School of Medicine and Health Sciences Poster Presentations

Title

Improving 23-Valent Pneumococcal Polysaccharide (PPSV23) Vaccination in Pediatric HIV Patients

Poster Number

313

Document Type

Poster

Status

Medical Student

Abstract Category

Quality Improvement

Keywords

Quality Improvement, Pneumococcal vaccine, HIV infected children

Publication Date

Spring 2018

Abstract

Background and Objectives: Children living with HIV are at increased risk for invasive pneumococcal disease. The American Academy of Pediatrics recommends all children with HIV infection receive 23-valent pneumococcal polysaccharide vaccine (PPSV23) after receiving the 13 valent pneumococcal conjugate (PCV13) vaccine series. Despite this recommendation, the rate of PPSV23 vaccination in children with HIV remains low. This quality improvement project aimed to increase the rate of PPSV23 vaccination rate among pediatric and adolescent high risk population attending Special Immunology Services (SIS) HIV specialty clinic at Children’s National. Methods: Eligible patients included children and adolescents receiving care at SIS clinic. A baseline assessment of PPSV23 vaccination rate was performed in April 2015. Interventions included proactive acquisition of updated vaccination records from primary care providers, determining need for PCV-13 vaccine series and PPSV-23 during clinic visits, and requesting primary care providers to administer required vaccinations or providing PPSV-23 at subsequent SIS appointments. A REDCap database was created to track documentation of PCV-13 and PPSV23 vaccination. Results: In April 2015, 184 children and adolescents were enrolled in care at SIS. Fifty-seven patients (40.0%) had immunization records available, and only 17 (9.2%) had documentation of completion of PCV-13 series and none (0.0%) had documentation of PPSV-23. After 2 Plan-Do-Study-Act cycles over a period of 8 months, there was an increase of total patients with immunization records to 95 (51.6%). Thirtysix (19.6%) had documentation of completion of PCV-13 series and 16 patients (8.7%) had documented PPSV-23 vaccine. Three (18%) PPSV23 vaccines were administered in SIS clinic. Conclusions: Obtaining patients’ current vaccination records from primary care providers and lack of prior administration of PCV-13 are two barriers to completing PPSV-23 vaccination in children with HIV receiving care in a specialty setting. Dedicated SIS staff time is required to consistently operationalize procuring updated immunization records and administering PCV-13 and PPSV-23 as recommended by national guidelines.

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Improving 23-Valent Pneumococcal Polysaccharide (PPSV23) Vaccination in Pediatric HIV Patients

Background and Objectives: Children living with HIV are at increased risk for invasive pneumococcal disease. The American Academy of Pediatrics recommends all children with HIV infection receive 23-valent pneumococcal polysaccharide vaccine (PPSV23) after receiving the 13 valent pneumococcal conjugate (PCV13) vaccine series. Despite this recommendation, the rate of PPSV23 vaccination in children with HIV remains low. This quality improvement project aimed to increase the rate of PPSV23 vaccination rate among pediatric and adolescent high risk population attending Special Immunology Services (SIS) HIV specialty clinic at Children’s National. Methods: Eligible patients included children and adolescents receiving care at SIS clinic. A baseline assessment of PPSV23 vaccination rate was performed in April 2015. Interventions included proactive acquisition of updated vaccination records from primary care providers, determining need for PCV-13 vaccine series and PPSV-23 during clinic visits, and requesting primary care providers to administer required vaccinations or providing PPSV-23 at subsequent SIS appointments. A REDCap database was created to track documentation of PCV-13 and PPSV23 vaccination. Results: In April 2015, 184 children and adolescents were enrolled in care at SIS. Fifty-seven patients (40.0%) had immunization records available, and only 17 (9.2%) had documentation of completion of PCV-13 series and none (0.0%) had documentation of PPSV-23. After 2 Plan-Do-Study-Act cycles over a period of 8 months, there was an increase of total patients with immunization records to 95 (51.6%). Thirtysix (19.6%) had documentation of completion of PCV-13 series and 16 patients (8.7%) had documented PPSV-23 vaccine. Three (18%) PPSV23 vaccines were administered in SIS clinic. Conclusions: Obtaining patients’ current vaccination records from primary care providers and lack of prior administration of PCV-13 are two barriers to completing PPSV-23 vaccination in children with HIV receiving care in a specialty setting. Dedicated SIS staff time is required to consistently operationalize procuring updated immunization records and administering PCV-13 and PPSV-23 as recommended by national guidelines.