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Immunization Patterns of Children with Chronic Neurological and Neurodevelopmental Disorders: A Cross-Sectional Study
Emek Uyur1, Merve İşeri Nepesov2, Nilüfer Eldeş Hacıfazlıoğlu1
1Department of Pediatric Neurology, Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Türkiye.
Insights
Children with chronic neurological and neurodevelopmental disorders (CNDD) often have interrupted immunizations, with partial vaccination being more common than refusal. Maternal age was the only factor linked to incomplete vaccination in this study.
Area of Science:
- Pediatric Neurology
- Immunology
- Public Health
Background:
- Children with chronic neurological and neurodevelopmental disorders (CNDD) are a vulnerable population.
- Routine childhood immunization can be interrupted due to clinical complexity and parental concerns in this group.
Purpose of the Study:
- To evaluate immunization patterns in children with CNDD.
- To identify factors associated with vaccination interruption and status.
- To analyze timing of vaccination interruption and sociodemographic influences.
Main Methods:
- Prospective cross-sectional study of 545 children (aged 1-18 years) with CNDD.
- Classification of immunization status: fully vaccinated, partially vaccinated, or unvaccinated.
- Assessment of clinical factors (e.g., Gross Motor Function Classification System) and sociodemographic data.
Main Results:
- 72.1% were fully vaccinated, 25.0% partially, and 2.9% unvaccinated.
- Vaccination status varied significantly by diagnosis (p < 0.001), with lower rates in autism spectrum disorder and cerebral palsy, higher in Down syndrome.
- Partial vaccination was more frequent than refusal; interruption after 48 months was common. Maternal age was linked to incomplete vaccination.
Conclusions:
- Incomplete immunization in CNDD is often partial vaccination, not complete refusal, with diagnosis-specific patterns.
- Pediatric neurology follow-up can support tailored immunization counseling.
- Understanding these patterns is crucial for improving vaccine coverage in this vulnerable population.
Abstract:
Background/Objectives: Children with chronic neurological and neurodevelopmental disorders (CNDD) constitute a medically vulnerable population in whom routine childhood immunization may be interrupted because of clinical complexity and parental concerns. This study aimed to evaluate immunization patterns, timing of vaccination interruption, and associated clinical and sociodemographic factors in children with CNDDs followed at a tertiary pediatric neurology center. Methods: This prospective cross-sectional study included 545 children aged 1-18 years with chronic neurological and neurodevelopmental disorders evaluated between September and November 2025. Immunization status according to the Turkish National Immunization Program was classified as fully vaccinated, partially vaccinated, or not vaccinated. Information regarding non-NIP vaccines, timing of vaccination interruption, parental characteristics, and motor impairment severity assessed using the Gross Motor Function Classification System (GMFCS) was collected. Associations between vaccination status and clinical variables were evaluated using chi-square tests and logistic regression analysis. Results: Overall, 72.1% of children were fully vaccinated, 25.0% were partially vaccinated, and 2.9% had never received routine childhood vaccines. Immunization status differed significantly across diagnostic groups (p < 0.001). Partial vaccination was more common than complete vaccine refusal across most diagnostic categories. Lower full vaccination rates were observed in autism spectrum disorder and cerebral palsy, whereas higher coverage was observed in Down syndrome. Among partially vaccinated children, interruption of routine immunization after 48 months was the most frequent pattern. In multivariable analysis, only maternal age remained significantly associated with incomplete or no vaccination. Conclusions: Incomplete immunization in children with CNDDs was more commonly characterized by partial vaccination than complete vaccine refusal and followed diagnosis-specific patterns. Evaluating vaccination continuity during pediatric neurology follow-up may help support diagnosis-sensitive immunization counseling.
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