Vaccine Counseling Research Articles

Italian Health Care Workers’ Knowledge, Attitudes, and Practices Regarding Human Papillomavirus Infection and Prevention

Objective: To assess healthcare workers’ knowledge and attitudes about human papillomavirus (HPV) infection, related diseases, and prevention. Methods: A cross-sectional multicenter survey about HPV and its prevention, targeted to healthcare workers involved in HPV vaccine counseling, was performed from May 2017 to December 2018. Results: The overall median knowledge and attitude scores were 69.2% (25–75, p = 61.5–84.6) and 5 (25–75, p = 4–5), respectively. Both knowledge and attitudes statistically significantly differ between physicians and healthcare professions. The median propensity score before and after the educational intervention was stable and high, at 10 (25–75, p = 9–10). The predictors of statistically significantly high knowledge scores are to be a physician, general practitioner, or pediatrician, attending courses/congresses, and consulting technical product characteristics and scientific literature to obtain information about the HPV vaccine. Being a physician and consulting scientific literature to obtain information about the HPV vaccine were found also as predictors of statistically significantly different attitude scores among study participants. Conclusions: Although healthcare workers showed overall positive attitudes towards the relevance of HPV burden and prevention tools, demonstrated knowledge was largely suboptimal, particularly that shown by healthcare professions. Obtained results allow highlighting knowledge gaps, and thus improving counselling to HPV vaccine targets.

Abstract C133: Human papillomavirus vaccine recommendations for the medically underserved: A pilot study on provider communication in a safety net clinic

Abstract Introduction The human papillomavirus (HPV) vaccine is highly effective in the prevention of cervical, vulvar, and anal cancers in women. Federally Qualified Health Centers (FQHCs) are safety-net clinics that serve a population disproportionately burdened by a lack of preventative health care services that would benefit from additional measures such as the HPV vaccine. Documenting HPV vaccine recommendations and beliefs of primary care providers in FQHCs may help in promoting evidence-based practices for vulnerable populations. Methods The specific aims of this study include: 1) to assess a baseline rate of HPV vaccination and counseling among women attending an FQHC clinic, and 2) to identify FQHC clinic and practitioner barriers for effective HPV vaccine recommendations. We performed a retrospective chart review of 105 women who attended an OB/GYN clinic at an FQHC in Santa Ana, CA between 1/1/2019 and 3/30/2019. Data included patient demographics, insurance type, and documentation of HPV vaccine counseling or vaccine administration. Provider data, as detailed from completion of a nationally validated HPV vaccination survey from an estimated 50 providers will also be discussed. Results 78% of patients self-identified as Hispanic, 14% reported Spanish as their primary language, and 86% of patients were enrolled in Medi-Cal. 25% (n = 27) of patients reviewed had documented administration of the HPV vaccine in the FQHC medical chart. Of those that had documented vaccine administration, 52% (n = 13) completed 3 doses of the vaccination program. During the study period, 11% of patient visits had documented counseling regarding the HPV vaccine, 14% had documentation of counseling within the prior 12 months of the encounter. Patients who were primarily English speaking versus Spanish were more likely to have received the HPV vaccine (29.9% vs 5.6%, p = 0.0374). Patients enrolled in Medi-Cal were more likely to receive the vaccine compared to other insurance types, including uninsured (31.5% vs 12.5%, p = 0.522). Hispanic women were less likely to have documented counseling regarding the HPV vaccine compared to non-Hispanic women (18.4% vs 0% (p = 0.0198). Conclusion Overall, OB/GYN providers at an FQHC are not routinely recommending the HPV vaccine for their patients. Patients who are primarily Spanish speaking are less likely to have received counseling regarding the vaccine documented in their chart. In order to maximize the public health benefit of the HPV vaccine to prevent cervical cancer, adherence to guidelines is necessary, especially in settings that provide care to medically underserved women. Citation Format: Kiran Clair, Melissa Perez, Patrick Penalosa, Kristine Penner, Suellen Hopfer. Human papillomavirus vaccine recommendations for the medically underserved: A pilot study on provider communication in a safety net clinic [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C133.

Women's Attitudes Toward Vaccination During Preconception Care [19A

INTRODUCTION: Infection with Rubella or Varicella during pregnancy can have potentially lethal consequences to the fetus. Increasingly pervasive anti-vaccine beliefs make it even more critical for providers to assess adherence to MMR and Varicella vaccination, particularly in women attempting pregnancy. The primary outcome of this study was prevalence of non-immune status to Rubella and Varicella. Secondary measures were obtained from those with a negative immunity titer: self-reported attitudes, self-reported incidence of follow-up, recency of vaccine counseling and knowledge of CDC vaccination recommendations. METHODS: University of Kansas Health System Advanced Reproductive Care clinic patients from January 2017 through June 2019 with negative Rubella or Varicella titer results were invited to anonymously participate in an IRB approved survey. RESULTS: 1,767 patient records were reviewed. Non-immune status to Rubella and Varicella represented 7.2% (n=124) and 4.5% (n=79) of records, respectively. Surveys administered to all non-immune patients achieved a 32.5% (n=65) response rate. A minority of respondents did not receive the recommended vaccines following a negative titer, reportedly not wishing to further delay fertility treatment. Most respondents stated that they would be open to further vaccine education from their providers (67.7%). CONCLUSION: The prevalence of Rubella non-immunity in the study population fell within the recognized range for sufficient herd immunity (less than 13%). Our results indicate that women have a generally positive attitude toward vaccine education during pre-conception counseling. The risk/benefit analysis of postponing fertility treatment to achieve adequate levels of immunity should be a focused discussion with patients in the setting of advanced reproductive care.

Determinants of vaccine hesitancy and effectiveness of vaccination counseling interventions among a sample of the general population in Palermo, Italy

ABSTRACT Counteract vaccine hesitancy is a public health priority. Main objectives of the cross-sectional study conducted were to evaluate knowledge, attitudes, and behaviors regarding vaccination issues, to estimate the prevalence of vaccine hesitancy and to estimate the effectiveness of vaccination counseling on community advocacy in a sample of general population. An anonymous validated questionnaire was administered in April 2017 at the main shopping center of Palermo and was followed by tailored vaccination counseling interventions. To estimate the effectiveness of the interventions four main connection parameters to the vaccinarsi.org website were evaluated, in the two months before and after the intervention and in the two months before the intervention compared with the same period of previous and following years. Among the 299 subject enrolled 12.7% were hesitant about vaccinations, and 4.7% declared being against vaccinations. General practitioners (GPs) and pediatricians were the most affordable source of information about vaccinations. A higher probability of vaccination hesitancy/refusal was reported among subjects who considered “alternative strategies” the best way for the prevention of infectious diseases (adj-OR = 7.01, IC95% 2.88–17.09, p-value < 0.001). A considerable increase of all the vaccinarsi.org website indicators analyzed was observed, from the area in which survey participants lived. Prevalence of vaccine hesitancy among population surveyed is consistent with the literature data. HCWs, such as GPs and pediatricians, should play a key role in modifying personal convictions and choices about vaccinations. A proper vaccination counseling could improve attitudes regarding vaccination issues, such as quality of web-based research.

Collaborating with Complementary and Alternative Medicine (CAM) Providers When Writing HPV Vaccine Review Articles

Novel strategies are needed to address vaccine hesitancy (VH), which correlates with complementary and alternative medicine (CAM). In Switzerland, CAM providers play important roles in vaccine counseling of vaccine hesitant (VH) parents, and traditional vaccination messaging tends to overlook CAM provider perspectives. In the setting of a Swiss national research program on VH, our key strategy has been to work together closely with CAM providers. To assess the feasibility of generating educational human papillomavirus (HPV) vaccine materials that would interest VH healthcare providers (HCPs), we invited four CAM providers to co-author two HPV vaccine review articles for general practitioners. We conducted thematic analysis of CAM provider comments to identify patterns that could complement and improve vaccination messaging from CAM perspectives. We identified several themes and generated an inventory of CAM provider messaging recommendations related to language use, presentation of background information, nuanced statements regarding HPV vaccine efficacy and safety, and communication tools that would be important to VH HCPs. Contrary to our initial expectations, and in an inclusive, respectful atmosphere of open dialogue, we were able to productively finalize our manuscripts. In the opinion of the CAM co-authors, the manuscripts effectively considered the communication needs and perspectives of VH HCPs. Engaging with CAM providers appears to be a feasible and innovative avenue for providing vaccine information and designing communication tools aimed at VH healthcare providers.

Knowledge and attitudes of parents after the implementation of mandatory vaccination in kindergartens of Palermo, Italy.

Background and aim of the work:Even though vaccination is easy to access in Europe, it has been facing several outbreaks caused by vaccine preventable diseases. Trying to balance the right to health of the community with individual self-determination, in Italy was mandate vaccination for ten vaccine preventable diseases in 2017. The project “Sportello Vaccinale” provided a counseling service to parents in kindergarten of Palermo. The main objective of the study was to investigate knowledge and compliance on vaccination by children’s parents after the implementation of mandatory vaccination.Methods:A cross sectional study was conducted among parents accessing to the “Sportello Vaccinale” using a questionnaire. The questionnaire consisted of 34 items divided into three sections: socio-demographic data; knowledge and attitude on mandatory vaccination using Health Belief Model (HBM); Health Literacy (HL) level.Results:A total of 95 questionnaires were garnered in the kindergartens from respondents with a mean age of 36 (±SD=6) years. The respondents who delayed hexavalent or Measles, Mumps, Rubella and Varicella (MMRV) vaccinations were 8 (8%) and the more frequent cause was fear of adverse reaction (87%). The sample had more often high level of health literacy (37%), and 55% had higher HBM score. The factor significantly associated with higher HBM score was the age of respondents (OR= 1.14, p=0.006) after controlling for other variables.Conclusions:Consent to vaccination practice was widely represented, but the results of the study highlighted the need for parents to have more information and more time devoted to the practice of vaccination counseling. Implementing counseling activities at school or at the vaccination service, could support an aware decision process of the parents on vaccination topic.

An educational intervention to improve attitudes regarding HPV vaccination and comfort with counseling among US medical students

ABSTRACT Many medical students are not comfortable recommending the human papillomavirus (HPV) vaccine because they do not feel prepared to discuss it with their patients. A prior study demonstrated that this is particularly a problem among unvaccinated students. Our purpose was to determine if medical student attitudes and comfort with counseling could be improved by attending a single lecture delivered by an expert on the topic. To assess the effects of the educational program, we conducted pre- and posttests on medical students before and after a single lecture on HPV vaccination. Changes in items related to attitude and comfort were examined. Student characteristics associated with changes in scores were also examined and compared. A total of 256 medical students participated in the pre- and posttests. Before the lecture, students demonstrated low knowledge of HPV vaccination and did not feel comfortable counseling parents of younger patients. However, students <30 years of age demonstrated significant improvements after the lecture in comfort. Asian and Hispanic students showed the greatest improvement in comfort with counseling, as did students who reported they had not received the HPV vaccine. Attending a single lecture given by an expert can improve medical students’ attitudes and comfort with HPV vaccine counseling, especially if the students were not vaccinated themselves. This study suggests that including material on HPV vaccination in the standard medical student curriculum could help increase physician recommendation for the HPV vaccine.

Conceiving an application ontology to model patient human papillomavirus vaccine counseling for dialogue management

BackgroundIn the United States and parts of the world, the human papillomavirus vaccine uptake is below the prescribed coverage rate for the population. Some research have noted that dialogue that communicates the risks and benefits, as well as patient concerns, can improve the uptake levels. In this paper, we introduce an application ontology for health information dialogue called Patient Health Information Dialogue Ontology for patient-level human papillomavirus vaccine counseling and potentially for any health-related counseling.ResultsThe ontology’s class level hierarchy is segmented into 4 basic levels - Discussion, Goal, Utterance, and Speech Task. The ontology also defines core low-level utterance interaction for communicating human papillomavirus health information. We discuss the design of the ontology and the execution of the utterance interaction.ConclusionWith an ontology that represents patient-centric dialogue to communicate health information, we have an application-driven model that formalizes the structure for the communication of health information, and a reusable scaffold that can be integrated for software agents. Our next step will to be develop the software engine that will utilize the ontology and automate the dialogue interaction of a software agent.

Azienda Sanitaria Locale Roma 4: the external evaluation as strategy to improve vaccination services

Abstract Issue Azienda Sanitaria Locale (ASL) Roma 4 is one of the ten local healthcare companies of Lazio Region. Vaccination Service (VS), organized in 15 ambulatories, is managed by dedicated and trained staff and this organization has led to high vaccination coverage over the years. In 2017, the National Immunization Plan and the new law on mandatory vaccination required a reshaping of VS. The Health Management of ASL Roma 4 has requested an external evaluation of the VS to a private company (PC) with the aim to highlight weaknesses and strengths. Description of the problem The PC, through inspections and questionnaires addressed to personnel, analysed four features: amplitude of the access to the ambulatory; management of the access; communication; tools. The analysis focused specifically on vaccination for people under 18 years old. Results The PC underlined these weaknesses: massive free access; strong influx of users from other adjacent ASL; computerized vaccination registry not available online; absence of a centralized booking and information request system; lack of targeted use of social networks. Best practices of the VS are: vaccination stocks centrally managed; preventive interview for travellers; structured procedures shared throughout the territory; focused vaccination campaigns; information material sent to the families of the new born; online portal available to users to view their personal data and download vaccination certificates; vaccination counselling; openings dedicated to specific user categories. Lessons The PC suggested these solutions: division of ambulatory opening into free access and booking/active call; online computerized registry; unique call center constitution; creation of official social network pages. ASL Roma 4 activated the unique call center and taken corrective actions for the other weaknesses. Key messages Best practices can be used in other healthcare setting and the periodically external evaluations can improve the vaccination service. Continuously monitoring the activities improves the quality of the vaccination service.

Determinants of vaccine hesitancy in Switzerland: study protocol of a mixed-methods national research programme

IntroductionVaccine hesitancy is a complex public health issue referring to concerns about the safety, efficacy or need for vaccination. Relatively little is known about vaccine hesitancy in Switzerland. This ongoing...

The recent Italian vaccination law and the role of Local Health Authorities: the case of LHA Roma 1

Abstract Issue/problem The increase of vaccine hesitancy is leading to decrease vaccination coverage. In Italy, a new vaccination law was approved in July 2017 to contrast the spread of preventable infections. 10 vaccines became mandatory for children and unaccompanied foreign minors aged 0-16 and provided for free according to the national immunization schedule for each birth cohort. Being vaccinated is now required to attend schools and kindergartens even if a ban for students aged 0-6 or a fine for the other are previewed. Description of the problem According to the law, in Lazio Region, a web platform was realized in May 2018 in order to permit schools to update the list of their pupils. Medical doctors from LHAs had to evaluate continuously the updated lists, verifying the vaccination status of each student in order to approve their enrolment at schools or to recall parents providing counseling about vaccination. Results From August 2018 to March 2019 schools settled in the area of LHA Roma 1 registered 121.687 pupils (among those 105.720 pupils were also resident in the area of LHA Roma 1). After a preliminary check within data already present in the regional vaccination registry, around 30 healthcare operators, from the 6 healthcare districts of LHA Roma 1, were widely involved in order to evaluate pupils’ vaccination status. The number of evaluations decreases in the same period from 19.634 to 4921, but 4908 out of these 4921 were pupils not found in the regional vaccination registry, probably for errors in the registration of personal data such as the fiscal code. Some students’ families received vaccination counseling. Lessons The web platform realization was an innovative way to monitor vaccination status: it facilitates a further collaboration among schools and LHAs in order to guarantee health in community and to increase awareness about vaccinations and their benefits. A great involvement of schools and healthcare operators was observed. Key messages Although some problems such as pupils not found in the regional vaccination registry persist, the way of working in a collaborative way addressing community troubles is clearly traced. Technology and information systems help community services in monitoring and improving health outcomes. Their use has to be improved and promoted.

US Medical Trainees' Knowledge of Human Papilloma Virus and Head and Neck Cancer.

Given the increasing incidence of human papilloma virus (HPV)-positive head and neck cancers (HNCs), discussion of this oncologic outcome should be incorporated into HPV vaccine counseling practices. Yet, preliminary evidence shows that knowledge of the association between HPV and HNC is lacking among most medical trainees. To better characterize this deficit, we nationally assessed knowledge of HPV's association with HNC among medical students and residents across 4 specialties (pediatrics, obstetrics and gynecology, family medicine, and otolaryngology). A total of 3141 responses from 46 states were obtained (n = 402 pediatric residents, n = 346 obstetrics/gynecology residents, n = 260 family medicine residents, n = 87 otolaryngology residents, and n = 2045 medical students). Only 40.3% of surveyed medical students and 56.1% of surveyed obstetrics/gynecology, pediatrics, and family medicine residents identified associations between persistent HPV infection and HNC. When counseling on the vaccine, nonotolaryngology residents more often discussed cervical cancer (99.8%) as compared with HNC (39.7%), commonly because of less HNC knowledge (61.5%). These results suggest that it is imperative to develop educational interventions targeted at medical students and resident trainees on the front line of HPV vaccine counseling and administration.

Utilizing Information Technology to Improve Influenza Vaccination in Pediatric Patients With Inflammatory Bowel Disease.

Pediatric patients with inflammatory bowel disease are undervaccinated against influenza. Gastroenterology nurses are ideally situated to assist in improving vaccination in this population. The objective of this quality improvement project was to evaluate the implementation of information technology prompts within the electronic medical record to improve influenza vaccination during specialty clinic visits. The proportion of patients with yearly influenza vaccination was evaluated at baseline, Year 1, and Year 2 following implementation. At baseline, only 10% of a random sample had documented influenza vaccination. Vaccination documentation improved to 39% (96/246) by Year 1 and to 61% (175/287) by Year 2 (p < .001). Vaccine counseling improved from 27% to 77% by Year 2 for unvaccinated patients (p < .001). Among patients seen by gastroenterology nurses, the proportion of patients with either documented vaccination or counseling was 94% by Year 2 compared with 70% if seen only by a physician (p < .001). Documentation of influenza vaccination improved with the use of customized prompts. Patients seen by a gastroenterology nurse had higher vaccination documentation and vaccine counseling than those who were seen by a physician alone.

Measles in Switzerland - progress made, but communication challenges lie ahead.

By learning from CAM physicians, we could improve the quality of our vaccination counselling, and health authorities should be able to avoid unnecessary vaccination mandates in Switzerland.

HPV Knowledge and Attitudes Among Medical and Professional Students at a Nevada University: A Focus on Oropharyngeal Cancer and Mandating the Vaccine.

Medical professionals and students often feel as if they do not have enough understanding of the human papillomavirus (HPV) vaccine in order to recommend or obtain vaccination themselves. A 25-question online survey regarding knowledge and attitudes about the HPV vaccine was distributed among professional students, including all classes of medical students, at a Nevada university. First- and second-year medical students were administered the same survey 1week after a new vaccine workshop. One third of respondents were aware of the link between HPV and oropharyngeal cancer, and 63% believed that the HPV vaccine should be mandatory. Reported full vaccination status (OR = 2.63 compared with no vaccination, 95% CI = 1.53, 4.53), awareness of the link to oropharyngeal cancer (OR = 1.85, 95% CI = 1.04, 3.29), and female sex (OR = 1.64, 95% CI = 1.00, 2.70) positively predicted whether a student believed the HPV vaccine should be mandatory. After an interactive workshop, first- and second-year medical students improved on HPV knowledge questions, comfort in HPV vaccine counseling, and having enough information to counsel on the HPV vaccine. Post-test knowledge scores surpassed those of current third- and fourth-year medical students, who never underwent such curriculum. Medical, physician assistant, graduate, and undergraduate students lack HPV knowledge, with a low percentage aware of oropharyngeal cancer as a result of HPV infection. An interactive curriculum implemented for first- and second-year medical students improved knowledge and comfort in counseling on HPV vaccination.

Influenza vaccination coverage among splenectomized patients: an Italian study on the role of active recall in the vaccination compliance

ABSTRACTPatients with anatomical or functional hypo-/a-splenia have a 10- to 50-fold higher risk of developing severe infectious diseases than does the general population. Thus, it is recommended to adhere to a specific vaccination schedule, including receiving influenza vaccine. During 2014, Bari Policlinico General Hospital approved a specific protocol to ensure that vaccines are actively offered to all splenectomized patients during their hospitalizations. The aim of this study is to evaluate the efficacy of this active recall protocol for performing influenza vaccination in the years following splenectomy among patients still involved in a specific vaccination program carried out by the hospital’s Hygiene department. From May 2014 to October 2016, 96 patients were involved in the vaccination program of the Hygiene department. In November 2017, 46/96 (48%) of patients received a specific invitation by phone to receive the annual influenza vaccine (intervention group), while 50/96 (52%) did not receive any such invitation (control group). At the end of the 2017 influenza season, 73/96 (76%; 95%CI = 66–84%) of patients reported having received the influenza vaccine; no differences were observed in the extent of vaccine coverage between the groups (intervention group = 80% vs. control group = 72%; p = 0.33). Older age, more recent splenectomy, hemo-lymphopathy and receiving the previous years’ doses of influenza vaccine are associated with receiving influenza vaccination during the 2017 season. These data indicate how effective communication at the time of the vaccine counseling results in good adherence to the vaccination program even after several years. Indeed, vaccination should be an opportunity not only limited to the administration of the vaccine but also for providing patient care.

Vaccine Education, Reasons for Refusal, and Vaccination Behavior

Little is known about associations between the reasons parents refuse or delay vaccines for their children, their responsiveness to vaccine counseling, and their children's vaccination status at various ages. Since 2015, Michigan has required parents to attend education sessions at local health departments to receive nonmedical exemptions. This requirement provides an opportunity to study otherwise opaque aspects of vaccine refusal. In 2017 and 2018, researchers analyzed a combined data set that included electronic medical records (n=4,098) generated by one Michigan health department during 2015 immunization education sessions, and immunization records from an August 2016 report of the Michigan Care Improvement Registry immunization registry. Analyses employed difference of proportions and ANOVAs to explore group differences in vaccination behaviors after education sessions and on-time vaccination status at various ages. Children whose parents stated a commitment to an alternative schedule at the education session subsequently received a vaccine their parents had refused at a much higher rate (39.2%) than did children whose parents refused for reasons of religion (4.4%), concerns about the risks of vaccines (8.1%), or beliefs that vaccines provide little benefit (10.5%). Different reasons for refusal are associated with different patterns of vaccination behavior. Furthermore, results suggest that education sessions may overcome vaccine refusal in some cases, and that distinct refusal reasons mark real differences in parental motivations regarding vaccination choices. These differences in parental motivations may indicate the existence of different sites for potential pro-vaccination interventions.

The role of the Community Pharmacist in promoting vaccinations among general population according to the National Vaccination Plan 2017-2019: results from a survey in Sicily, Italy.

The 2017-2019 Italian National Vaccination Plan promotes the improvement of knowledge and attitudes of healthcare workers about vaccine prevention, in order to spread a vaccination culture among general population. Similarly to the General Practitioner, the Pharmacist represents a fundamental forefront for both patients and healthy people, also in promoting vaccine acceptance. This research aims to analyze knowledge and attitudes about vaccines of Community Pharmacists and to evaluate the burden of vaccination counselling during their work activities. A standardized, self-administered and previously validated questionnaire, including 5 sections and 28 items, was submitted to a sample of Community Pharmacists working in Western Sicily. The survey was carried out through an online questionnaire, that investigated socio-demographic data, knowledge and attitudes towards vaccination and the role of the Pharmacist as vaccination counselor during his work. A total of 120 Pharmacists were surveyed. 99.2% of them were definitely agreed with the Regional Vaccination Schedule. A large majority (n = 114, or 95%) were fully vaccinated and have vaccinated, or would vaccinate in future, their children. According to Community Pharmacists interviewed, at least 90% of clients asked for further explanations about vaccination, and the citizens' trust towards vaccination increased (30%) or remained stable (54.2%) over time in the last 5 years. Finally, as reported by interviewed Pharmacists, a correct counselling provided by General Practitioners (GPs) and Family Pediatricians was the main boost in increasing vaccination confidence, instead of mass-media and web misinformation that has led to skepticisms among general population. The study demonstrated the key role of the Community Pharmacist for their consumers in vaccination counselling. In future, a strong collaboration between Community Pharmacists and all the actors promoting vaccination themes (GPs, family Pediatricians, public health workers) will be essential, as well as a uniform and standardized University training on vaccination themes for all these categories.

Influenza Vaccination Documentation Rates During the First Year After Diagnosis of Diffuse Large B Cell Lymphoma

IntroductionInfluenza infection causes significant morbidity and mortality in patients with cancer, and annual influenza vaccination for individuals with cancer is recommended. We sought to examine the documentation rate of influenza vaccine administration, refusal, or counseling in the first year after diagnosis of diffuse large B cell lymphoma (DLBCL) for patients across 3 hospitals in 2 health care systems. Patients and MethodsDocumentation of vaccine administration, refusal, or counseling by physicians, advanced practice providers, or nursing staff during the first period of influenza vaccine availability after diagnosis (August to April) was assessed in medical records of patients diagnosed with DLBCL between February 2015 and October 2017 who presented to Emory St. Joseph Hospital (community hospital), Winship Cancer Institute of Emory University (academic medical center), or Grady Memorial Hospital (county hospital). ResultsOf the 57% (61/107) of newly diagnosed patients with DLBCL who had vaccine-related documentation, 43% refused vaccination. Counseling was not documented for any patient. Inpatient nursing performed 75% of all documentation. Primary oncologists documented vaccination in 4% of all cases. ConclusionDespite the limited immunization documentation and high refusal rates observed in this study, the influenza vaccine refusal rate was lower than the average for the United States, the state of Georgia, and the previous studies of patients with cancer. Although routine outpatient vaccination occurs, improvements in screening, strategies for sharing patient vaccine-related information, and counseling of patients who refuse the vaccine are needed. Further work is also needed to determine the effectiveness of influenza vaccination in patients receiving anti-cancer therapy.

Influenza Vaccination Rates during the First Year after Diagnosis of Diffuse Large B Cell Lymphoma

Objective: Influenza infection is a significant cause of morbidity and mortality in patients with cancer, and thus the National Comprehensive Cancer Network (NCCN) recommends annual influenza vaccination for all individuals with cancer. We sought to examine the documentation rate of influenza vaccination administration, refusal, or discussion of vaccination in the first year after diagnosis of diffuse large B cell lymphoma (DLBCL) for patients across three hospitals in two healthcare systems.Methods: Medical records were reviewed for 114 patients with a new diagnosis of DLBCL between February 2015 and October 2017 who presented to either Emory St. Joseph Hospital (a community hospital setting), Winship Cancer Institute at Emory University (an academic medical center), or Grady Memorial Hospital (a county hospital). Documentation of administration, refusal, or discussion regarding influenza vaccination by physicians, advanced practice providers, or nursing staff during the period of influenza vaccine availability for the first influenza season after diagnosis was assessed.Results: Among 114 patients with newly diagnosed DLBCL, 54% were male, and 46% were over 60 years of age with a median age of 59 years (range 21-88 years). One patient was excluded from analysis as she was enrolled in hospice prior to influenza season. Documentation of influenza vaccination status within 1 year of diagnosis of DLBCL was performed for 56% (63/113) of patients. Nearly 75% (47/63) of documentation regarding vaccination was performed by inpatient nursing staff at time of admission. Documentation of influenza vaccination status was performed by the primary oncologist in 4% (5/113) of all cases and 8% of the documented cases respectively (5/63). The county hospital and the academic medical center had higher documentation of vaccination rates (62% [5/8] and 60% [27/45], respectively) compared with the community hospital (50% [5/10]). Of the patients with documentation of influenza vaccination status, vaccine refusal was documented for 41% (26/63) of patients, and counseling regarding the importance of vaccination was not documented for any patient.Conclusions: Our study shows that documentation of education and administration of influenza vaccination is suboptimal in these 2 healthcare systems. Although vaccinations that occurred outside of these healthcare systems by primary care providers, pharmacies, and other providers would not be recorded in this dataset unless the patient had a hospital admission, these data suggest a gap in patient care and education that could lead to increased risk of worse outcomes from influenza infection. Routine outpatient vaccination screening and counseling in oncology clinics will be explored to improve documentation of influenza vaccination and influenza vaccination rate. Additionally, strategies for sharing patient information about vaccination between providers in different healthcare systems could improve vaccination compliance in patients with lymphoma. Further work is needed to determine the effectiveness of routine influenza vaccination in patients receiving anti-cancer therapy. DisclosuresAllen:Merck: Research Funding; Bayer: Consultancy. Flowers:BeiGene: Research Funding; Burroughs Wellcome Fund: Research Funding; Pharmacyclics/ Janssen: Consultancy; Genentech/Roche: Consultancy; Bayer: Consultancy; Denovo Biopharma: Consultancy; Eastern Cooperative Oncology Group: Research Funding; Gilead: Research Funding; Spectrum: Consultancy; Celgene: Research Funding; Karyopharm: Consultancy; Genentech/Roche: Research Funding; Janssen Pharmaceutical: Research Funding; TG Therapeutics: Research Funding; OptumRx: Consultancy; Millennium/Takeda: Research Funding; National Cancer Institute: Research Funding; V Foundation: Research Funding; Acerta: Research Funding; Abbvie: Research Funding; Pharmacyclics: Research Funding; Gilead: Consultancy; Abbvie: Consultancy, Research Funding.