Vaccination guidelines after hematopoietic stem cell transplantation: practitioners' knowledge, attitudes, and gap between guidelines and clinical practice

• Published in: Transplant infectious disease Vol. 16; no. 6; pp. 878 - 886
• Main Authors: Ariza-Heredia, E.J., Gulbis, A.M., Stolar, K.R., Kebriaei, P., Shah, D.P., McConn, K.K., Champlin, R.E., Chemaly, R.F.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01-12-2014; Wiley Subscription Services, Inc
• Subjects: Data Collection; guidelines; GVHD; Health Knowledge, Attitudes, Practice; Hematopoietic Stem Cell Transplantation; Humans; Practice Guidelines as Topic; Practice Patterns, Physicians; Retrospective Studies; stem cell transplant; Vaccination; vaccines; Vaccines - administration & dosage; Vaccines - immunology; guidelines; stem cell transplant; GVHD; vaccines
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12312

Background
Hematopoietic stem cell transplant (HCT) recipients are more susceptible to infections from vaccine‐preventable diseases than the general population. Despite the development of international consensus guidelines addressing immunization after HCT, studies have shown that deviations from recommended immunization practices commonly occur.
Methods
An anonymous survey aimed at determining awareness of the guidelines and attitudes toward vaccination was distributed to our HCT clinicians. In parallel, we retrospectively evaluated patients' characteristics and post‐HCT vaccine administration practices from 2010 to 2013.
Results
The majority of survey respondents (96%) were familiar with post‐HCT vaccination protocols. Seventy‐four percent of respondents reported that influenza vaccines were given to >70% of their patients, and 41% stated that they prescribed live vaccines to eligible patients. However, our pharmacy database review revealed that 38% of patients received the first series of vaccinations by the recommended 6 months post HCT, and 60% received them by 1 year after HCT. Most patients who had their vaccines withheld had relapsed disease or were undergoing treatment for graft‐versus‐host disease. Furthermore, we identified lower immunization rates in non‐English speaking individuals, African‐Americans, and Hispanic patients.
Conclusions
Survey respondents reported being aware of current guidelines; however, adherence to the recommendations varied, likely connected to conflicting data on vaccine effectiveness and a lack of clear recommendations in complex clinical scenarios. Similar to the general population, patient barriers also could have contributed to lower vaccination rates in some cases. To decrease the large gap between the post‐HCT vaccination guidelines and clinical practice, further studies on vaccine effectiveness and specific populations are warranted.