Tran Cheryl L, Selewski David T, Oh Gia J, Troost Jonathan P, Massengill Susan F, Al-Akash Samhar I, Mahesh Shefali, Amin Rasheda, Ashoor Isa F, Chanchlani Rahul, Kallash Mahmoud, Woroniecki Robert P, Gipson Debbie S
Division of Pediatric Nephrology, Department of Pediatrics, Mayo Clinic, Rochester, MN, United States.
Division of Pediatric Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States.
Front Pediatr. 2021 Feb 5;8:619548. doi: 10.3389/fped.2020.619548. eCollection 2020.
Children with nephrotic syndrome (NS) are at high risk for vaccine-preventable infections due to the immunological effects from the disease and concurrent treatment with immunosuppressive medications. Immunizations in these patients may be deferred due to their immunosuppressive treatment which may increase the risk for vaccine-preventable infections. Immunization practices in children with NS continue to vary among pediatric nephrologists. This raises the question of whether children with NS are receiving the recommended vaccinations at appropriate times. Therefore, it is critical to understand the practices and patient education provided by physicians to patients on the topic of vaccinations. After informed consent, parents/guardians of 153 pediatric patients (<18 years old) diagnosed with NS from 2005 to 2018 and 50 pediatric nephrologists from 11 participating centers completed anonymous surveys to evaluate immunization practices among pediatric nephrologists, assess the vaccine education provided to families of children with NS, assess the parental knowledge of immunization recommendations, and assess predictors of polysaccharide pneumococcal vaccine adherence. The Advisory Committee on Immunization Practices (ACIP) Immunization 2019 Guideline for those with altered immunocompetence was used to determine accuracy of vaccine knowledge and practices. Forty-four percent of providers self-reported adherence to the ACIP guidelines for inactive vaccines and 22% to the guidelines for live vaccines. Thirty-two percent of parents/guardians reported knowledge that aligned with the ACIP guidelines for inactive vaccines and 1% for live vaccines. Subjects residing in the Midwest and provider recommendations for vaccines were positive predictors of vaccine adherence ( < 0.001 and 0.02, respectively). Vaccine recommendation by medical providers is paramount in vaccine adherence among pediatric patients with NS. This study identifies potential educational opportunities for medical subspecialty providers and family caregivers about immunization recommendations for immunosuppressed patients.
由于肾病综合征（NS）患儿所患疾病的免疫效应以及同时使用免疫抑制药物进行治疗，他们面临疫苗可预防感染的高风险。这些患者的免疫接种可能会因免疫抑制治疗而推迟，这可能会增加疫苗可预防感染的风险。NS患儿的免疫接种做法在儿科肾病学家中仍存在差异。这就提出了一个问题，即NS患儿是否在适当的时候接受了推荐的疫苗接种。因此，了解医生就疫苗接种这一主题向患者提供的做法和患者教育至关重要。在获得知情同意后，2005年至2018年期间诊断为NS的153名儿科患者（<18岁）的父母/监护人以及来自11个参与中心的50名儿科肾病学家完成了匿名调查，以评估儿科肾病学家的免疫接种做法，评估向NS患儿家庭提供的疫苗教育，评估父母对免疫接种建议的了解情况，并评估多糖肺炎球菌疫苗依从性的预测因素。使用免疫实践咨询委员会（ACIP）2019年免疫功能改变者指南来确定疫苗知识和做法的准确性。44%的提供者自我报告遵守了ACIP关于非活性疫苗的指南，22%遵守了活性疫苗的指南。32%的父母/监护人报告其了解情况与ACIP关于非活性疫苗的指南一致，而对于活性疫苗这一比例为1%。居住在中西部地区的受试者以及提供者对疫苗的推荐是疫苗依从性的积极预测因素（分别为<0.001和0.02）。医疗提供者的疫苗推荐对于NS儿科患者的疫苗依从性至关重要。本研究确定了医学专科提供者和家庭护理人员在免疫抑制患者免疫接种建议方面的潜在教育机会。
