Evaluation of Service and Clinical Outcomes of the Infectious Diseases Global and Pre-Treated Patient (ID-GAPP) Program
Hanson Cowan, Anita Max, Sheena MukkadaAbstract
Background
St. Jude Children’s Research Hospital (SJCRH) serves pediatric oncology patients worldwide. Treatment for malignancies represents a vulnerable time for the activation or reactivation of infections in oncology patients. It is necessary to systematically review the potential sources of infections, and to take appropriate measures through vaccination, and prophylaxis to reduce the risk of complications during their subsequent chemotherapy or surgeries. Just as travel medicine or refugee health screenings evaluate the risk of exposures and infections in travelers, the ID-GAPP program serves a similar purpose to search for potential infectious disease complications prior to initiation of chemotherapy. The results of preventative, diagnostic and therapeutic interventions patients underwent after the ID-GAPP consultation, and subsequent rates of infectious disease complications are described.
Methods
SJCRH patients qualified for an ID-GAPP evaluation if they resided in the continental US for less than a year prior to arrival at St. Jude, had been hospitalized outside the continental US for treatment of their cancer or due to a complication, or traveled outside the continental US within 3 months of referral to St. Jude between June 2019 and December 2024. Patients’ initial history and physical notes were screened for the forementioned criteria. For patients who met these criteria and received an ID-GAPP consultation, patient demographic, past medical history, details of current cancer diagnosis, details from the ID-GAPP consultation, and infectious disease complications related to the ID-GAPP consultation in the subsequent year were collected.
Results
From June 2019 to December 2024, a total of 71 patients received an ID-GAPP consultation. Most ID-GAPP patients originated from North/Central America (47%), Europe (20%), and South America (17%). From initial immunization screening, 18 (12.7%) patients were Hepatitis B non-immune, 11 (15.5%) Varicella nonimmune, and an additional 8 (11.3%) were under-vaccinated. Subsequently, vaccination recommendations for patients included 9 Hepatitis B, 3 Varicella, 12 COVID-19, 10 seasonal influenza, 2 HPV, and 1 meningococcal immunization. Additionally, infectious disease testing identified 9 (12.7%) patients with ESBL, VRE, or CRE colonization form rectal swabs. Infectious disease complication in the subsequent year included 10 (14.1%) cases of ESBL bacteremia, and an additional 4 (5.6%) with non-ESBL bacteremia.
Conclusion
The ID-GAPP program allows for better treatment of SJCRH’s global patient population through screening of vaccine preventable diseases, and consideration of locally acquired infections. Screening through the ID-GAPP program allowed early intervention on vaccine preventable illness, targeted infectious disease prophylaxis, and identification of possible infectious disease complications.