Advertisement

Vaccine preventable diseases in pediatric palliative care – a multicenter cross-sectional study

      Abstract

      Context

      Vaccine preventable diseases lead to distressful symptoms and complications among pediatric patients receiving specialized home palliative care. There was no data on the vaccination compliance.

      Objective

      The objective was to determine the vaccination coverage, discuss the relevance of vaccinations and provide vaccination recommendations in pediatric palliative care.

      Methods

      Vaccination data were compared in a multicenter cross-sectional study. Expert interviews were conducted to evaluate symptom burden. The vaccination status of patients treated by six German pediatric specialized home palliative care teams was recorded from 01/2019 to 12/2019. The data were compared to the national immunization schedule and the vaccination rate of a representative German pediatric cohort. Onset of missed vaccination was compared to the date of diagnosis of the life-limiting condition. A risk score was calculated to evaluate the relevance of each individual vaccinations.

      Results

      Vaccination rates of Tdpa, haemophilus influenzae type B, poliomyelitis, hepatitis B, pneumococcal disease, meningococcal diseases type C, and MMR were lower compared to healthy controls. There were no significant differences in varicella. In most cases the discontinuation of recommended immunizations occurred after diagnosis of the palliative condition. Influenza had the highest risk score and was the most frequent vaccine preventable disease in retrospective data. This paper includes a pragmatic proposal for the management of vaccination in this vulnerable population.

      Conclusion

      Children and adolescents with life-limiting conditions are at increased risk of vaccine preventable diseases. Individual vaccination counselling is recommended.

      Key Words

      Abbreviations:

      HepB (hepatitis B), HiB (haemophilus influenzae type b), HPV (human papillomavirus), ICD (International Classification of Diseases), KiGGS (Study on the Health of Children and Adolescents in Germany), MMR (measles, mumps, and rubella), RSV (respiratory syncytial virus), Tdap (tetanus, diphtheria, and pertussis), WHO (World Health Organization)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pain and Symptom Management
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Pandolfi E
        • Carloni E
        • Marino MG
        • et al.
        Immunization coverage and timeliness of vaccination in Italian children with chronic diseases.
        Vaccine. 2012; 30: 5172-5178
        • Smith M
        • Peacock G
        • Uyeki TM
        • Moore C.
        Influenza vaccination in children with neurologic or neurodevelopmental disorders.
        Vaccine. 2015; 33: 2322-2327
        • Tillmann BU
        • Tillmann HC
        • Heininger U
        • Lütschg J
        • Weber P.
        Acceptance and timeliness of standard vaccination in children with chronic neurological deficits in north-western Switzerland.
        Eur J Pediatr. 2005; 164: 320-325
        • Pandolfi E
        • Marino MG
        • Carloni E
        • et al.
        The effect of physician's recommendation on seasonal influenza immunization in children with chronic diseases.
        BMC Public Health. 2012; 12: 984
        • Dinleyici M
        • Carman KB
        • Kilic O
        • et al.
        The immunization status of children with chronic neurological disease and serological assessment of vaccine-preventable diseases.
        Hum Vaccin Immunother. 2018; 14: 1970-1976
        • Nakamura MM
        • Lee GM.
        Influenza vaccination in adolescents with high-risk conditions.
        Pediatrics. 2008; 122: 920-928
        • Greenwood VJ
        • Crawford NW
        • Walstab JE
        • Reddihough DS.
        Immunisation coverage in children with cerebral palsy compared with the general population.
        J Paediatr Child Health. 2013; 49: E137-E141
        • Raddish M
        • Goldmann DA
        • Kaplan LC
        • Perrin JM.
        The immunization status of children with spina bifida.
        Am J Dis Child. 1993; 147: 849-853
        • Masson A
        • Launay O
        • Delaisi B
        • et al.
        Vaccine coverage in CF children: A French multicenter study.
        J Cyst Fibros. 2015; 14: 615-620
        • Righolt CH
        • Pabla G
        • Donelle J
        • et al.
        Vaccine coverage among children with epilepsy in two Canadian provinces: A Canadian immunization research network study.
        Vaccine. 2021; 39: 2117-2123
        • Kruk SK
        • Pacheco SE
        • Koenig MK
        • et al.
        Vulnerability of pediatric patients with mitochondrial disease to vaccine-preventable diseases.
        J Allergy Clin Immunol Pract. 2019; 7 (2415-2418 e3)
        • Klein NP
        • Aukes L
        • Lee J
        • et al.
        Evaluation of immunization rates and safety among children with inborn errors of metabolism.
        Pediatrics. 2011; 127: e1139-e1146
        • Cerutti M
        • De Lonlay P
        • Menni F
        • et al.
        Vaccination coverage of patients with inborn errors of metabolism and the attitudes of their parents towards vaccines.
        Vaccine. 2015; 33: 6520-6524
        • Tuckerman J
        • Misan S
        • Crawford NW
        • Marshall HS.
        Influenza in Children With Special Risk Medical Conditions: A Systematic Review and Meta-analysis.
        Pediatr Infect Dis J. 2019; 38: 912-919
        • O'Neill J
        • Newall F
        • Antolovich G
        • Lima S
        • Danchin M.
        Vaccination in people with disability: a review.
        Hum Vaccin Immunother. 2020; 16: 7-15
        • Top KA
        • Brna P
        • Ye L
        • Smith B.
        Risk of seizures after immunization in children with epilepsy: a risk interval analysis.
        BMC Pediatr. 2018; 18: 134
        • Hauch H
        • Klinkel N
        • Chao CM
        • et al.
        [Constitution of a New Specialised Pediatric Home Care Team - First Year Experience].
        Klin Padiatr. 2016; 228: 145-148
        • Groh G
        • Feddersen B
        • Führer M
        • Borasio GD.
        Specialized home palliative care for adults and children: differences and similarities.
        J Palliat Med. 2014; 17: 803-810
        • Hauch H
        • Tretiakova I
        • Kaestner J
        • et al.
        Vaccine preventable diseases in palliative treated children – Report of the PalliVac study group.
        Integrative Clinical Medicine. 2020; 4
        • RKI GSCoVat
        Recommendations of the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute –2017/2018.
        Epid Bull. 2017; : 333-376
        • TfSL
        A Guide to Children's Palliative Care (Fourth Edition).
        2018 (In: 4 ed. Bristol)
        • Poethko-Müller C
        • Kuhnert R
        • Gillesberg Lassen S
        • Siedler A
        [Vaccination coverage of children and adolescents in Germany: New data from KiGGS Wave 2 and trends from the KiGGS study].
        Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2019; 62: 410-421
      1. RKI. [email protected] 2.0 - Web-based survey of notification data according to the Infection Protection Act. Available from: https://survstat.rki.de. Accessed 22.11.2021,

        • Shteinberg M
        • Haq IJ
        • Polineni D
        • Davies JC
        Cystic fibrosis.
        Lancet. 2021; 397: 2195-2211
        • Wong KK
        • Jain S
        • Blanton L
        • et al.
        Influenza-associated pediatric deaths in the United States, 2004-2012.
        Pediatrics. 2013; 132: 796-804
        • Tanabe T
        • Tagawa T
        • Arai H
        • et al.
        Survey of Japanese pediatricians on vaccination of children with neurological disorders.
        Pediatr Int. 2011; 53: 626-629
        • Tuckerman JL
        • Kaufman J
        • Danchin M
        • Marshall HS.
        Influenza vaccination: A qualitative study of practice level barriers from medical practitioners caring for children with special risk medical conditions.
        Vaccine. 2020; 38: 7806-7814
        • Kempe A
        • Daley MF
        • Crane LA
        • et al.
        Misperceptions regarding influenza vaccine safety for individuals with chronic medical illness.
        Prev Med. 2007; 45: 80-82
        • Tsang TK
        • Fang VJ
        • Ip DKM
        • et al.
        Indirect protection from vaccinating children against influenza in households.
        Nat Commun. 2019; 10: 106
        • Murphy K.WC.
        Janeway's Immunobiology.
        9th edition. Garland Science, Taylor & Francis Group, LLC, New York, NY2017
        • Sasson M
        • Mandelboim M
        • Shvartzman P.
        Influenza vaccination for terminally ill cancer patients receiving palliative care: a preliminary report.
        J Pain Symptom Manage. 2011; 41: 485-490
        • Tanislav C
        • Kostev K.
        Fewer non-COVID-19 respiratory tract infections and gastrointestinal infections during the COVID-19 pandemic.
        J Med Virol. 2022; 94: 298-302
        • Hoell JI
        • Weber HL
        • Balzer S
        • et al.
        Advance care planning and outcome in pediatric palliative home care.
        Oncotarget. 2018; 9: 17867-17875