COVID Vaccination Rates in Children and Adults with Sickle Cell Disease in British Columbia, Canada
COVID Vaccination Rates in Children and Adults with Sickle Cell Disease in British Columbia, Canada
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DOI：
10.1182/blood-2021-152141
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发表时间：
2021-12-24
期刊：
影响因子：
20.3
通讯作者：
O'Donnell M
中科院分区：
文献类型：
--
作者：
Merkeley H;McGuire M;Ding L;McCartney H;Amid A;Strahlendorf C;Sandhu N;Vergidis D;O'Donnell M
背景：感染 SARS CoV-2 病毒的镰状细胞病 (SCD) 患者住院和死亡的风险显着增加，强烈建议充分接种疫苗。此前曾在 SCD 人群中描述过对疫苗的犹豫，并且据报道，一些研究对其他推荐疫苗的使用率较低。本研究的目的是评估加拿大不列颠哥伦比亚省 (BC) 符合条件的儿科和成人 SCD 患者的疫苗接种率，与普通人群和其他“临床极度脆弱”(CEV) 群体的疫苗接种率相比。方法：BC省12岁及以上患有SCD的人被确定为CEV人群并优先进行免疫接种。我们采取了全面的流程来查找和识别 BC 省的所有 CEV 患者，并通知他们其优先状态。该省诊断为 SCD 的个人在共享儿科和成人患者登记处 (iCHIP) 中被识别，该登记处跟踪人口统计、诊断和治疗，并添加到 CEV 患者名单中。 SCD 患者通过省卫生官员的标准邮件以及儿科和成人 SCD 项目的电子邮件和电话得知其优先状态。 16岁以上的人被邀请从2021年3月开始登记免疫，而12-15岁的人从2021年5月开始被允许登记。成年患者有资格接受辉瑞和Moderna的mRNA疫苗以及阿斯利康(AZ) COVISHIELD疫苗，而12-17岁的人只有资格接种辉瑞疫苗。省免疫登记处 (PIR) 接受询问以确认疫苗接种情况。主要结果指标是接受第一剂和第二剂新冠疫苗的 SCD 患者的比例。结果：iCHIP 数据库中识别出 138 名 12 岁以上患有 SCD 的个体。 71.0% 患有镰状细胞性贫血 (SCA)，25.4% 患有血红蛋白 SC (Hb SC)，3.6% 患有其他基因型。参与者的年龄范围为 12 岁至 69 岁，中位年龄为 28 岁。 67.4% 正在接受疾病缓解治疗（76 人接受羟基脲治疗，11 人接受定期红细胞交换，1 人接受 crizanlizumab，5 人接受 Hb SC 静脉切开术）。没有人接受基因治疗或移植治疗。 7 人之前曾感染过 PCR 确诊的 SARS CoV-2，但在免疫接种后没有感染过。截至 2021 年 7 月 30 日：68.8% 的 SCD 患者接种了第一剂新冠疫苗，55.1% 的患者接种了第二剂新冠疫苗。除了第一剂 AZ 外，几乎所有剂量都是基于 mRNA 的疫苗。表 1 显示了不同年龄范围和基因型之间的疫苗接种率。与 Hb SC/其他基因型患者相比，SCA 患者的疫苗接种率没有显着差异：第 1 剂疫苗接种率为 64.3% 对比 80.0% (p=0.0703)，第 2 剂疫苗接种率为 48.0% 对比 62.5% (p =0.12114)。 SCD 组的疫苗接种率与其他年龄匹配的 CEV 人群以及一般省级人群进行了比较，详情见表 2 和表 3。与一般人群相比，20 岁以下 SCD 患者接受第一剂疫苗（70.8% 对比 31.1%；p<0.00001）和第二剂疫苗（50.0 对比 15.3%；p <0.00001）的比例较高人口。然而，如表 2 所示，20-49 岁和 50 岁以上年龄组接受第一剂疫苗的比例较低。此外，与其他 CEV 群体相比，所有年龄段的 SCD 患者接种疫苗的比例较低。如表 3 所示，与一般 BC 人群相比，SCD 与接受第一剂疫苗无关（OR 0.8，0.56 至 1.16 95% CI，p=0.2481）。相比之下，其他 CEV 群体中接受第一剂 COVID 免疫接种的可能性是一般 BC 人群的两倍 (p<0.0001)。没有报告严重的疫苗相关并发症，包括疫苗诱导的免疫性血栓性血小板减少症（VITT）。免疫接种后 21 天内，有 7 例因血管闭塞危象 (VOC) 到医院就诊。结论：尽管 CEV 正在积极寻找并邀请 SCD 患者接种疫苗，但这些数据表明 BC 省 SCD 患者的疫苗接种率低于其他 CEV 年龄匹配群体。成年人的疫苗接种率也低于一般人群，但 20 岁以下人群的疫苗接种率较高。随后正在进行一项定性研究，探讨 BC 省 SCD 患者对新冠疫苗的犹豫情况。没有需要申报的相关利益冲突。
Background: Persons with Sickle Cell Disease (SCD) infected with the SARS CoV-2 virus have significantly increased risks of hospitalization and death and are strongly recommended to be fully vaccinated. Vaccine hesitancy has previously been described in the SCD population and uptake of other recommended vaccines has been reported to be low in some studies. The goal of this study was to assess how vaccination rates amongst eligible pediatric and adult SCD patients in British Columbia (BC), Canada, compared to those of the general population and other “clinically extremely vulnerable” (CEV) groups. Methods: Persons age 12 and over with SCD in BC were identified as a CEV population and prioritized for immunization. A comprehensive process was undertaken to find and identify all CEV patients in BC and notify them of their priority status. Individuals diagnosed with SCD in the province were identified in the shared pediatric and adult patient registry (iCHIP), which tracks demographics, diagnoses and therapies, and added to the CEV patient list. SCD patients were notified of their priority status through standard mail from the provincial health officer, as well as emails and phone calls from the pediatric and adult SCD programs. Those aged 16+ were invited to register for immunization beginning in March 2021 while those 12-15 years were permitted to register starting in May 2021. Adult patients were eligible to receive mRNA vaccines from Pfizer and Moderna as well as the Astra-Zeneca (AZ) COVISHIELD vaccine, while those aged 12-17 were eligible only for Pfizer vaccines. The provincial immunization registry (PIR) was interrogated to confirm vaccine administration. The main outcome measure was the proportion of SCD patients who received 1st and 2nd dose COVID vaccines. Results: 138 individuals age 12+ with SCD were identified in the iCHIP database. 71.0% had Sickle Cell Anemia (SCA), 25.4% had Hemoglobin SC (Hb SC) and 3.6% had other genotypes. Participants ranged in age from 12-69 years with a median of 28 years. 67.4% were receiving disease-modifying therapy (76 were on hydroxyurea, 11 on regular red cell exchange, 1 was receiving crizanlizumab, and 5 with Hb SC were phlebotomized). None were treated with gene therapy or transplant. 7 individuals had a PCR-confirmed SARS CoV-2 infection prior, but none following immunization. As of July 30, 2021: 68.8% of persons with SCD received a 1st and 55.1% received a 2nd dose of COVID vaccine. Almost all doses were mRNA-based vaccines with the exception of a single 1st dose administration of AZ. Vaccination rates amongst different age ranges and genotypes are displayed in Table 1. Patients with SCA did not have significantly different vaccination rates compared to those with Hb SC/other genotypes: 64.3% versus 80.0% for 1st dose (p=0.0703) and 48.0% versus 62.5% (p =0.12114) for 2nd dose. Vaccination rates amongst the SCD group were compared to other age matched CEV populations as well as the general provincial population and are detailed in Tables 2 and 3. A higher proportion of persons with SCD under the age of 20 received 1st dose (70.8% versus 31.1%; p<0.00001) and 2nd dose (50.0 versus 15.3%; p <0.00001) of vaccines compared to the general population. However, a lower proportion age 20-49 and 50+ years old received a 1st dose as demonstrated in Table 2. In addition, lower proportions of persons with SCD of all age ranges were vaccinated in comparison to other CEV groups. As demonstrated in Table 3, SCD was not associated with receiving a 1st dose vaccine compared to the general BC population (OR 0.8, 0.56 to 1.16 95% CI, p=0.2481). In contrast, persons in other CEV groups were twice as likely to receive a first dose COVID immunization compared to the general BC population (p<0.0001). No severe vaccine-related complications including vaccine-induced immune thrombotic thrombocytopenia (VITT) were reported. There were 7 presentations to hospital for vaso-occlusive crises (VOC) within 21 days of immunization. Conclusion: Despite an active CEV process to find and invite persons with SCD to be vaccinated, these data demonstrate that vaccination rates amongst persons with SCD in BC are below those of other CEV age-matched groups. Vaccination rates amongst adults are also lower than the general population, however there is a high vaccination rate in persons under 20 years old. A subsequent qualitative study exploring COVID vaccine hesitancy amongst persons with SCD in BC is being explored. No relevant conflicts of interest to declare.