533. Vaccination Rates in Liver Transplant Recipients, a Single Center Observation: Are We Following Guidelines?
Session: Poster Abstract Session: Vaccine Use in Immunocompromised Hosts
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Vaccination poster2.revised[1].pdf (422.8 kB)
  • Background:

    Solid-organ-transplant (SOT) recipients are at increased risk for vaccine-preventable diseases. Current American Society of Transplant (AST) guidelines recommend assessment of vaccination status in SOT candidates and administration of appropriate vaccines pre-transplant. If vaccines are not given pre-transplant it is recommended that missing inactivated vaccines should be provided post transplant.

    There is scant data on the application of these guidelines in clinical practice. We, therefore, examined the vaccination rates in our liver-transplant (LT) recipients to identify gaps in the application of guidelines.

    Methods:

    A retrospective chart review was performed of 299 adult patients who received an orthotopic LT between January 2008 and December 2010, at Henry Ford Hospital, Detroit MI. Vaccine status, eligibility, and completion of appropriate vaccines were determined. Vaccines reviewed were the Hepatitis B (HBV), Hepatitis A (HAV), Influenza, Varicella zoster (VZV), TdaP, pneumococcal and meningococcal vaccines. Eligibility for vaccines was assessed using AST and the CDC Advisory Committee on Immunizations Practices (ACIP) recommendations based on age, medical conditions, antibody titers, and seasons.  Follow-up was at least one year post-transplant.

    Results:

    The mean age of the LT recipients was 53.9±10.3 years. Males composed 64.9%. Vaccination rates of the recommended vaccination pre-and post-transplant are shown in Table 1.

    Table 1: Vaccination Status in 299 Adult Liver-Transplant Recipients:

    Vaccine

    No. of vaccine-eligible patients

    pre-transplant

    No. vaccinated pre-transplant (%)

    No. of vaccine-eligible patients

    post-transplant

    No. vaccinated post-transplant (%)

    Hepatitis B

    245

    10(4.1%)

    229

    4(1.7%)

    Hepatitis A

    182

    4(2.2%)

    172

    1(0.6%)

    Influenza

    204

    29(14.2%)

    171

    23(13.5%)

    Varicella Zoster

    83

    0

    -

    -

    Tdap

    278

    0

    271

    14(5.2%)

    Pneumococcal

    273

    0

    266

    25(9.4%)

    Meningococcal

    2

    0

    2

    0

    Conclusion:

    There is a significant gap between the recommendations for vaccination in adult SOT patients and vaccination rates in our LT recipients. Gap analysis to determine factors affecting implementation of vaccination recommendations including, patient and provider awareness, and barriers to vaccine delivery are being evaluated. This will help guide strategies to improve immunization rates in this group.

    Hadeel Zainah, MD1, Mona Hassan, MD2, Laila Shiekh Sroujieh, MD2, Sarah Chamas-Alhelo, MD3, Sravana Kumar Reddy Jeepalyem, Medical student3, Ghattas Alkhoury3, George Alangaden, MD4 and Mayur Ramesh, MD5, (1)Infectious Diseases, Henry Ford Health System, Wayne State University,, Detroit, MI, (2)Internal Medicine, Wayne State University, Henry Ford Health System, Detroit, MI, (3)Henry Ford Hospital, Detroit, MI, (4)Infectious Diseases, Henry Ford Health System, Detroit, MI, (5)Infectious Diseases, Henry Ford Hospital, Detroit, MI

    Disclosures:

    H. Zainah, None

    M. Hassan, None

    L. Shiekh Sroujieh, None

    S. Chamas-Alhelo, None

    S. K. R. Jeepalyem, None

    G. Alkhoury, None

    G. Alangaden, None

    M. Ramesh, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.