New research reveals a strategy to increase vaccination adherence among patients with sickle cell disease (SCD). The approach incorporates nurse reviews, order sets and flags in the electronic medical record (EMR), and enhanced patient education.
“Vaso-occlusion in SCD leads to functional asplenia, increasing severe infection risk from encapsulated bacteria, viruses, and parasites,” wrote the authors, led by Evan Keiser of the University of Wisconsin-Madison. “Patients with SCD also face systemic barriers, particularly decreased access to treatment.”
The authors’ clinic observed low vaccine adherence among adults with SCD: In 2022 to 2024, for example, vaccine rates in that population were pneumococcal 35%, meningococcal ACWY 15%, meningococcal B 20%, Haemophilus influenzae type b 48%, and influenza 39%. The authors sought to increase adherence to these asplenia-related vaccines by 50% within 9 months and 75% within 12 months.
First, the team identified potential root causes of care gaps, including providers’ difficulty assessing vaccine status in the EMR, time constraints, limited patient knowledge, insurance coverage, and the absence of a vaccine administration protocol. Subsequently, an interdisciplinary team of providers, a nurse care manager, pharmacists, and information technology personnel designed and implemented a workflow for vaccine review, administration, and patient education to address the perceived care gaps.
For example, the team added functional asplenia in the EMR to flag vaccine-eligible patients and improve coding and billing. The workflow dictated that a nurse care manager would review vaccination gaps and make recommendations to the physicians. The team also created a templated order set in the EMR and patient education materials.
The intervention began in April 2025, and the team recently presented their preliminary outcomes. In the 3-month time frame, the clinic saw 36 adults with SCD. The nurse care manager review identified 94.4% (n=34) of patients who required an updated vaccine or booster and provided education to 58.3% (n=21). Subsequently, 50% (n=18) agreed to or requested vaccination. Vaccination rates increased to 41.7% for pneumococcal, 27.8% for meningococcal ACWY, and 77.8% for Haemophilus influenzae type b — gains the authors said they are building upon.
One significant barrier involved the inability to run prior authorizations for insurance coverage of in-clinic vaccinations. The team pivoted to prescribing vaccinations for administration in the pharmacies where patients obtain their medications.
The team will continue to implement and assess outcomes through the 12-month mark.
Reference
Keiser E, Sandhu H, Lattin L, et al. Addressing functional asplenia in sickle cell disease: A quality improvement approach to improve vaccination rates. Abstract abs25-9561. Presented at: the 67th American Society of Hematology Annual Meeting and Exposition, Dec. 6-9, 2025, Orlando, FL.
