Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 11;11(8):1355.
doi: 10.3390/vaccines11081355.

A Nationwide Digital Multidisciplinary Intervention Aimed at Promoting Pneumococcal Vaccination in Immunocompromised Patients

Shirley Shapiro Ben David  1   2 , Orna Shamai-Lubovitz  1 , Vered Mourad  1 , Iris Goren  1 , Erica Cohen Iunger  1 , Tamar Alcalay  1 , Angela Irony  1 , Shira Greenfeld  1 , Limor Adler  1   2 , Amos Cahan  3
Affiliations

A Nationwide Digital Multidisciplinary Intervention Aimed at Promoting Pneumococcal Vaccination in Immunocompromised Patients

Shirley Shapiro Ben David et al. Vaccines (Basel). .

Abstract

Immunocompromised patients (IPs) are at high risk for infections, some of which are vaccine-preventable. The Israeli Ministry of Health recommends pneumococcal conjugate vaccine 13 (PCV13) and pneumococcal polysaccharide vaccine 23 (PPSV23) for IP, but vaccine coverage is suboptimal. We assessed the project's effectiveness in improving the pneumococcal vaccination rate among IP. An automated population-based registry of IP was developed and validated at Maccabi Healthcare Services, an Israeli health maintenance organization serving over 2.6 million members. Included were transplant recipients, patients with asplenia, HIV or advanced kidney disease; or those receiving immunosuppressive therapy. A personalized electronic medical record alert was activated reminding clinicians to consider vaccination during IP encounters. Later, IP were invited to get vaccinated via their electronic patient health record. Pre- and post-intervention vaccination rates were compared. Between October 2019 and October 2021, overall PCV13 vaccination rates among 32,637 IP went up from 11.9% (n = 3882) to 52% (n = 16,955) (p < 0.0001). The PPSV23 vaccination rate went up from 39.4% (12,857) to 57.1% (18,652) (p < 0.0001). In conclusion, implementation of targeted automated patient- and clinician-facing alerts, a remarkable increase in pneumococcal vaccine uptake was observed among IP. The outlined approach may be applied to increase vaccination uptake in large health organizations.

Keywords: PCV13; PPSV23; alerts; digital; electronic medical record; immunocompromised; intervention; pneumococcal vaccine.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A targeted pop-up vaccine recommendation is displayed in the electronic medical record during a medical encounter with a specific patient. A screenshot of the MHS electronic health record clinical decision support system showing a targeted alerts pop-up screen activated during a medical encounter. Selecting the checkbox next to the recommendation automatically generates a referral for a nurse to administer the vaccine. The physician also has the option to have the recommendation presented again during the next visit.
Figure 2
Figure 2
Algorithm for electronic medical record reminders for pneumococcal vaccines. The algorithm for pneumococcal vaccine electronic health record reminders involves using the EMR system to generate automated reminders for healthcare providers during patient encounters, specifically prompting them to assess and recommend pneumococcal vaccination based on patient criteria such as age, underlying medical conditions, and previous vaccination history * Excluded: bone marrow transplant, active oncologic patients. PCV13: pneumococcal conjugate vaccine; PPSV23: pneumococcal polysaccharide vaccine.
Figure 3
Figure 3
Vaccination rates among immunocompromised patients prior to and following the intervention. Vaccinated patients are included in the immunocompromised patients registry [15]. (a) PCV13: pneumococcal conjugate vaccine; (b) PPSV23: pneumococcal polysaccharide vaccine; IT, immunosuppressive therapy; Advanced CKD, chronic kidney disease (GFR < 30 mL/min); PLWH, patients living with HIV.
Figure 3
Figure 3
Vaccination rates among immunocompromised patients prior to and following the intervention. Vaccinated patients are included in the immunocompromised patients registry [15]. (a) PCV13: pneumococcal conjugate vaccine; (b) PPSV23: pneumococcal polysaccharide vaccine; IT, immunosuppressive therapy; Advanced CKD, chronic kidney disease (GFR < 30 mL/min); PLWH, patients living with HIV.
Figure 4
Figure 4
(a). Monthly PCV13 vaccinations during the intervention period. * Beginning of COVID-19 pandemic ** COVID-19 vaccination started. (b). The proportion of patients’ PCV13 vaccination over time. (c). Monthly PPSV23 vaccinations during the intervention period. * Beginning of COVID-19 pandemic ** COVID-19 vaccination started. (d). The proportion of patients’ PPSV23 vaccination over time.
Figure 4
Figure 4
(a). Monthly PCV13 vaccinations during the intervention period. * Beginning of COVID-19 pandemic ** COVID-19 vaccination started. (b). The proportion of patients’ PCV13 vaccination over time. (c). Monthly PPSV23 vaccinations during the intervention period. * Beginning of COVID-19 pandemic ** COVID-19 vaccination started. (d). The proportion of patients’ PPSV23 vaccination over time.
Figure 4
Figure 4
(a). Monthly PCV13 vaccinations during the intervention period. * Beginning of COVID-19 pandemic ** COVID-19 vaccination started. (b). The proportion of patients’ PCV13 vaccination over time. (c). Monthly PPSV23 vaccinations during the intervention period. * Beginning of COVID-19 pandemic ** COVID-19 vaccination started. (d). The proportion of patients’ PPSV23 vaccination over time.
See this image and copyright information in PMC

References

    1. Ben-Shimol S., Regev-Yochay G., Givon-Lavi N., van der Beek B.A., Brosh-Nissimov T., Peretz A., Megged O., Dagan R., Bacteremia I.P., Meningitis Group (IPBMG) et al. Israeli Pediatric Bacteremia and Meningitis Group (IPBMG); Israeli Adult Invasive Pneumococcal Disease (IAIPD) Group Dynamics of Invasive Pneumococcal Disease in Israel in Children and Adults in the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Era: A Nationwide Prospective Surveillance. Clin. Infect. Dis. 2022;74:1639–1649. - PubMed
    1. van Aalst M., Lötsch F., Spijker R., van der Meer J.T., Langendam M.W., Goorhuis A., Grobusch M.P., de Bree G.J. Incidence of invasive pneumococcal disease in immunocompromised patients: A systematic review and meta-analysis. Travel Med. Infect. Dis. 2018;24:89–100. doi: 10.1016/j.tmaid.2018.05.016. - DOI - PubMed
    1. Shigayeva A., Rudnick W., Green K., Chen D.K., Demczuk W., Gold W.L., Johnstone J., Kitai I., Krajden S., Lovinsky R., et al. Invasive pneumococcal disease among immunocompromised persons: Implications for vaccination programs. Clin. Infect. Dis. 2016;62:139–147. doi: 10.1093/cid/civ803. - DOI - PubMed
    1. Backhaus E., Berg S., Andersson R., Ockborn G., Malmström P., Dahl M., Nasic S., Trollfors B. Epidemiology of invasive pneumococcal infections: Manifestations, incidence and case fatality rate correlated to age, gender and risk factors. BMC Infect. Dis. 2016;16:367. doi: 10.1186/s12879-016-1648-2. - DOI - PMC - PubMed
    1. Kumar D., Humar A., Plevneshi A., Green K., Prasad G.V.R., Siegal D., McGeer A., Toronto Invasive Bacterial Diseases Network Invasive pneumococcal disease in solid organ transplant recipients--10-year prospective population surveillance. Am. J. Transplant. 2007;7:1209–1214. doi: 10.1111/j.1600-6143.2006.01705.x. - DOI - PubMed

Grants and funding

LinkOut - more resources