Abstract

Objective: There is a lack of data relating to vaccination of children with special health care needs (CSHCN) and its influencing factors in China. We investigated the disease spectrum of CSHCN at the Vaccination Consultation Clinic in Zhejiang province as well as the underlying factors of vaccination recommendations of these children.Methods: In this study, we retrospectively analyzed the data of 4,525 CSHCN, who visited to our clinic for a vaccination consultation from January 1, 2016 to May 30, 2018. Descriptive data were presented as mean ± standard deviation (SD) and percentages. Multivariate analysis was performed with non-conditional bivariate logistic regression to identify the underlying factors of vaccination recommendations. Subsequent information regarding the following vaccination and the occurrence of AEFI were also collected and analyzed.Results: The main diseases consulted were those relating to the circulatory and nervous systems as well as neonatal diseases. The distribution of diseases varied by age: 53.6% infants under 12 months were counseled for circulatory system diseases, while 44.6% children aged 12~24 months and 54.7% children over 25 months were counseled for nervous system diseases. According to the evaluation reports issued by the consultation clinic, 75.0% of CSHCN were recommended to be vaccinated normally, 21.2% were recommended to defer specific vaccination, while only 3.8% were recommended to defer all vaccinations. In logistic regression analysis, age, history of adverse events following immunization (AEFI) and the number of diseases combined were all strong correlative factors for vaccination recommendations. Children who were aged over 25-month-old (OR = 1.34, 95%CI: 1.11–1.61) or had a history of AEFI (OR = 3.77, 95%CI: 2.83~5.01) or those who had numerous diseases combined (OR = 2.00, 95%CI: 1.46~2.75) tended to have a higher rate of deferred vaccination recommendation. Among those CSHCN who received nationally-recommended vaccines, the estimated AEFI rate was 24.29/100 000. No uncommon or rare serious adverse reactions were detected.Conclusion: Age, history of AEFI, and the number of diseases combined were important factors that affected the vaccination recommendations of CSHCN. Most CSHCN can be safely vaccinated according to the nationally-recommended schedule.

Highlights

  • Vaccination is one of the most cost-effective interventions of preventing infectious disease and reducing the burden of disease [1]

  • It is common for vaccination providers to encounter Children with special health care needs (CSHCN) who suffering from various diseases, like congenital heart disease (CHD), seizure, thrombocytopenic purpura or various allergic diseases

  • Some other studies focusing on the impact of some socioeconomic factors on vaccination and indicated that the outreach of medical support programs targeted to CSHCN, family’s socioeconomic status and parental educational level are all related to the vaccination coverage [3, 4, 6]

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Summary

Introduction

Vaccination is one of the most cost-effective interventions of preventing infectious disease and reducing the burden of disease [1]. It makes up a significant component of the prevention of comprehensive preventive and primary care services for all children, including those with special medical conditions. Children with special health care needs (CSHCN) are those who have or are at increased risk for physical, developmental, behavioral, or emotional disorders [2]. They always require special health services beyond the basic healthcare that is provided for the general public. Some other studies focusing on the impact of some socioeconomic factors on vaccination and indicated that the outreach of medical support programs targeted to CSHCN, family’s socioeconomic status and parental educational level are all related to the vaccination coverage [3, 4, 6]

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