On-Site Review and Administration of Immunizations Improves Vaccination Compliance in Children with Cochlear Implants

Transcription

1 On-Site Review and Administration of Immunizations Improves Vaccination Compliance in Children with Cochlear Implants Prashant S. Malhotra, MD, FAAP Director, Hearing Program Nationwide Children s Hospital Columbus, OH

2 Disclosures None

3 Meningitis In Cochlear Implants Spike in post-implantation bacterial meningitis noted in 2002 by FDA 16-30x greater than healthy children Primarily Streptococcal pneumoniae and Haemophilus influenzae Inner ear malformations, immunodeficiency, hx of VP shunt, AOM increase risk

4 Immunizations and Cochlear Implants 2000 PCV 7 licensed by FDA 2002 CDC recommends all CI recipients have PCV7 & PPSV PCV-13 licensed, succeeds PCV AAP Policy Statement (focused on children <6) 2012 PCV-13 recommended for adults 2013 PCV-13 recommended for kids 6-18 yrs old regardless of PCV-7 or PPSV 23 status

5 AAP Policy Statement (2010) Before implant surgery, PCPs and CI teams should ensure that immunizations are up to date, preferably with completion of indicated vaccines at least 2 weeks before implant surgery. PCPs Another visit Familiarity with CI-related recommendations? Most pediatric providers do not routinely carry Pneumovax 23 as it is a special population/adult vaccination Meningococcal vs. pneumococcal confusion

6 AAP Policy Statement (2010) All CI patients need to have age appropriate doses of: Pneumococcal conjugate (PCV 13 or 7) Haemophilus influenza type b conjugate vaccines In addition, age 24 months and older, a single dose of PPSV 23 should be administered.

7 AAP Policy Statement (2010) Kids months that had all PCV 7 shots should get one dose of PCV 13 Everyone 6-18 y/o should have had at least 1 dose of PCV 13 If not previously received, all children should receive one done of PCV 13 prior to PPSV 23 If they are months, they should receive 2 doses of PCV 13 if 2 doses or less were given prior to 24 months If they had 3 doses PCV 7/13 under age 24 months, need one more dose if under 6 Annual influenza vaccine recommended

8 So how were we doing? 56% rate (Ou 2010, US - Washington state) 46% (Moore 2012, UK) Suggestions for assessing documentation better

9 Methods Retrospective Inclusion: Pediatric cochlear implants 8/1/ /2014 Bilateral simultaneous counted as 1 event, sequentials counted as separate documentation events

10 On-site, Clinic Based Intervention Nurse Practitioner and Nurse in Hearing Program take on role of: Obtaining documentation of vaccinations Assessing vaccinations for compliance with guidelines Administering CI-related vaccinations in clinic

11 Methods Start Implementation of new protocol 8/1/2010 8/1/2012 Evaluate documentation of vaccination Evaluate compliance with AAP policy statement

12 Results - Overview Total N=87 Pre-Intervention: N=21 (24.14%) 21 vaccines administered at any time Post-Intervention: N=66 (75.86%) 64 vaccines administered at any time Total 85 vaccines were provided in our Hearing Clinic

13 Results Descriptive Stats Period Variable Median Mean Min Max Pre Age at CI (yrs) (N=21) Follow up (months) Post Age at CI (yrs) (N=66) Follow up (months) Overall Age at CI (yrs) (N=87) Follow up (months) No statistically significant difference (at an α=0.05 level) in age at CI between the two groups (Wilcoxon rank sum p-value= )

14 Results - Meningitis No post-ci meningitis in any group No difference in cochleovestibular anomalies on imaging

15 Results HIb Documentation Documentation at time of surgery Fisher s exact test p-values=

16 Results PCV-7 Documentation Documentation at time of surgery Fisher s exact test p-values= and

17 Results PCV-13 Compliance Compliance at time of surgery p-value <.0001

18 Results PPV23 Compliance Compliance at time of surgery p-value <.0001 p-value <.0001

19 Results Learning curve (PPV23 6 mos)

20 Results Current Compliance All CI kids are now evaluated at each visit, we have updated unvaccinated children: 95% of patients currently compliant with PPV-13 92% of patients currently compliant with PPV23

21 Future Prospectively, study outcomes: Rates of AOM in our population Rates of post-implant meningitis Rates of post-implant related infections to see how compares with reported literature

22 NCH Hearing and Implant Program Medical Director: Prashant Malhotra, MD Audiology Manager: Gina Hounam, Ph.D.-CCC-A Program/Clinical Coordinator: Kimberly Davis, APN Otolaryngology Oliver Adunka, MD (Director, OSU) Ed Dodson, MD Kris Jatana, MD Prashant Malhotra, MD Audiology: Rebecca Belt, Au.D., CCC-A, FAAA Nikia L. Bridges, Au.D., CCC-A Jamie Hadley Godsey, AuD-CCC-A Kimberly Harhager, Au.D., CCC-A Gina Hounam, Ph.D.-CCC-A Alecia Jayne, Au.D., CCC-A Melissa Skarl Kappes, M.A., CCC-A Shana Moore, M.A., CCC-A Jennifer Phelan, AuD, CCC-A Brittney Sprouse, Au.D., ABA Lindsey Turover, Au.D., CCC-A Jori Weingarten, AuD., CCC-A Cindi Warner, Au.D., CCC-A Speech and Language: Jennifer Davitz, CCC-SLP Jean Hruschak, MA, CCC-SLP Shana Lucius, MA, CCC-SLP, LSLS Cert. AVT Andrea Purvis, CCC-SLP Neuropsychology: Jennifer Cass, PhD Vestibular Therapy/OT: Marianne Mayhan Nursing: Kimberly Davis, APN Lura Keating, RN Social Work: Charae Williams, MSW

23 Nationwide Children s Hospital

24 Nationwide Children s Hospital

25 Hiring Pediatric CI Audiology positions!! Gina Hounam Prashant Malhotra