Vaccination Coverage among Immunocompromised Patients in a Large Health Maintenance Organization: Findings from a Novel Computerized Registry

Abstract

Immune-compromised patients (IPs) are at high risk for infections, some of which are preventable by vaccines. Specific vaccines are recommended for IP; however, the vaccination rate is suboptimal. The aim of this study is to describe the development of an IP registry and to assess vaccination rates in this population. A population-based registry of IPs was developed using an automated extraction of patient electronic health-record data in Maccabi Healthcare Services (MHS), an Israeli health maintenance organization serving over 2.4 million members. Included in the registry were patients receiving immunosuppressive therapy (IT); patients living with HIV (PLWH); solid organ and bone marrow transplant recipients (TR); patients with advanced kidney disease (AKD), and asplenic patients. We evaluated the full schedule for each vaccine's uptake rates for influenza, pneumococcal, meningococcal, and hepatitis B. On 1 October 2019, 32,637 adult immune-compromised patients were identified by the registry. Of them, 1647 were PLWH; 2354 were asplenic; 5317 had AKD; 23,216 were on IT; and 1824 were TR. Their mean age was 57 and 52.4% were females. The crude rate of immune compromise among adult MHS members was 2%. Vaccine coverage rate was overall low for PCV13, with only 11.9% of all IPs in the registry having received one dose. Influenza and PPV23 vaccination rates were higher (45% and 39.4%, respectively). Only 5.3% of all IPs received all three vaccines. Overall, low vaccination coverage was found among IPs. Our registry can serve to identify target-patient populations for interventions and monitor their effectiveness.

Keywords: PCV13; PPV23; hepatitis B; immunocompromised; influenza; meningococcal; pneumococcal; registry; vaccine.

Figure 1

Immune-compromised patients registry structure and population, Israel, October 2019.

Figure 2

Pneumococcal and influenza vaccination rate uptake among immune-compromised patients in the immunocompromised registry, Israel, October 2019. (a) PCV13—pneumococcal conjugate vaccine; (b) PPV23—pneumococcal polysaccharide vaccine; (c) influenza seasonal vaccine, 2018–2019. Total immunocompromised patient registry, N = 32,637; TR—transplant recipients n = 1824; IT—immunosuppressive therapy, n = 23,216; CKD—advanced chronic kidney disease (GFR < 30 mL/min), n = 5462; asplenia n = 2354; PLWH—patients living with HIV, n = 1647.