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E-Vaccine Registry Helps HIV Group
Improve Poor Vaccination Record
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HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow
Mark Mascolini
High proportions of 328 HIV-positive adults in Geneva did not have basic vaccines, like pneumococcal and tetanus vaccines, in a 2016-2018 analysis [1]. An e-vaccine registry spotted shortfalls and helped many get catchup vaccinations.
People with HIV infection run an increased risk of infectious diseases with potentially heavy morbidity and mortality burdens. Yet many are not up to date on standard vaccines that can prevent these infections. Researchers at the University Hospitals of Geneva suggested 2 reasons for low vaccine rates: (1) no routine vaccine schedule review at regular office visits, and (2) concern about vaccine side effects and compromised efficacy in an immune-deficient population.
The Geneva team conducted a before-and-after cohort study, starting with a vaccine consultation for all HIV-positive adults who made an office visit between May 2016 and April 2018. Using a national electronic immunization registry accessible to clinicians and patients (www.myvaccines.ch), the researchers determined how many people had 6 standard vaccines. The system automatically generates a catchup immunization plan for each participant.
Among 328 participating adults with HIV, 182 (55%) had any vaccination record available and 146 (45%) had none. The group had a median age of 49 (range 18 to 85), 90% had a CD4 count above 200, and the male/female ratio was 2.2.
At study enrollment, under two thirds of participants, 62.8%, had been vaccinated against hepatitis B, while 57.6% had a hepatitis A vaccine and 56.1% had their varicella vaccination. Initial vaccination rates were much lower for other infections: measles 14.6%, tetanus 2.4%, and pneumococcus 0%.
By June 2018, after the vaccine catchup reminders, proportions up to date for each vaccine were 63.1% for hepatitis B (+0.3%), 62.8% for hepatitis A (+5.2%), 57.0% for varicella (+0.9%), 29.6% for measles (+14.9%), 43.0% for tetanus (+40.5%), and 26.5% for pneumococcus (+26.5%).
The Geneva investigators concluded that HIV-positive adults in their clinic were poorly immunized despite regular office visits. Undertaking systematic evaluation supported by an electronic system generating "ready-to-use catchup plans" significantly increased coverage for tetanus and S pneumoniae and improved coverage of every other infections considered.
Participants "readily accepted" vaccine recommendations unless their insurance did not cover the vaccine. Incomplete insurance coverage of all vaccines limited catchup. The researchers believe poor vaccine completion rates in this cohort reflect "missed opportunities during routine care and not vaccine hesitancy or refusal."
US opportunistic infection guidelines offer HIV-specific advice for vaccination against major infectious disease [2].
References
1. Enriquez N, Pecoul V, Hartley M, Siegrist C, Calmy A. E-vaccine registry: systematic vaccine registry improves immunisation coverage in HIV patients. HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow. Abstract P219.
2. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf
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