Meningococcal vaccination in patients with newly diagnosed asplenia in the United States

Abstract

Background: Patients with asplenia are recommended to receive meningococcal ACWY (MenACWY) and B (MenB) vaccines in the United States (US).

Objectives: To examine uptake and time to receipt of meningococcal vaccines in newly diagnosed asplenia patients, and identify factors associated with vaccination.

Methods: For this retrospective database analysis, patients were identified from 1/1/2010 (MenACWY) or 1/1/2015 (MenB) through 3/31/2018 from an administrative claims database including commercially insured US patients with ≥1 inpatient or ≥2 outpatient claims with evidence of a new asplenia diagnosis (sickle cell disease was excluded); continuous enrollment for ≥12 months before and ≥6 months after the index date; and age ≥2 (MenACWY) or ≥10 (MenB) years. Co-primary outcomes were uptake and time to receipt of ≥1 dose, separately for MenACWY and MenB, by Kaplan-Meier analysis. Cox proportional hazards regression models were used to identify characteristics associated with vaccination.

Results: Among 2,273 and 741 patients eligible for the MenACWY and MenB analyses, respectively, 28.1% and 9.7% received MenACWY and MenB in the first 3 years after a new asplenia diagnosis. Patients were more likely to receive meningococcal vaccines if they had received pneumococcal vaccines (MenACWY: hazard ratio [HR] 26.02; 95% confidence interval [CI] 21.01-32.22; MenB: HR 3.89; 95% CI 2.07-7.29) or attended ≥1 well-care visit (MenACWY: HR 6.63; 95% CI 4.84-9.09; MenB: HR 11.17; 95% CI 3.02-41.26).

Conclusions: Meningococcal vaccination rates among newly diagnosed asplenia patients were low, highlighting the need to educate providers about the recommendations for high-risk conditions and ensure healthcare access for vulnerable patients.

Keywords: Asplenia; Meningococcal vaccines; Meningococcus serogroup B; Meningococcus serogroups A, C, W, and Y.