Pandemic influenza vaccination coverage in children with type 1 diabetes: analysis from seven Italian centers

Vaccine coverage in children, adolescents and adults with type 1 diabetes and their close contacts in Crete

BACKGROUND

Individuals with type 1 diabetes (T1D) are at increased risk of infections from vaccine-preventable diseases. This study focuses on compliance of T1D patients to the recommended vaccination schedule, vaccination of their close contacts for influenza and on factors potentially contributing to vaccination program deviations.

METHODS

The study population comprised children, adolescents and adults with T1D under follow-up at the Department of Pediatrics University Hospital and the Diabetic Center General Hospital, Heraklion, Crete-Greece. Data were extracted, following informed consent, from individual's vaccination booklet, medical files and telephone interview. Vaccination records, demographic parameters, glycemic control and influenza vaccination of close contacts were assessed.

RESULTS

The study included 258 participants (111 children/adolescents, 147 adults). Vaccination coverage for influenza was 76.7% for children, 64.4% for adults, for PCV 90.9% for children, but only 10.8% for the 23-valent, for hepatitis B 99% for children and 78.2% for adults. Youngsters were vaccinated against Hib 91.9%, meningococcus C 98.2%, measles-mumps-rubella 90.3%, chickenpox 86.4%, hepatitis A 76.5% and HPV 42.5%. Less than 65% of all individuals were fully vaccinated for diphtheria-tetanus-pertussis and meningococcus ACWY. Approximately 50% of the 605 close contacts were not vaccinated against influenza. Individuals with better glycemic status seemed to adhere to the recommended schedule and had a better vaccinated family environment.

CONCLUSIONS

Vaccination coverage for T1D individuals was sufficient regarding the majority of routine childhood vaccines, but less for adolescence and group-specific vaccines. Their family contacts were not sufficiently vaccinated for influenza. Targeted interventions are required in order to increase vaccination rates.

Caring for children and adolescents with type 1 diabetes mellitus: Italian Society for Pediatric Endocrinology and Diabetology (ISPED) statements during COVID-19 pandemia

AIMS

Our study aimed to review the impact of COVID-19 pandemia in children and adolescents with type 1 diabetes mellitus, to analyze the clinical characteristics of the infection and to propose clinical practice recommendations from the Italian Society for Pediatric Endocrinology and Diabetology (ISPED).

METHODS

A literature search was carried out in the guideline databases, Medline and Embase and in Diabetes Societies websites until May 21st, 2020 for guidelines and recommendations on type 1 diabetes mellitus management during COVID-19 pandemic.

RESULTS

COVID-19 infection in pediatric patients seems to be clinically less severe than in adults; children have so far accounted for 1-5% of diagnosed cases, with a median age of 6.7 years (1 day-15 years) and better prognosis. Clinical manifestations include mild, moderate, severe disease up to critical illness. There is currently no evidence suggesting a higher risk of COVID-19 infection in children with diabetes than unaffected peers. Besides general recommendations for pediatric patients, ISPED has proposed specific measures for patients with diabetes.

CONCLUSION

COVID-19 outbreak modified type 1 diabetes management, and telemedicine has been demonstrating to be an effective new tool for patients care. Moreover psychological aspects deserve attention and future researchs are mandatory.

Vaccination adherence to influenza, pneumococcal and hepatitis B virus in adult type 1 diabetes mellitus patients

AIM

To document adherence to influenza, pneumococcal and hepatitis B virus (HBV) vaccination programme in adult type 1 diabetes mellitus (T1DM) patients.

MATERIALS AND METHODS

Observational retrospective study using data obtained from computerized clinical records. We contacted all adult T1DM registered in our database from a tertiary diabetes care hospital. Primary efficacy outcome was to describe influenza, pneumococcal and HBV vaccination status.

RESULTS

Three hundred patients were analyzed (male 53%). Mean age was 40.0±14.4years and T1DM duration was 19.7±11.8years. Thirty-five percent of the patients had complementary indications for studied vaccines. Adherence to vaccination program for influenza, pneumococcal and HBV was achieved by 55%, 18% and 17% of the patients, respectively. Only 3% of the subjects were vaccinated against the three microorganisms. Predictor of correct vaccination were: age, shorter diabetes duration, insulin pump treatment, better diabetes control and being a health professional. We detected 17 sick leaves, 127 lost working days and 3 hospitalizations due to flue during the follow-up.

CONCLUSIONS

The uptake of recommended vaccinations against influenza, pneumococcal and HBV in adult T1DM patients was below desirable levels. A special effort is required to all health professionals to implement immunization among adult people with T1DM. Clinical Trials NCT03478254.

Glycaemic control, antidiabetic medications and influenza vaccination coverage among patients with diabetes in Udine, Italy

Objective

The objectives of this study were to estimate influenza vaccination coverage among patients with diabetes mellitus in an Italian 250 000-inhabitant area in the 2017-2018 season and to assess whether glycaemic control and pharmacological treatment were associated with the likelihood of being vaccinated.

Design

In this cross-sectional study, we analysed anonymous health administrative databases, linked with each other at the individual patient level through a stochastic key: diabetes mellitus registry, vaccinations, drug prescriptions and laboratory database.

Setting

The study was conducted in the catchment area of the University Hospital of Udine ('the Udine area'), a 250 000-inhabitant area in the northeast of Italy.

Participants

The study included all subjects included in the regional registry of patients with diabetes mellitus, living in the Udine area as of 1 October 2017.

Main outcome measures

Vaccination coverage in the 2017-2018 influenza season was calculated. The association between patients' characteristics and the likelihood of being vaccinated was assessed through multivariate log binomial regression.

Result

53.0% of 15 900 patients with diabetes living in the area were vaccinated. Coverage increased with age, approaching 75% at ≥85 years. Patients lacking recent glycated haemoglobin testing were less likely to be vaccinated (43.4% vaccination coverage), as were those not treated pharmacologically (44.4% vaccination coverage). Patients treated with both insulin, metformin and other antidiabetic medications were more likely to be vaccinated than those treated with metformin alone (58.1% vaccination coverage; adjusted relative risk=1.07, 95% CI 1.01 to 1.14).

Conclusion

Influenza vaccination coverage was suboptimal in this Italian population of patients with diabetes. Strategies to improve diabetes management could in turn positively affect influenza coverage.

Health Maintenance Deficits in a Fully Insured Population of Adolescents With Chronic Medical Conditions

The current national monitoring of routine wellness care and vaccine uptake does not provide data on health maintenance among pediatric populations with chronic medical conditions. In this case-control study that analyzes wellness visits and vaccine uptake among adolescents, ages 16 to 18 years, we identified 938 without (controls) and 74 with (cases) 1 of 12 specific chronic medical conditions. The PPSV23 (23-valent pneumococcal polysaccharide vaccine) is recommended by the Advisory Committee on Immunization Practices for these 12 conditions and served as a measure of uptake for medically indicated vaccines. Our controls were twice as likely as cases to have a documented well visit in the past year, and there was a significantly higher proportion of controls than cases vaccinated with Tdap (tetanus toxoid, reduced diphtheria toxoid, acellular pertussis), MCV-4 (quadrivalent meningococcal conjugate), and HPV (human papillomavirus), all P < .05. More than 60% of cases failed to receive PPSV23. Adolescents with chronic medical conditions are at high risk of neglecting routine health maintenance.