Department of Pediatric Neurology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey.
Department of Pediatric Infectious Diseases, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey.
Eur J Pediatr. 2022 Jan;181(1):383-391. doi: 10.1007/s00431-021-04219-4. Epub 2021 Aug 5.
Children with chronic neurological diseases, including cerebral palsy (CP), are especially susceptible to vaccine-preventable infections and face an increased risk of severe respiratory infections and decompensation of their disease. This study aims to examine age-appropriate immunization status and related factors in the CP population of our country. This cross-sectional prospective multicentered survey study included 18 pediatric neurology clinics around Turkey, wherein outpatient children with CP were included in the study. Data on patient and CP characteristics, concomitant disorders, vaccination status included in the National Immunization Program (NIP), administration, and influenza vaccine recommendation were collected at a single visit. A total of 1194 patients were enrolled. Regarding immunization records, the most frequently administrated and schedule completed vaccines were BCG (90.8%), hepatitis B (88.9%), and oral poliovirus vaccine (88.5%). MMR was administered to 77.3%, and DTaP-IPV-HiB was administered to 60.5% of patients. For the pneumococcal vaccines, 54.1% of children received PCV in the scope of the NIP, and 15.2% of children were not fully vaccinated for their age. The influenza vaccine was administered only to 3.4% of the patients at any time and was never recommended to 1122 parents (93.9%). In the patients with severe (grades 4 and 5) motor dysfunction, the frequency of incomplete/none vaccination of hepatitis B, BCG, DTaP-IPV-HiB, OPV, and MMR was statistically more common than mild to moderate (grades 1-3) motor dysfunction (p = 0.003, p < 0.001, p < 0.001, p < 0.00, and p < 0.001, respectively). Physicians' influenza vaccine recommendation was higher in the severe motor dysfunction group, and the difference was statistically significant (p = 0.029).Conclusion: Children with CP had lower immunization rates and incomplete immunization programs. Clinicians must ensure children with CP receive the same preventative health measures as healthy children, including vaccines. What is Known: • Health authorities have defined chronic neurological diseases as high-risk conditions for influenza and pneumococcal infections, and they recommend vaccines against these infections. • Children with CP have a high risk of incomplete and delayed immunization, a significant concern given to their increased healthcare needs and vulnerability to infectious diseases. What is New: • Influenza vaccination was recommended for patients hospitalized due to pneumonia at a higher rate, and patients were administered influenza vaccine more commonly. • Children with CP who had higher levels of motor dysfunction (levels 4 and 5) were more likely to be overdue immunizations.
儿童慢性神经疾病,包括脑瘫(CP),特别容易感染可通过疫苗预防的传染病,且面临更严重呼吸道感染和疾病恶化的风险。本研究旨在检查我国 CP 人群的适龄免疫状况和相关因素。这是一项在土耳其各地 18 家儿科神经病学诊所进行的横断面前瞻性多中心调查研究,纳入了门诊 CP 患儿。在单次就诊时收集了患者和 CP 特征、合并症、国家免疫规划(NIP)中包含的疫苗接种状况、管理和流感疫苗推荐等数据。共纳入 1194 例患者。关于免疫记录,最常接种且完成接种计划的疫苗为卡介苗(BCG)(90.8%)、乙型肝炎(88.9%)和口服脊髓灰质炎疫苗(OPV)(88.5%)。77.3%的患者接种了麻疹-腮腺炎-风疹疫苗(MMR),60.5%的患者接种了百白破-脊髓灰质炎-乙型流感嗜血杆菌联合疫苗(DTaP-IPV-HiB)。对于肺炎球菌疫苗,54.1%的儿童在 NIP 范围内接种了 PCV,15.2%的儿童未按年龄完全接种。只有 3.4%的患者在任何时候接种过流感疫苗,而 1122 名家长(93.9%)从未推荐过流感疫苗。在严重(4 级和 5 级)运动功能障碍的患者中,乙型肝炎、BCG、DTaP-IPV-HiB、OPV 和 MMR 未完全/未接种的频率明显高于轻度至中度(1-3 级)运动功能障碍(p=0.003,p<0.001,p<0.001,p<0.00,p<0.001)。在严重运动功能障碍组中,医生推荐流感疫苗的频率更高,且差异具有统计学意义(p=0.029)。结论:CP 患儿的免疫接种率较低,免疫接种计划不完整。临床医生必须确保 CP 患儿获得与健康儿童相同的预防保健措施,包括疫苗接种。已知情况:• 卫生当局将慢性神经疾病定义为流感和肺炎球菌感染的高风险疾病,并建议接种这些感染的疫苗。• CP 患儿存在不完全和延迟免疫的高风险,鉴于他们增加的医疗保健需求和对传染病的易感性,这是一个重大问题。新情况:• 因肺炎住院的患者更有可能被建议接种流感疫苗,且更常接种流感疫苗。• 运动功能障碍水平较高(4 级和 5 级)的 CP 患儿更有可能错过免疫接种。