title: Vaccination guidelines after hematopoietic stem cell transplantation: practitioners' knowledge, attitudes, and gap between guidelines and clinical practice.
abstract: BACKGROUND
  Hematopoietic stem cell transplant (HCT) recipients are more susceptible to infections from vaccine-preventable diseases than the general population. Despite the development of international consensus guidelines addressing immunization after HCT, studies have shown that deviations from recommended immunization practices commonly occur.
  
  
  METHODS
  An anonymous survey aimed at determining awareness of the guidelines and attitudes toward vaccination was distributed to our HCT clinicians. In parallel, we retrospectively evaluated patients' characteristics and post-HCT vaccine administration practices from 2010 to 2013.
  
  
  RESULTS
  The majority of survey respondents (96%) were familiar with post-HCT vaccination protocols. Seventy-four percent of respondents reported that influenza vaccines were given to >70% of their patients, and 41% stated that they prescribed live vaccines to eligible patients. However, our pharmacy database review revealed that 38% of patients received the first series of vaccinations by the recommended 6 months post HCT, and 60% received them by 1 year after HCT. Most patients who had their vaccines withheld had relapsed disease or were undergoing treatment for graft-versus-host disease. Furthermore, we identified lower immunization rates in non-English speaking individuals, African-Americans, and Hispanic patients.
  
  
  CONCLUSIONS
  Survey respondents reported being aware of current guidelines; however, adherence to the recommendations varied, likely connected to conflicting data on vaccine effectiveness and a lack of clear recommendations in complex clinical scenarios. Similar to the general population, patient barriers also could have contributed to lower vaccination rates in some cases. To decrease the large gap between the post-HCT vaccination guidelines and clinical practice, further studies on vaccine effectiveness and specific populations are warranted.
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Ariza-Heredia
authors.forename: A M
authors.initials: AM
authors.lastname: Gulbis
authors.forename: K R
authors.initials: KR
authors.lastname: Stolar
authors.forename: P
authors.initials: P
authors.lastname: Kebriaei
authors.forename: D P
authors.initials: DP
authors.lastname: Shah
authors.forename: K K
authors.initials: KK
authors.lastname: McConn
authors.forename: R E
authors.initials: RE
authors.lastname: Champlin
authors.forename: R F
authors.initials: RF
authors.lastname: Chemaly
mesh_terms: D003625:Data Collection; D007722:Health Knowledge, Attitudes, Practice; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014611:Vaccination; D014612:Vaccines / Q000008:administration & dosage* / Q000276:immunology*
chemical_list: D014612:Vaccines
keywords: GVHD; guidelines; stem cell transplant; vaccines