Faculty Collaboration Database

Quality improvement project to improve vaccinations in the pediatric liver transplant population. Pediatr Transplant 2021 Nov;25(7):e14076

Date

06/30/2021

Pubmed ID

34185930

DOI

10.1111/petr.14076

Scopus ID

2-s2.0-85108843693 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

OBJECTIVES: A quality improvement approach was used to increase pediatric liver transplant recipient live and inactive vaccination rates by assessing titers and recommending vaccinations.

METHODS: A new screening and immunization process for both live and inactive vaccines was discussed with families at their annual visit. Antibody titers for varicella, measles, mumps, rubella, Haemophilus influenzae type B, hepatitis A, and hepatitis B were obtained. Specific criteria were developed for live virus vaccination candidacy. Vaccines were recommended based on patient titers and vaccination candidacy criteria. Surveillance for adverse effects to live vaccines was performed. Repeat titers were obtained approximately 1-month post-vaccine administration.

RESULTS: After PDSA cycle 1, 99% (71/72) of pediatric liver transplant patients had titers obtained. Live vaccines were recommended for 32 patients and 16 (50%) were vaccinated. Inactive vaccines were recommended to 64 patients, and 31 (48%) were vaccinated. Eight of 13 (62%) patients with follow-up titers achieved immunity for inactive vaccines. Zero patients had an adverse reaction to any live vaccine. Ten of 12 (83%) patients with follow-up titers achieved immunity from live vaccines. The most common barriers to receive live vaccines included not scheduling appointment with primary care provider (n = 3) and "non-vaccinators" (n = 3).

CONCLUSIONS: Administering live and inactive vaccines to select pediatric liver transplant patients appears to be safe and effective in our studied population. For PDSA cycle 2, we will continue our current practice and consider offering vaccines in transplant clinic, since this was a barrier to vaccination identified during PDSA cycle 1.

Author List

Gumm AJ, Lerret S, Zeman M, Rueter J, Huppler AR, Khan Z, Telega G, Vitola B

Authors

Alexis J. Gumm MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin
Anna H. Huppler MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Stacee Lerret PhD Professor Hybrid in the Pediatrics department at Medical College of Wisconsin
Grzegorz W. Telega MD Professor in the Pediatrics department at Medical College of Wisconsin
Bernadette Vitola MD, MPH Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Female
Humans
Immunization Schedule
Infant
Liver Transplantation
Male
Quality Improvement
Transplant Recipients
Vaccination
Wisconsin
Young Adult