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Evaluation of Revised Vaccination Guideline for Hematopoietic Cell Transplant Patients in Singapore General Hospital
Allogeneic hematopoietic cell transplant (HCT) is increasingly used to treat patients with malignancies. The use of pre-HCT immunosuppressive conditioning chemotherapy and post-HCT immunosuppression predispose these patients to infections. A departmental vaccination guideline was implemented in Singapore General Hospital (SGH) in year 2004. As a clinical improvement initiative to facilitate easy reference and prompt prescribing, the guideline was updated and modified into a vaccination chart detailing the vaccines needed at various time-points in October 2012. This chart was filed in the patients' progress notes to ensure accurate tracking of patients' vaccination status. The aim of this study was to review the usefulness of this chart in facilitating prompt prescribing.
Methods
A retrospective review of all patients who underwent allogeneic HCT in SGH between January 2005 and December 2010, with at least one year follow-up, was carried out for the pre-implementation phase. Patients who underwent allogeneic and autologous HCT between May 2012 and February 2013, with at least six months follow-up were reviewed for the post-implementation phase. Primary endpoint was the overall vaccination rate. Secondary endpoints included the time to first vaccination and infection rate.
Results
Eighty-one evaluable patients were included in the pre-implementation phase, of whom, 41 did not receive any vaccination. In the post-implementation phase, among the 39 evaluable patients, only 9 did not receive any vaccination. Among those vaccinated, median time to first vaccination was 20 (range, 4-72) months post-HCT in the pre-implementation phase versus 6 (range, 4-13) months post-HCT in the post-implementation phase. Overall vaccination rate at various time-points was 3.4% and 59.3% for the pre- and post-implementation group, respectively (p<0.05). Influenza infection occurred in 18 (22.2%) patients pre-implementation as compared to 3 (7.7%) post-implementation. Of note, these infections occurred in patients who did not receive influenza vaccine.
Conclusions
The vaccination chart detailing the required vaccines at various time-points post-HCT proved to be a useful aid in facilitating timely prescribing and accurate tracking of vaccination status. Timely administration of required vaccines may result in reduced infectious complications. Importance of more effective strategies to further improve vaccination rates in this high risk population is underscored.