| Abstract |
Vaccination is the most effective strategy to reduce the impact of adverse effects of vaccine preventable diseases in children and adolescents with chronic medical conditions. However, it has been observed that the percentage of vaccination coverage in this vulnerable group of the population remains unsatisfactory. Children with chronic medical conditions must be the primary goal of strategic immunization interventions, as the chronic disease they suffer makes them particularly vulnerable to infections and complications of these infections. Influenza and invasive pneumococcal disease are associated with increased morbidity, hospitalization rates and mortality in children and adolescents with chronic medical conditions compared to healthy population.
The study population comprised children and adolescents examined in the Pediatric Department of the University Hospital in Heraklion from June to December 2017. According to the National Program for Vaccination for Children and Adolescents 2017, which was developed by the National Vaccine Commission of Greece, we have identified the recommended vaccination coverage for the basic vaccine schedule as well as the additional influenza and pneumococcal vaccines recommended for children with chronic diseases. In order to check for differences in the frequency of vaccination coverage according to various demographic characteristics, the Pearson's x2 Fisher's exact tests were applied. The analysis was performed with the Stata 13 statistical package (p.value < 0,001).
Totally, 305 children and adolescents with chronic diseases participated in this study: asthma, type I diabetes, neurological - neuromuscular disorders, nephrotic syndrome, chronic renal failure and cystic fibrosis. High vaccination coverage rates were as follows: Hepatitis B, Polio and Meningococcal vaccine (MenC) 98%, measles, mumps rubella, (MMR) 93%, Hib vaccine 92%, Varicella (VAR) 88%, Hepatitis A 85%, Diphtheria, Tetanus, Pertussis (DTaP/Tdap) 73%, and Pneumococcal (PCV7 or 10 or 13) 64%, PCV (7 or 10 or 13) ≥ 1 doses in children > 1 year old 93% and MCV4 vaccination coverage in adolescents 59%. Vaccination coverage for vaccines specially recommended for children and adolescents with chronic medical conditions was found to be at lower rates. Specifically, for PPSV 23 at 4% and at least one dose of PCV 13 after diagnosis at 12%. In the past seasonal flu period (2016-2017), 21% of the participants were vaccinated for influenza, and only 5% had three-year in a row influenza vaccination coverage, taking into account the three preceding seasonal flu periods 2014-15, 2015-16 and 2016-17.
Although it was an heterogeneous sample of children and adolescents with chronic health problems, the results of this study highlight the need to organize continuous education and establish reminding techniques for in time delivery of vaccine doses to children and adolescents with chronic diseases, in order to improve their vaccination status. The use of a computerized recording and reporting system for the administration of vaccine doses could help to identify gaps in vaccination status and attempt to successfully increase the vaccination coverage.
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Εμβολιασμοί σε παιδιά και εφήβους με χρόνια προβλήματα υγείας στην Κρήτη
