Improving the immunization rates in a large paediatric cystic fibrosis clinic

Abstract

Background: In Australia, children with cystic fibrosis (CF) are recommended to have influenza and pneumococcal vaccinations (medically atrisk vaccinations) in addition to those on the national immunization program (NIP). Children with CF are at an additional risk of vaccinepreventable diseases, particularly those related to respiratory infections, and the additional vaccinations are often not considered by primary health care providers. The Queensland Children's Hospital cystic fibrosis clinic in Brisbane is a large paediatric centre that provides care for 450 patients over a vast geographical area. In October 2024 the data from the 2023 site report for the Statewide CF paediatric service showed low rates of the influenza vaccination in our cohort. Further investigation indicated that adherence to the NIP and medically at-risk vaccination schedule was lower in our site than the average in other Australian CF clinics. In response, a targeted intervention was implemented to identify barriers and potential solutions to improve vaccination rates. Methods: The intervention began in October 2024 targeting all patients when they were due to attend their next planned clinic. The intervention included three CF team members completing an immunization course and comprehensive education for caregivers and healthcare providers by the Queensland Specialist Immunization Service (QSIS), emphasising the importance of timely vaccinations for children with CF. The CF nurses and CF pharmacist identified eligible patients and communicated with caregivers prior to and at the CF clinic. The intervention facilitated access to vaccines through QSIS staff attending CF clinics, improving convenience and access for children to allow adherence to the immunization schedule. QSIS and CF pharmacist accessed Australian Immunization Register prior to seeing the patients in the CF clinic. Prescription datawas accessed through the CF Dashboard. Uptake datawas collected throughout the immunization program. Results:We have been able to identify immunization gaps and gain verbal consent from patients and families prior to them attending clinic so that the children could be immunized in clinic as part of their visit. QSIS present a gap analysis on all patients including those at outreach centres twoweeks prior to their clinic and record this on the electronic record. While the intervention is ongoing both pre and post intervention data has been collected, for example a recent six-week snapshot has been collected to assess the intervention's impact. During this time period, of the 47 vaccinations given through the CF clinic 21 were medically at-risk vaccination catch ups. Conclusions: The success of this intervention highlights the effectiveness of targeted immunization strategies for influenza vaccination, medically atrisk vaccination and NIP in improving health outcomes for children with CF. Future initiatives could consider measuring the reduction in the incidence of vaccine preventable diseases in this cohort.