26 - Factors Associated with Meningococcal Vaccination among Patients with Newly Diagnosed High-Risk Conditions

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Presenting Author(s)

Parinaz Ghaswalla

Manager
GSK
Philadelphia, Pennsylvania
Disclosure: GlaxoSmithKline (Employee, Shareholder)

Co-Author(s)

LB

Lindsay Bengtson

Associate Director
Optum
Eden Prairie, MN
Disclosure: Optum (Employee, I am an employee of Optum. Optum was paid by GSK for this work. My employment at Optum is not contingent upon this work.)
Gary S. Marshall

Professor of Pediatrics
Norton Children's and University of Louisville School of Medicine
Louisville, KY
Disclosure: GlaxoSmithKline (Consultant, Scientific Research Study Investigator)Merck (Consultant, Scientific Research Study Investigator)Pfizer (Consultant, Scientific Research Study Investigator)Sanofi Pasteur (Consultant, Grant/Research Support, Scientific Research Study Investigator, Honorarium for conference lecture)Seqirus (Consultant, Scientific Research Study Investigator)
AB

Ami R. Buikema

Senior Director, Respiratory and Infectious diseases
Optum
Eden Prairie, MN
Disclosure: Optum (Employee, I am an employee of Optum. Optum was paid by GSK for this work. My employment at Optum is not contingent upon this work.)
TB

Tim Bancroft

Associate Director of Methods
Optum
eden prairie, Minnesota
Disclosure: Optum (Employee, I am an employee of Optum. Optum was paid by GSK for this work. My employment at Optum is not contingent upon this work.)
KS

Krista Schladweiler

Associate Director
Health Economics and Outcomes Research
Eden Prairie, Minnesota
Disclosure: Optum (Employee, I am an employee of Optum. Optum was paid by GSK for this work. My employment at Optum is not contingent upon this work.)
EK

Eleena Koep

Senior Research Analyst
UnitedHealth Group
Minnetonka, Minnesota
Disclosure: Optum (Employee)
PN

Patricia Novy

US Medical Affairs Lead, Meningococcal Vaccines
GSK
Philadelphia, Pennsylvania
Disclosure: GSK (Employee, Shareholder)
CH

Cosmina Hogea

Director
GSK
Philadelphia, Pennsylvania
Disclosure: GlaxoSmithKline (Employee, Shareholder)

Background: Vaccination is recommended for persons at increased risk for invasive meningococcal disease (IMD) due to complement component deficiency (CD), asplenia or human immunodeficiency virus (HIV) infection. However, uptake of quadrivalent conjugate and polysaccharide meningococcal vaccines (MenACWY) one year following a new high-risk diagnosis is very low (doi:10.1093/ofid/ofz360.2403). This retrospective cohort study identified factors associated with MenACWY vaccination among patients newly diagnosed with CD or HIV.

Methods: Patients identified from a large US commercial administrative claims database (Optum Research Database) with continuous enrollment for ≥12 months before and ≥6 months after appearance of an incident high-risk diagnosis through the end of the study period (3/31/2018) were considered eligible (Figure). Cox proportional hazards regression models were used to identify characteristics associated with time to receipt of ≥1 dose of MenACWY during time periods corresponding with Advisory Committee on Immunization Practices (ACIP) recommendations.Figure: Study Design Schematic

Results: The CD cohort consisted of 1,470 (mean=40.9 years of age) patients and the HIV cohort of 1,208 (38.8 years). Only 7.9% and 20.8% of patients with CD or HIV, respectively, received ≥1 dose of MenACWY between their index date and the end of the study period. A strong association between receipt of MenACWY and pneumococcal vaccines was seen for CD [hazard ratio (HR): 3.2; 95% CI: 1.8-5.7] and HIV [23.0; 13.9-38.1]. Age (11-18 years; for CD only) and having a well-care visit after the index date (for CD and HIV) was associated with higher likelihood of vaccination. Vaccination rates for HIV were lowest in the South.

Conclusion: The association of MenACWY vaccination with age in patients with CD suggests confusion between routine age-based and high-risk recommendations, whereas in patients with CD or HIV, the association with pneumococcal vaccines suggests that providers recognize the overlap in risk factors for IMD and pneumococcal disease. Ensuring healthcare access for these vulnerable patients and educating providers about high-risk recommendations is crucial.

Funding: GlaxoSmithKline Biologicals SA (study identifier: HO-18-19581)