INCREASING VACCINATION IN CHILDREN. Susanna Esposito

Transcription

1 INCREASING VACCINATION IN CHILDREN Susanna Esposito Pediatric Highly Intensive Care Unit, University of Milan, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Italy

2 DISCLOSURE OF INTEREST Research grants from Cubist, GSK, Novartis, Pfizer, Roche Consultant, speaker, and adisory board member for GSK, Janssen, Novartis, Pfizer, Valeas, Vifor Pharma

3 How parents may feel about immunizations

4 VACCINATION COVERAGE IN ITALY Year POL3 DTP3 DT-DTP3 EpB3 MMR1 M-MMR1 Hib ,6 87,3 95,3 94,1 74,1 74,1 54, ,8 93,3 95,9 94,5 76,1 76,9 70, ,9 92,9 96,8 95,4 79,8 80,8 83, ,6 95,8 96,6 95,4 82,0 83,9 90, ,8 94,0 96,6 96,3 85,1 85,7 93, ,5 94,7 96,2 95,7 82,7 87,3 94, ,5 96,2 96,6 96,3 88,2 88,3 95, ,7 96,5 96,7 96,5 89,6 89,6 96, ,3 96,1 96,7 96,1 89,7 90,1 95, ,1 96,0 96,2 96,1 89,9 90,0 95, ,3 96,2 96,4 95,8 90,5 90,6 94, ,1 95,8 96,3 96,0 89,9 90,1 95, ,2 96,0 96,2 96,1 89,2 90,0 94, ,4 95,3 95,4 95,3 88,1 88,1 94,5 Ministry of Health, Directorate General of Heath Prevention 4

5 Annual variation of vaccination coverage for 1st dose of measles (24 months) by Region, Abruzzo Basilicata Calabria Campania Emilia Romagna Lazio Liguria Lombardia Marche Molise P. A. Trento P.A. Bolzano Piemonte Puglia Sardegna Sicilia Toscana Umbria Valle d'aosta Veneto Friuli-Venezia-Giulia Italia Variazione annua (regr) M-MPR1-MPRV: ,00-1,50-1,00-0,50 0,00 0,50 1,00-1,50-0,6-0,29-0,3-0,2-0,2-0,2-0,04-0,03 0,04 0,02 0,03 0,0 0,0 0,0 0,1 0,20 0,16 0,3 0,3 0,47 0,38

6 MAIN HEALTH SYSTEM BARRIERS TO VACCINATION AND POSSIBLE SOLUTIONS (Esposito S et al., CMI 2014)

7 MAIN PROVIDER BARRIERS TO VACCINATION AND POSSIBLE SOLUTIONS (Esposito S et al., CMI 2014)

8 Communication has a key role for reaching high vaccination coverage in pediatric age Audience Type of messagge Information s reference

9 Audience It is mandatory to know demographic and social characteristics of populations It is important to define priorities for communications

10 INFLUENZA VACCINATION RATES AMONG 5,286 ITALIAN CHILDREN AND ADOLESCENTS (Esposito S et al., Vaccine 2006) % Flu season High risk children Flu season Flu season Healthy children

11 Influenza vaccination coverage in children with underlying medical conditions (From Esposito S et al., Vaccine 2006)

12 % INTERVENTIONS TO IMPROVE INFLUENZA VACCINATION COVERAGE AMONG CHILDREN WITH CHRONIC ASTHMA *p<0.05 Esposito et al., ESWI 2008

13 Randomisation group Influenza vaccination in previous season ( ), No. (%) Influenza vaccination with intervention strategy ( ), No. (%) P value Group A (n=71) 11 (15.5) 31 (43.7) < Chemotherapy completion 4 (14.8) 20 (74.1) < <6 mos (n=27) Chemotherapy completion 7 (15.9) 11 (25.0) mos-2 yrs (n=44) Group B (n=64) 12 (18.8) 27 (42.2) Chemotherapy completion 4 (18.2) 17 (77.2) <6 mos (n=22) Chemotherapy completion 8 (19.0) 10 (23.8) mos-2 yrs (n=42) Group C (n=70) 19 (27.1) 34 (48.6) Chemotherapy completion 8 (32.0) 20 (80.0) <6 mos (n=25) Chemotherapy completion 6 mos-2 yrs (n=45) 11 (24.4) 14 (31.1) Cecinati V, Esposito S et al. Human Vacc 2010

14 Clear Simple Positive Evidence-based Emotional Messagge Different according to patient s age

15 The risk is yours. Why isn't the choice?

16 True Information From health autorithies From persons who cured from the disease From a testimonial Be carefull to newspaper and TV

17 October 1, 2009 Cancer jab girl 'died of tumour' A girl who was vaccinated against cervical cancer died from a malignant tumour of the chest and not from a reaction to the jab, it has emerged. Natalie Morton, 14, died after being given the injection at the Blue Coat Church of England School in Coventry. Deputy coroner for Coventry Louise Hunt said the vaccine was not thought to have been a contributing factor. A pathologist said her undiagnosed condition was "so severe that death could have arisen at any point." Natalie collapsed less than two hours after being given the Cervarix vaccine on Monday and was pronounced dead at Coventry's University Hospital. The deputy coroner, who opened and adjourned the hearing at Coventry Magistrates' Court, said: "It appears that Natalie died from a tumour in her chest involving her heart and her lungs." The inquest was told that the tumour had "heavily infiltrated" her heart and extended into her left lung. Cervarix (Human Papillomavirus vaccine [Types 16, 18]. Recombinant, adjuvanted, adsorbed) is a registered trade mark of the GlaxoSmithKline group of companies BBC News website. Available at: (accessed April 2013)

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19 Internet Web sites are increasingly important as a source of information on vaccines Some sites present information that is not based on science Some web sites opposing to vaccines are more appealing than those presenting good science

20 VACCINATED HIGH-RISK CHILDREN (No.=72) Why is your child vaccinated against influenza? ANSWER Pediatrician s recommendation FREQUENCY 63 (87.5%) Protection of parents 6 (8.3%) Protection of an elderly family members Previous serious influenza-like illness 2 (2.8%) 1 (1.4%) Esposito S et al., Vaccine 2006

21 UNVACCINATED HIGH-RISK CHILDREN (No.=202) Why is your child not vaccinated against influenza? ANSWER FREQUENCY Lack of awareness 173 (85.6%) Inconvenience 11 (5.5%) Concern about side effects 18 (8.9%) Esposito S et al. Vaccine 2006

22 PEDIATRICIANS OPINIONS CONCERNING INFLUENZA (No.=256) If you do not recommend influenza vaccination in a child with chronic disease, what are the reasons? ANSWER Influenza infection not sufficiently severe Poor efficacy of influenza vaccines Concern about side effects FREQUENCY 68 (26.6%) 149 (58.2%) 39 (15.2%) Esposito S et al., Vaccine 2006

23 Fear from parents Low perception of disease s risk Uncertainity on cost/benefit of vaccine Death subsequent to vaccination Vaccines reactogenicity Too many vaccines during the same visit Risks related to actions considered higher than those related to no action

24 POLIO

25 TYPICAL MEASLES IN PEDIATRICS

26 Measles-related deaths Bulgaria : France : WHO European Region 2013: died 10 died 7 died 11 infants 9 children/teenagers: 1-19 years old 4 adults 9 patients: <30 years old 7 patients were immunodeficient 2 infants 3 children/teenagers: 1-19 years old 2 adults 26

27 Measles complications (n=1,389) among 3,931 reported cases, Italy Diarrhea Stomatitis Other Pneumonia Keratoconjunctivitis Otitis media Hepatitis Respiratory insufficiency Laringotracheobronchitis Thrombocytopenia Convulsions Encephalitis % of cases had at least 1 complication (N=919) - 29% of cases was hospitalised (N=1,030) - No deaths reported Data source: integrated measles-rubella surveillance system (ISS) % of total number of complications 31

28 Key topics to convice parents to administer vaccines to their Individual perception of disease risk Individual benefit from vaccination Personal decision children

29 CRITICAL ISSUES TO REDUCE VACCINE-PREVENTABLE DISEASE BURDEN Improved political committment National plan of action with coordinated activities High quality vaccination campaign Awareness and coverage among HCWs Comprehensive communication Advocacy from civil society organizations Enhanced surveillance

30 Difficulties with parents Long waiting No attention Rigid communication

31 Encounter times (mins) for 164 Well Visits (< 24 mos. old) 25 th % Median 75 th % Primary care provider Vaccine discussion Other health discussion Physical exam LeBaron, et.al, Arch Pediatr Adolesc Med 1999;153:

32 Bad communication examples Mixed messages from multiple experts Late information overcome by events Over-reassuring messages No reality check on recommendations Myths, rumors, doomsayers not countered Improper modeling of behavior, lack of affect, bad humor by spokesperson/leader Public power struggles and confusion Barbara Reynolds, CDC

33 Questions parents want answered What vaccines will my child have? Why so many? What diseases do they prevent? What are the common, mild side effects, and how do I manage them? What are the severe risks? What is the overall schedule and when is the next vaccine?

34 To convince parents on the importance of vaccines To gain confidence To be authoritative showing an adequate knowledge also on the latest data To clarify parents responsability (including written dissent) in relation to vaccine s benefits

35 Do you read guidelines?

36 Impact of immunization (USA) Disease Before immunization year 2000 % variation Diphtheria 31, Measles 390, Mumps 21, Pertussis 117,998 7, Polio 4, Rubella 9, Congenital rubella 19, Tetanus 1, Hib 24, Total 566,706 8, Adverse events 0 13,

37 How parents can be classified "Vaccine Believer - convinced of the benefit of vaccination "Cautious" - high emotional investment in their child "Relaxed" - less involved parenting style, some skepticism about vaccines "Unconvinced" - distrust of vaccinations and vaccination policy Vaccine Mar 31;23(19):

38 Vaccine believers Tailored communication strategies Safety concern Likelihood to accept routine vaccines Likelihood to accept new vaccines Time to communicate Low High High Brief Cautious Medium High High Longer Relaxed Medium Medium Low Longer Unconvinced High Low Low Longest

39 SEE YOU IN MILAN!

40 Questions.In your institution How is perception on pediatric vaccines in your country? Do you have an idea of vaccine coverage rates of healthy children and those with underlying disease in your country? Do you know if there are some programmes to improve vaccination rates?