New research examines barriers to vaccination in immunocompromised children

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Credit: Pediatric Academic Societies

BALTIMORE – A new study examines the barriers to vaccination of immunocompromised children (ICC). Findings from the study will be presented during the Pediatric Academic Societies (PAS) 2019 Meeting, taking place on April 24 – May 1 in Baltimore.

“Immunosuppressive medications have dramatically improved the outcomes of autoimmune diseases such as lupus and inflammatory bowel disease (IBD),” said Vidya Sivaraman, MD, one of the authors of the study. “While the long-term outcomes of these patients have improved, their care has become more complex and fragmented between the specialist and primary care physician (PCP). We realized that vaccination in these patients has been suboptimal, leaving these patients susceptible to many vaccine-preventable diseases. In this study, our primary aim was to assess vaccine knowledge, comfort, and vaccination practices among parents and PCPs of children with childhood onset systemic lupus and IBD and determine measures to reduce these gaps in preventive care.”

Researchers surveyed 31 systemic lupus erythematosus (c-SLE) and 26 IBD patients. The survey found that most patients received their vaccines from their PCP or health department and 16% received vaccines from their subspecialist. The survey indicated that 96% felt that their PCP was well informed about vaccines and 91% reported that their subspecialist discussed vaccines in the past year, most commonly influenza, human papilloma virus, pneumococcal and Hepatitis B. Only two parents expressed concerns for vaccine adverse effects and triggering a disease flare.

Of the 30 PCP responses, 70% had over 20 years’ experience and 50% preferred to provide all vaccines to ICC. Yet, there were major barriers to completing vaccines: 14 of 16 (85%) stated they did not stock the 23-valent pneumococcal vaccine. PCPs felt “very confident” about providing vaccines in their ICC only 40% of the time. Practitioners felt poorly informed about their patients’ immunosuppressive medications and concern for exacerbating the underlying illness as the main reason for their lack of confidence.

The study concluded that there was discordance between patients feeling confident in their PCP being aware of vaccine recommendations and PCP comfort in vaccinating their ICC patients due to lack of knowledge and concern for triggering a disease flare. Despite that most ICC received vaccines at their PCP’s office, most offices did not carry the 23-valent pneumococcal vaccine and did not routinely recommend vaccination of household members. Providing recommended vaccines and lack of education about appropriate vaccination in ICC remain significant barriers and areas for improvement.

Audrey Lloyd, MD, one of the authors of the study, will present findings from “Barriers to vaccination in immunocompromised children” on Sunday, April 28 at 10:30 a.m. EDT. Reporters interested in an interview with Dr. Sivaraman and/or Dr. Lloyd should contact PAS2019@piercom.com. Please note that only the abstracts are being presented at the meeting. In some cases, the researchers may have additional data to share with media.

The PAS 2019 Meeting brings together thousands of pediatricians and other health care providers to improve the health and well-being of children worldwide. For more information about the PAS 2019 Meeting, please visit http://www.pas-meeting.org.

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About the Pediatric Academic Societies Meeting

The Pediatric Academic Societies (PAS) Meeting brings together thousands of pediatricians and other health care providers united by a common mission: to improve the health and well-being of children worldwide. This international gathering includes pediatric researchers, leaders in pediatric academics, clinical care providers and community practitioners. Presentations cover issues of interest to generalists as well as topics critical to a wide array of specialty and sub-specialty areas. The PAS Meeting will be the premier North American scholarly child health meeting. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit http://www.pas-meeting.org. Follow us on Twitter @PASMeeting and #PAS2019, and like us on Facebook.

Abstract: Barriers to vaccination in immunocompromised children

Background: The vaccination of immunocompromised children (ICC) remains suboptimal.

Objective: Our primary aim was to assess vaccine knowledge, comfort, and practices among parents of and primary care physicians (PCP) caring for children with systemic lupus erythematosus (c-SLE) and inflammatory bowel disease (IBD).

Design/Methods: Surveys were obtained from patients ?18y and parents of younger children during routine clinic visits to the Rheumatology and Gastroenterology clinics at Nationwide Children’s Hospital (NCH) between Jan – Aug 2018 as a random convenience sample. PCPs affiliated with NCH were surveyed at their monthly meeting followed by an online survey. Responses were recorded in a Redcap database for statistical analysis. Chart review was performed for demographic information, medication exposure, and confirmation of diagnosis. This study was exempt from IRB approval.

Results: We surveyed 31c-SLE and 26 IBD patients. Patient characteristics are detailed in Table 1. Patient data: Most patients received their vaccines from their PCP or Health Department, 16% received vaccines from their subspecialist. 96% felt that their PCP was well informed about vaccines. 91% reported that their subspecialist discussed vaccines in the past year, most commonly Influenza, Human Papilloma Virus, pneumococcal and Hepatitis B. Only 2 parents expressed concerns for vaccine adverse effects and triggering a disease flare. PCP data: 30 responses. 70% had over 20 years’ experience and 50% preferred to provide all vaccines to ICC. Yet, there were major barriers to completing vaccines: 14 of 16 (85%) stated they did not stock the 23-valent pneumococcal vaccine. PCP felt “very confident” about providing vaccines in their ICC only 40% of the time. Practitioners felt poorly informed about their patient’s immunosuppressive medications and concern for exacerbating the underlying illness as the main reason for their lack of confidence.

Conclusion(s): In our survey of patients and PCPs, there was discordance between patients’ feeling confident in their PCP being aware of vaccine recommendations and PCP comfort in vaccinating their ICC patients due to lack of knowledge and concern for triggering a disease flare. Despite that most ICC received vaccines at their PCP’s office, most offices did not carry the 23-valent pneumococcal vaccine and did not routinely recommend vaccination of household members. Providing recommended vaccines and lack of education about appropriate vaccination in ICC remain significant barriers and areas for improvement.

Authors (Last Name, First Name): Lloyd, Audrey R.; Ardura, Monica I.; Wise, Kelly; Chavarin, Daniel; Crandall, Wallace; Boyle, Brendan; Sivaraman, Vidya

Authors/Institutions: A.R. Lloyd, Internal Medicine and Pediatrics , Nationwide Children’s Hospital, Columbus , Ohio, UNITED STATES|M.I. Ardura, Pediatrics, Infectious Diseases, Nationwide Children’s & The Ohio State University, Columbus, Ohio, UNITED STATES|K. Wise, Rheumatology, Nationwide Children’s, Columbus, Ohio, UNITED STATES|D. Chavarin, Ohio State University College of Medicine, Columbus, California, UNITED STATES|W. Crandall, Pediatric Gastroenterology, Nationwide Children’s Hospital, Columbus, Ohio, UNITED STATES|B. Boyle, Gastroenterology, Nationwide Children’s Hospital, Columbus, Ohio, UNITED STATES|V. Sivaraman, Nationwide Children’s Hospital, Columbus, Ohio, UNITED STATES

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