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Lloyd AR, Ardura MI, Wise K, Chavarin DJ, Boyle B, Sivaraman V. Barriers to vaccination in immunocompromised children: A needs assessment in children with childhood-onset SLE and inflammatory bowel disease. Front Pediatr 2023; 11:1103096. [PMID: 36937959 PMCID: PMC10014617 DOI: 10.3389/fped.2023.1103096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/17/2023] [Indexed: 03/05/2023] Open
Abstract
Background Vaccination of immunocompromised children (ICC) remains suboptimal. Methods Needs assessment surveys were administered to patients and caregivers during routine ambulatory visits to the rheumatology and gastroenterology clinics at Nationwide Children's Hospital (NCH) from January 1 through August 31, 2018, and to community primary care physicians (PCPs) at their monthly meeting and electronically. Results Completed surveys were received for 57 patients (31 with childhood-onset systemic lupus erythematosus (c-SLE) and 26 with inflammatory bowel disease (IBD)) and 30 PCPs. Of the patient cohort, 93% (n = 53) felt their PCP was well informed about vaccines and 84% (n = 47) received vaccinations from either their PCP or local health department. Two patient surveys noted concerns of vaccine safety. Among the 30 responses completed by PCPs 50% (n = 15) preferred to provide all vaccines themselves, however, only 40% (n = 12) of PCPs felt "very confident" when providing vaccines to ICC. Further, 83% (n = 25) did not stock the 23-valent pneumococcal vaccine and only 27% (n = 8) routinely recommended vaccination of household contacts. Conclusions Our study found a discordance between parent and PCP comfort in vaccinating ICC, highlighting an important barrier to vaccination in this patient population. In our cohort of patients, vaccine hesitancy was not a barrier to vaccination.
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Affiliation(s)
- Audrey R. Lloyd
- Internal Medicine, Division of Infectious Diseases, University of Alabama, Birmingham, AL, United States
| | - Monica I. Ardura
- Pediatrics, Divisions of Infectious Disease, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, United States
| | - Kelly Wise
- Pharmacy, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, United States
- Pediatrics, Rheumatology, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, United States
| | - Daniel J. Chavarin
- Internal Medicine, Division of Internal Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Brendan Boyle
- Pediatrics, Gastroenterology, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, United States
| | - Vidya Sivaraman
- Pediatrics, Rheumatology, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, United States
- Correspondence: Vidya Sivaraman
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Kazantzi M, Prapa M, Christakou E, Paraschou D, Kalabalikis P, Barbaressou C, Papaevangelou V. Admissions due to vaccine preventable diseases in a large paediatric intensive care unit in Greece over a 10-year period. J Paediatr Child Health 2022; 58:312-317. [PMID: 34467594 DOI: 10.1111/jpc.15711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/05/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Abstract
AIM Childhood immunisation is an important preventive measure. However, care givers may delay routine immunisations or seek exemptions from state vaccine mandates. Vaccine refusal creates barriers on vaccine coverage and leads to morbidity and mortality. METHODS Our study reviews morbidity and mortality from vaccine preventable diseases (VPDs) in a large paediatric intensive care unit in Greece over a 10-year period. RESULTS During the study period, 73 cases of VPDs were recorded, corresponding to 3.5% of total paediatric intensive care unit admissions. Influenza was the most prevalent VPD, followed by pneumococcal disease, measles, pertussis and meningococcal disease. Most patients (83.3%) were unvaccinated for the admission's VPD. Outcome was unfavourable for 31.9% of the patients (17 children died, 6 developed chronic impairment). CONCLUSION Absent or incomplete vaccination may result in serious morbidity and mortality from preventable diseases. Strengthening vaccination strategies are needed to improve individual protection as well as herd immunity.
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Affiliation(s)
- Maria Kazantzi
- Pediatric Intensive Care Unit, 'Aghia Sofia' Children's Hospital of Athens, Athens, Greece
| | - Marilena Prapa
- Pediatric Intensive Care Unit, 'Aghia Sofia' Children's Hospital of Athens, Athens, Greece
| | - Eleni Christakou
- Pediatric Intensive Care Unit, 'Aghia Sofia' Children's Hospital of Athens, Athens, Greece
| | - Dimitra Paraschou
- Pediatric Intensive Care Unit, 'Aghia Sofia' Children's Hospital of Athens, Athens, Greece
| | - Panagiotis Kalabalikis
- Pediatric Intensive Care Unit, 'Aghia Sofia' Children's Hospital of Athens, Athens, Greece
| | - Charikleia Barbaressou
- Pediatric Intensive Care Unit, 'Aghia Sofia' Children's Hospital of Athens, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece
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Scott EM, Stein R, Brown MF, Hershberger J, Scott EM, Wenger OK. Vaccination patterns of the northeast Ohio Amish revisited. Vaccine 2021; 39:1058-1063. [PMID: 33478791 DOI: 10.1016/j.vaccine.2021.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The Holmes County Amish have low vaccination rates, an increasingly diverse population, and have an increased incidence of certain inherited diseases. The objectives were to evaluate; the rate and influences of vaccine hesitancy compared to a decade ago, vaccination patterns between Amish affiliations, vaccine practices of Amish special needs children, and the Amish's acceptance of a COVID-19 vaccine. STUDY DESIGN In April of 2020, a survey assessing vaccination patterns and beliefs were mailed to 1000 Amish families, including ultra-conservative Amish sects and special needs families. RESULTS The response rate was 39%. Among 391 respondents, 59% did not vaccinate their children, compared to only 14% that refused all vaccinations reported by Wenger et al in the same community only a decade ago. The ultra-conservative Amish rejected vaccines more often. Amish special needs children were more likely to receive vaccines than healthy Amish children. 75% responded they would reject a COVID-19 vaccine. Fear of adverse effects was the most common reason to reject vaccines. Families that accepted vaccines were more likely to cite a healthcare worker as the primary influence to vaccinate. Wives were more likely to cite their spouse as the primary influence to vaccinate. Families that rejected vaccines were more likely to state their bishop was the most influential person on vaccination. CONCLUSION The Holmes County Amish have decreasing vaccine acceptance. Efforts to improve vaccination will require a targeted focus on the primary influences and beliefs of sub-populations within the Amish. Physician advocacy, peer mentorship, father-directed education, and close partnership with Church leadership will be needed to limit vaccine-preventable disease. The Amish may be at risk for low uptake of a COVID-19 vaccine.
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Affiliation(s)
- Ethan M Scott
- New Leaf Center Clinic for Special Children, 16014 E Chestnut St, Mt Eaton, OH 44659, United States; Akron Children's Hospital, Department of Pediatrics, 214 W Bowery St, Akron, OH 44308, United States.
| | - Rachel Stein
- West Virginia University, Department of Sociology and Anthropology, 307 Knapp Hall, Morgantown, WV 26506, United States
| | - Miraides F Brown
- Akron Children's Hospital, Rebecca D Considine Research Institute, 214 W Bowery St, Akron, OH 44308, United States
| | - Jennifer Hershberger
- New Leaf Center Clinic for Special Children, 16014 E Chestnut St, Mt Eaton, OH 44659, United States
| | - Elizabeth M Scott
- New Leaf Center Clinic for Special Children, 16014 E Chestnut St, Mt Eaton, OH 44659, United States
| | - Olivia K Wenger
- New Leaf Center Clinic for Special Children, 16014 E Chestnut St, Mt Eaton, OH 44659, United States; Akron Children's Hospital, Department of Pediatrics, 214 W Bowery St, Akron, OH 44308, United States
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Ahmed BS, Beck MJ, Williamson G, Ericson JE, Kumar P. Pediatric Tetanus in Central Pennsylvania. J Pediatric Infect Dis Soc 2019; 8:358-360. [PMID: 30184217 PMCID: PMC7317151 DOI: 10.1093/jpids/piy086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 08/09/2018] [Indexed: 11/14/2022]
Abstract
Approximately 20% of the nationally reported tetanus infections in children aged 0 to 14 years that occurred in the United States between 2005 and 2015 were treated at Penn State Children's Hospital. With an electronic medical record search, we identified 5 cases of pediatric tetanus; 100% of these cases occurred in unimmunized children. Their median length of stay was 10 days, and the costs were significant.
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Affiliation(s)
| | - Michael J Beck
- Division of General Inpatient Pediatrics, Department of Pediatrics, Penn State Children’s Hospital, Hershey, Pennsylvania
| | | | - Jessica E Ericson
- Penn State College of Medicine, Hershey, Pennsylvania
- Division of Pediatric Infectious Disease, Department of Pediatrics, Penn State Children’s Hospital, Hershey, Pennsylvania
| | - Parvathi Kumar
- Division of General Inpatient Pediatrics, Department of Pediatrics, Penn State Children’s Hospital, Hershey, Pennsylvania
- Division of Pediatric Infectious Disease, Department of Pediatrics, Penn State Children’s Hospital, Hershey, Pennsylvania
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Pertussis outbreak in an Amish Community: Kent County, Delaware, 2018. Dela J Public Health 2019; 5:12-17. [PMID: 34467024 PMCID: PMC8396756 DOI: 10.32481/djph.2019.005.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Amish lead a very simplistic lifestyle free of modern conveniences. They have unique perceptions and beliefs regarding health and illness and generally do not adhere to conventional preventive measures such as immunizations, which can result in un- or under-immunized populations. Populations with low vaccination coverage are at greater risk of outbreaks compared to vaccinated populations as a result of low herd immunity. Over the past two decades, the Delaware Division of Public Health (DPH) has recorded three distinct outbreaks of pertussis in Delaware's Amish community. The third, and most recent, outbreak was detected in May 2018. DPH conducted an outbreak investigation in the Amish community to identify cases, estimate the burden of disease in the community, and implement control measures including vaccination, treatment, and post-exposure prophylaxis. Through the conduct of active surveillance activities, DPH interviewed 134 families and identified 181 confirmed and probable cases of pertussis. The majority of pertussis cases (77%) occurred among children ≤10 years of age, of which 87% were unvaccinated. DPH engaged the Amish community in meetings, distributed educational materials, and provided medication and vaccines in the community to encourage prevention and implement control measures. DPH officially closed the outbreak investigation on December 20, 2018 following three full incubation periods (63 days) without any new pertussis cases identified in the community.
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Truelove SA, Graham M, Moss WJ, Metcalf CJE, Ferrari MJ, Lessler J. Characterizing the impact of spatial clustering of susceptibility for measles elimination. Vaccine 2019; 37:732-741. [PMID: 30579756 PMCID: PMC6348711 DOI: 10.1016/j.vaccine.2018.12.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 01/16/2023]
Abstract
Measles elimination efforts are primarily focused on achieving and maintaining national vaccination coverage goals, based on estimates of the critical vaccination threshold (Vc): the proportion of the population that must be immune to prevent sustained epidemics. Traditionally, Vc estimates assume evenly mixing populations, an invalid assumption. If susceptible individuals preferentially contact one another, communities may remain vulnerable to epidemics even when vaccination coverage targets are met at the national level. Here we present a simple method to estimate Vc and the effective reproductive number, R, while accounting for spatial clustering of susceptibility. For measles, assuming R0 = 15 and 95% population immunity, adjustment for high clustering of susceptibility increases R from 0.75 to 1.29, Vc from 93% to 96%, and outbreak probability after a single introduction from <1% to 23%. The impact of clustering remains minimal until vaccination coverage nears elimination levels. We illustrate our approach using Demographic and Health Survey data from Tanzania and show how non-vaccination clustering potentially contributed to continued endemic transmission of measles virus during the last two decades. Our approach demonstrates why high national vaccination coverage sometimes fails to achieve measles elimination, and that a shift from national to subnational focus is needed as countries approach elimination.
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Affiliation(s)
- Shaun A Truelove
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Matthew Graham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; The Hospital for Tropical Diseases, Wellcome Trust Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA; Office of Population Research, Woodrow Wilson School, Princeton University, Princeton, NJ, USA
| | - Matthew J Ferrari
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA; Department of Biology, The Pennsylvania State University, University Park, PA, USA
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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