Many patients with blood disorders don’t receive recommended vaccines and screenings

The research, led by Luis E. Malpica Castillo, MD, in the division of hematology/oncology, aims to improve awareness and utilization of infection prevention tools.

Many patients with blood disorders don’t receive recommended vaccines and screenings click to enlarge Luis E. Malpica Castillo, MD

New research from the University of North Carolina School of Medicine has found that only a low percentage of hospital patients being treated for immune-mediated blood disorders, such as immune thrombocytopenic purpura, receive the recommended vaccinations and infectious disease screenings.

"The management of patients with blood disorders carries a risk of infections which can deeply affect a patient's outcome,” said Luis E. Malpica Castillo, MD, a fellow in in the division of hematology/oncology in the UNC Department of Medicine and lead author of an article published in the American Journal of Hematology.    

“Vaccination and infectious disease screening can decrease these infectious complications and improve safety when treating patients with blood disorders, Malpica said. “However, some health care providers are not fully aware of these prevention tools. Our study aims to develop strategies to improve awareness and utilization of these infection prevention tools when treating patients with blood disorders.”

Malpica will give a presentation about his research at the American Society of Hematology’s annual meeting in Orlando, Florida, in December.

For the presentation, Malpica and five UNC co-authors analyzed data from 269 patients treated at six hospitals for conditions including immune thrombocytopenic purpura, autoimmune hemolytic anemia, acquired coagulation factor deficiency, thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome, paroxysmal nocturnal hemoglobinuria, and antiphospholipid syndrome. 

Overall, only 6 percent of these patients were appropriately immunized as recommended by national guidelines. In patients treated with eculizumab, 38 percent received both of the recommended vaccines. In patients treated with splenectomy (a surgery to remove the spleen), 11 percent received guideline recommended vaccines, but only 8 percent were appropriately vaccinated by receiving all indicated vaccines at least four weeks prior to their scheduled surgery. In patients treated with rituximab, 68 percent were appropriately screened for hepatitis B at odds with national recommendations of 100%. Overall, 36 percent received an annual influenza vaccine and 11 percent of eligible patients received the herpes zoster vaccine.  

Based on these results, Malpica and study co-authors created infographics aimed at improving awareness among health care providers. They summarized recommendations in an easy-to-use pocket brochure which they are hoping to nationally disseminate to the different health care providers. Additionally, efforts are being placed to build immunization reminders into UNC Health Care’s electronic medical record system for prescriptions of rituximab or eculizumab. They plan to propagate the results of their study and hope that other academic medical centers will replicate it.

Senior author of the paper is Stephan Moll, MD, professor in the division of hematology/oncology at UNC. Co-authors, all from UNC, are David van Duin, MD, PhD, associate professor in the division of infectious diseases, Shannon Palmer, MS; Anqi Zhu, MS; Allison Deal, MS; and Shen-Li Chen, PharmD.

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