

Disclosure: The researchers report no relevant financial disclosures.