A National Survey Across Primary Care Pediatricians Regarding Immunization Views and Practices in Children With Rheumatic Diseases

Abstract

The aims of this study were to describe the knowledge, attitude, and current practice of general pediatricians working in primary care regarding vaccination in children with rheumatic diseases (RDs) and to identify barriers and facilitators that could be used to promote uptake.Methods: Cross-sectional survey conducted with an anonymous questionnaire of 34 items distributed to pediatricians via an online platform. Four hundred questionnaires were sent, and 256 were returned and analyzed using STATA 13. Data collection included demographics, questions on knowledge, perceptions, and opinions, as well as advice given to families. Results: The majority of doctors felt that vaccination in children withRDs is essential. Responders were using a variety of guidelines to reach a clinical decision. Fifty percent were hesitant to adhere to the national vaccination scheme without expert input. Reasons were as follows: not convinced from current literature that the vaccine is safe (32%), afraid to cause disease flare (43%), and unable to deal with parental concerns/ refusal (54%). Twelve percent of responders felt that the RD may have been triggered by a vaccine. The majority (82%) of doctors were pro annual influenza vaccination. Seventy percent of doctors were keener to administer booster doses rather than primary ones.Conclusions: Variation in opinion and clinical practice exists. Overall, although general pediatricians are informed regarding efficacy and adverse effects of immunizations in patients with RDs, there are steps to be made from principle to practice. Vaccinating these children is of vital importance, and primary care pediatricians should be updated regarding existing guidelines referring to this field.

Knowledge of mothers regarding children’s vaccinations in Greece: an online cross-sectional study

“…Pediatricians' advice was identified as an important influential factor to maternal decisions regarding childhood vaccination. A recent study showed pediatricians' incompetence to deal with parental concerns about the vaccination of children with rheumatic diseases [62]. Of interest, a previous study in Italy showed that the majority of pediatricians were favorable to vaccinations, however, some gaps between their overall positive attitudes towards vaccination and their knowledge, beliefs and practices were reported [63].…”

Vaccination completeness in children with rheumatic diseases: A longitudinal, observational multicenter cohort study in Switzerland

“…For children never receiving IST the vaccination status was 2.97 times (1.2–7.07) more likely to be up to date compared to those receiving non-bDMARD treatment at any time and 6.24 times (2.58–15.33) more likely compared to patients receiving bDMARD treatment at any time ( 21 ). In a cross-sectional anonymous survey study, 50% of pediatricians stated that they are hesitant to adhere to the NIP in PRD patients without specialist input ( 31 ). Main reasons for this were fear to provoke a disease flare (43%) and inability to deal with parental concerns (54%) ( 31 ).…”

Real-life vaccination coverage in Slovak children with rheumatic diseases

“…Most of them are not specific for non-live vaccines and represent a vaccination problem in PRD patients in general. Despite growing knowledge about vaccination in PRD patients, concerns about vaccination safety still remain among parents and also among physicians (10,17). Vaccine hesitancy may be further exacerbated by the rise of antivaccination movements (33) and the unproven presumption, that immune-mediated diseases may be provoked by preceding vaccination (34).…”

“…The crucial tool for improving vaccination compliance is effective communication between healthcare professionals and parents (35), in particular between pediatric rheumatologists, primary care pediatricians and parents. A National Survey in Greece showed that 50% of primary care pediatrician were hesitant to adhere to the national vaccination scheme without the expert input of the pediatric rheumatologist (17). Targeted training of healthcare providers, systematization of work by creating an immunization algorithm, preliminary planning and sending reminders have proven to be effective measures in increasing vaccination rates against pneumococci in patients with PRDs (36).…”

“…In spite of growing evidence for vaccine safety and efficacy in this group of children (15,16), some questions and concerns remain, both, among physicians and parents. These include concerns about disease flare induction and vaccination-related side effects, as well as possible blunting of the post-vaccination immune response by ongoing IST (10,17). Until recently, due to concerns about potential infection with vaccination strains, contraindication of live-attenuated vaccines during high-dose IST was considered standard of care (18).…”