Vaccination guidelines after hematopoietic stem cell transplantation: practitioners' knowledge, attitudes, and gap between guidelines and clinical practice
Vaccination guidelines after hematopoietic stem cell transplantation: practitioners' knowledge, attitudes, and gap between guidelines and clinical practice
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DOI：
10.1111/tid.12312
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发表时间：
2014-12-01
影响因子：
2.6
通讯作者：
Chemaly, R. F.
中科院分区：
文献类型：
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作者：
Ariza-Heredia, E. J.;Gulbis, A. M.;Chemaly, R. F.
研究背景造血干细胞移植（HCT）受者比普通人群更容易受到疫苗可预防疾病的感染。尽管发展的国际共识的指导方针，解决免疫后HCT，研究表明，偏离推荐的免疫接种practices commonlyoccurs.MethodsAn匿名调查，旨在确定认识的指导方针和对疫苗接种的态度分发给我们的HCT临床医生。同时，我们回顾性评估了2010年至2013年患者的特征和HCT后疫苗接种实践。结果大多数调查受访者（96%）熟悉HCT后疫苗接种方案。74%的受访者报告称，超过70%的患者接种了流感疫苗，41%的受访者表示他们为符合条件的患者开了活疫苗。然而，我们的药房数据库审查显示，38%的患者在推荐的HCT后6个月接受了第一系列疫苗接种，60%的患者在HCT后1年接受了疫苗接种。大多数暂停接种疫苗的患者疾病复发或正在接受移植物抗宿主病治疗。此外，我们确定了较低的免疫接种率在非英语为母语的个人，非洲裔美国人和西班牙裔patient.ConclusionsSurvey受访者报告说，知道目前的指导方针，但是，遵守的建议各不相同，可能连接到相互矛盾的数据疫苗的有效性和缺乏明确的建议，在复杂的临床情况。与一般人群类似，在某些情况下，患者障碍也可能导致疫苗接种率降低。为了缩小HCT后疫苗接种指南与临床实践之间的巨大差距，需要对疫苗有效性和特定人群进行进一步研究。
BackgroundHematopoietic stem cell transplant (HCT) recipients are more susceptible to infections from vaccine-preventable diseases than the general population. Despite the development of international consensus guidelines addressing immunization after HCT, studies have shown that deviations from recommended immunization practices commonly occur.MethodsAn anonymous survey aimed at determining awareness of the guidelines and attitudes toward vaccination was distributed to our HCT clinicians. In parallel, we retrospectively evaluated patients' characteristics and post-HCT vaccine administration practices from 2010 to 2013.ResultsThe majority of survey respondents (96%) were familiar with post-HCT vaccination protocols. Seventy-four percent of respondents reported that influenza vaccines were given to >70% of their patients, and 41% stated that they prescribed live vaccines to eligible patients. However, our pharmacy database review revealed that 38% of patients received the first series of vaccinations by the recommended 6months post HCT, and 60% received them by 1year after HCT. Most patients who had their vaccines withheld had relapsed disease or were undergoing treatment for graft-versus-host disease. Furthermore, we identified lower immunization rates in non-English speaking individuals, African-Americans, and Hispanic patients.ConclusionsSurvey respondents reported being aware of current guidelines; however, adherence to the recommendations varied, likely connected to conflicting data on vaccine effectiveness and a lack of clear recommendations in complex clinical scenarios. Similar to the general population, patient barriers also could have contributed to lower vaccination rates in some cases. To decrease the large gap between the post-HCT vaccination guidelines and clinical practice, further studies on vaccine effectiveness and specific populations are warranted.