New research examines barriers to vaccination in immunocompromised children

A new study examines the barriers to vaccination of immunocompromised children (ICC). Findings from the study will be presented during the Pediatric Academic Societies (PAS) 2019 Meeting, taking place on April 24—May 1 in Baltimore.

"Immunosuppressive medications have dramatically improved the outcomes of autoimmune diseases such as lupus and inflammatory bowel disease (IBD)," said Vidya Sivaraman, MD, one of the authors of the study. "While the long-term outcomes of these patients have improved, their care has become more complex and fragmented between the specialist and primary care physician (PCP). We realized that vaccination in these patients has been suboptimal, leaving these patients susceptible to many vaccine-preventable diseases. In this study, our primary aim was to assess vaccine knowledge, comfort, and vaccination practices among parents and PCPs of children with childhood onset systemic lupus and IBD and determine measures to reduce these gaps in preventive care."

Researchers surveyed 31 systemic lupus erythematosus (c-SLE) and 26 IBD patients. The survey found that most patients received their vaccines from their PCP or health department and 16% received vaccines from their subspecialist. The survey indicated that 96% felt that their PCP was well informed about vaccines and 91% reported that their subspecialist discussed vaccines in the past year, most commonly influenza, human papilloma virus, pneumococcal and Hepatitis B. Only two parents expressed concerns for vaccine adverse effects and triggering a disease flare.

Of the 30 PCP responses, 70% had over 20 years' experience and 50% preferred to provide all vaccines to ICC. Yet, there were major barriers to completing vaccines: 14 of 16 (85%) stated they did not stock the 23-valent pneumococcal vaccine. PCPs felt "very confident" about providing vaccines in their ICC only 40% of the time. Practitioners felt poorly informed about their patients' immunosuppressive medications and concern for exacerbating the underlying illness as the main reason for their lack of confidence.

The study concluded that there was discordance between patients feeling confident in their PCP being aware of vaccine recommendations and PCP comfort in vaccinating their ICC patients due to lack of knowledge and concern for triggering a disease flare. Despite that most ICC received vaccines at their PCP's office, most offices did not carry the 23-valent pneumococcal vaccine and did not routinely recommend vaccination of household members. Providing recommended vaccines and lack of education about appropriate vaccination in ICC remain significant barriers and areas for improvement.