Underimmunization of the solid organ transplant population: An urgent problem with potential digital health solutions

Abstract

Solid organ transplant recipients are at risk for potentially life-threatening infections due to lifelong immunosuppression. Vaccine-preventable infections result in graft injury, morbidity, mortality, and significantly increased medical costs. Unfortunately, the majority of transplant recipients continue to be underimmunized at the time of transplant and thereafter. Given the rising rates of vaccine hesitancy and refusal in the general population, transplant recipients can no longer rely on herd immunity to protect them from vaccine-preventable infections. Novel tools are desperately needed to overcome transplant-specific immunization barriers to improve immunization rates in this high-risk population. Digital health technologies may offer a solution by addressing transplant-specific barriers: specifically, providing accurate information about vaccine safety, efficacy, and timing in the pre- and posttransplant periods; making a complete immunization record universally available and easily accessible; enabling communication between patients and multiple providers; and providing automated vaccine reminders to both patients and providers when vaccines are due using transplant-specific immunization guidelines. Digital health has transformed health care by empowering patients with their own health information and connecting patients, their providers, and public health officials. In doing so, it offers a potential platform to address and overcome the problem of underimmunization in the transplant population.

Keywords: clinical research/practice; editorial/personal viewpoint; infection and infectious agents; infection and infectious agents - viral: herpes zoster/Varicella; infectious disease; organ transplantation in general; preventive health care; vaccine.

Figure 1:

A digital health tool could help overcome barriers to pre-transplant immunization by providing education about immunizations in the setting of transplant, enhancing communication between providers and families, sending out computerized reminder when immunizations are due, and providing a central easily accessible repository for vaccines.

Figure 2:

A transplant digital health tool could be created to help increase immunization rates. At enrollment, vaccination history and patient specific requirements such as transplant type and date would be entered into the client side. The platform’s forecaster would generate a vaccination and notification schedule, delivering the reminders at the set timepoints incorporating entered data. When a new vaccination is administered (by the PCP for example), it would be entered into the platform and shared with all users. The forecaster would update and future messages would account for that new vaccine.