Evaluation of immunization status in patients with cerebral palsy: a multicenter CP-VACC study
Sema Bozkaya-Yilmaz1, Eda Karadag-Oncel2, Nihal Olgac-Dundar3
1Department of Pediatric Neurology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey. semabozkayayilmaz@gmail.com.
Insights
Children with cerebral palsy (CP) show lower vaccination rates and incomplete immunization schedules, particularly those with severe motor dysfunction. Increased clinical focus on preventative vaccines is crucial for this vulnerable population.
Area of Science:
- Pediatric Neurology
- Immunology
- Public Health
Background:
- Children with cerebral palsy (CP) are at increased risk for severe infections and disease decompensation.
- Health authorities identify chronic neurological diseases as high-risk for influenza and pneumococcal infections, recommending vaccination.
- CP is associated with a high risk of incomplete and delayed immunizations, posing a significant concern.
Purpose of the Study:
- To assess age-appropriate immunization status in children with CP.
- To identify factors associated with vaccination status in the CP population.
- To evaluate influenza vaccine recommendation and administration rates in children with CP.
Main Methods:
- A cross-sectional, prospective, multicentered survey study involving 1194 children with CP across 18 pediatric neurology clinics in Turkey.
- Data collection included patient and CP characteristics, comorbidities, National Immunization Program (NIP) vaccination status, and influenza vaccine recommendations.
- Statistical analysis compared immunization rates between children with mild-to-moderate (grades 1-3) and severe (grades 4-5) motor dysfunction.
Main Results:
- Overall immunization rates were suboptimal, with 15.2% of children not fully vaccinated according to age.
- BCG, hepatitis B, and oral poliovirus vaccine had high completion rates (over 88%), while DTaP-IPV-HiB (60.5%) and pneumococcal conjugate vaccine (PCV) (54.1% within NIP) were lower.
- Influenza vaccine administration was very low (3.4%), with 93.9% of parents never having received a recommendation.
- Children with severe motor dysfunction (grades 4-5) had significantly higher rates of incomplete/no vaccination for several NIP vaccines compared to those with mild-to-moderate dysfunction.
- Physicians were more likely to recommend the influenza vaccine to children with severe motor dysfunction (p=0.029).
Conclusions:
- Children with CP exhibit lower immunization coverage and incomplete vaccination programs.
- Severity of motor dysfunction in CP correlates with higher rates of incomplete immunizations.
- Clinicians must prioritize and ensure children with CP receive comprehensive preventative health measures, including timely vaccinations, comparable to healthy children.
Abstract:
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.
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