Adequacy of Vaccine Documentation Against Encapsulated Bacteria in a Population of Children with Sickle Cell Disease

Abstract 4853

Immunization status is often used as an indicator of improved quality of health care and access in pediatric populations. The increased life expectancy in the general pediatric population has largely been attributed to the prevention of infectious disease through immunizations, and this fact is even truer for individuals with sickle cell disease. Adherence to recommended vaccination schedules against encapsulated bacteria in patients with sickle-cell anemia has not been well studied in any population. In order to determine documented compliance rates based on the current recommendations of the Department of Health and Human Services Center for Disease Control Immunization Schedules, a retrospective chart review was performed on 117 patients diagnosed with sickle cell anemia (HbSS) followed at the Penn State Hershey Children's Hospital Regional Pediatric Sickle Cell Center, through the year 2009. Since the vaccinations were given by each patient's primary provider(s), we attempted to obtain documentation of immunizations given by these providers, particularly against encapsulated bacteria. For 35 of the 117 patients, we were unable to obtain any forwarded documentation of any vaccinations. The vaccination schedules of the remaining 82 patients were audited for coverage against encapsulated bacteria. Only 16 of the 82 patients (19.5%) with forwarded documents demonstrated complete documented compliance, defined as having complete coverage against H. influenzae, N. meningitides, and S. pneumococcus. Of the remaining forwarded charts, 63 patients (76.8%) demonstrated some form of partial documented compliance, but four patients (4.9%) did not have documentation of vaccinations against any encapsulated bacteria despite documentation of receiving other vaccinations. Full documented compliance as indicated by forwarded records was most noted in children between the ages of 0–11.9 years (14/16 of patients with complete compliance). The proportion of adolescents without any forwarded documentation was larger than the younger age group; however, this difference did not reach statistical significance (p=0.36). Of the 82 patients whose primary care physicians forwarded documents, significantly more (14 of 34) adolescents (≥12 years of age) than children aged 0–11.9 years (8 of 48) were missing documentation of more than half of their vaccines (p=.014). These results indicate deficient documentation of vaccination coverage against encapsulated organisms, particularly in the adolescent population. To determine the clinical implications of these results, further studies detailing the demographics, socioeconomic status and correlations of such characteristics to morbidity and mortality should be completed.