One-stop service improves influenza vaccination rates among organ recipients

The uptake rate of vaccination against influenza among solid organ transplant (SOT) recipients has increased following the implementation of the one-stop influenza vaccination service, which increases accessibility and addresses barriers such as lack of knowledge of such need, reports a Singapore study.

“SOT recipients who had received influenza vaccination in the previous year have been associated with a reduced incidence of influenza infection and SOT recipients with a shorter number of years post-transplant are more likely to receive influenza vaccination,” the researchers said.

This single-centre prospective study on influenza vaccination among SOT recipients at Singapore General Hospital was approved by the Singhealth Centralised Institutional Review Board. A one-stop influenza vaccination service was implemented in the outpatient transplant centre where SOT recipients could avail of the vaccine during their outpatient clinic visit.

Nurses administered the influenza vaccine after the physician prescribed it at the same outpatient clinic visit. Survey forms were then administered to collect data on the influenza vaccination rate among SOT recipients prior to the implementation of the one-stop service, as well as the reasons for not receiving influenza vaccination annually.

Pharmacists and nurses educated those who refused the vaccination using standardized educational materials from the Singapore Health Promotion Board. [https://www.healthhub.sg/a-z/diseases-and-conditions/103/topics_influenza]

Three hundred and eight SOT recipients followed-up from December 2014 to February 2015 were surveyed, of which 25.0 percent received their annual influenza vaccination previously. Among those who have not, 60.6 percent received vaccination after the education.

SOT recipients were found to be unaware of the importance of annual influenza vaccination (66.7 percent). Those with a shorter number of years post-transplant (odds ratio [OR], 0.95, 95 percent confidence interval [CI], 0.91–0.99) and a history of diabetes (OR, 0.48, 95 percent CI, 0.23–0.94) were more likely to be vaccinated. [Proc Singapore Healthc 2021;29:223-227]

As a result of the one-stop service implementation, incidence of influenza decreased, albeit not statistically significant (p=0.668). SOT recipients who had been previously vaccinated were less likely to acquire the virus (OR, 0.19, 95 percent CI, 0.04–0.99).

“The percentage of SOT recipients who had influenza infection was reduced by 46.6 percent after the implementation of patient education and the one-stop vaccination service,” the researchers said.

“Although it was not statistically significant, the absolute reduction in the incidence of influenza infection among SOT recipients may be clinically significant, given that the severity of influenza infection is higher in immunocompromised individuals,” they added. [Lancet Infect Dis 2010;10:521-526; Clin Microbiol Infect 2012;18:67-73]

The presence of liver disease also correlated with a reduction in the incidence of influenza infection, but patients with a history of chronic liver disease are at greater risk of developing complications related to the infection. Of note, these patients are recommended to be vaccinated per Center for Disease Control and Prevention guidelines. [PLoS One 2014;9:e101785]

“Therefore, this seemed to be an anomaly result and a meaningful conclusion to this result cannot be drawn,” the researchers said.