Changing Parental Attitudes Towards Rotavirus Vaccine.

BACKGROUND:  Rotavirus is known to be one of the most common infections, usually associated with severe diarrhea. Despite the existence of two licensed vaccines, many countries, including Turkey, have not included rotavirus vaccination in their nationally funded vaccination program. This article explores what factors influence parents' decisions about whether to have their children vaccinated against rotavirus and which factors changed from 2010 through 2016. MATERIALS AND METHODS:  Data were collected over two periods via questionnaires. The first period was from January 2009 through March 2010, and data were gathered from a semi-private pediatric outpatient clinic in Kocaeli, Turkey. The second period was from August 2015 through May 2016, and data were collected from parents during their pediatric outpatient clinic visits. Two questionnaires were designed to find out the rotavirus vaccination status of the children, socio-demographic factors, and reasons for excluding/accepting the rotavirus vaccine. The level of knowledge about the rotavirus vaccine was investigated. Parents indicated their level of agreement with each statement using a five-point Likert scale. RESULTS:  While only 3.8% of the parents accepted the rotavirus in 2009-2010, it increased to 69.5% in 2015-2016. Significant factors influencing parents' decision to vaccinate their children for rotavirus were advice from a pediatrician, a lack of correct and timely rotavirus information, and the cost of the vaccine. CONCLUSIONS:  The acceptance of the rotavirus vaccine depends on parental perceptions, which may be influenced by accurate and timely information, the advice of their healthcare provider, and inclusion in the nationally funded vaccination program. In contrast to other studies reported, the education level of the mothers and fathers and their job types appear to be important. It was also found that parents' attitudes and perceptions changed over time.

Knowledge, Attitude, Perceptions, and Concerns of Pregnant Women Regarding the Influenza Vaccination in Kocaeli, Turkey.

Introduction In order to better understand the barriers to influenza vaccination, we have designed a study to investigate pregnant women's knowledge, attitude, perceptions, and concerns towards the inactivated influenza vaccine. Materials and methods In this prospective study, carried out between July 1, 2019, and December 31, 2019, 252 pregnant women (≥12 weeks of gestational age), who had consented to be enrolled in the study, were asked to complete an interviewer-administered questionnaire during their stay in the hospital ward. Results The lack of information about influenza vaccines (59.4%) was in the first rank among the reasons for personal and parental vaccine rejection. Most (65.1%) pregnant women either did not believe in or had doubts about the efficiency of the influenza vaccine during gestation. Most of them (80.9%) either were not sure about or did not have much confidence in the prenatally inoculated vaccine's ability to protect their babies postnatally. Some (25.6%) participants attributed their vaccinal unwillingness to fear of adverse effects, and some (11.5%) deemed gestational influenza immunization unnecessary because of their tendency to underestimate the grave consequences of influenza contracted by infants within the first six months of life. The higher the education level, the higher was the knowledge of and the willingness to be immunized against influenza. Discussion It is known that about one-third of pregnant women in Turkey have never heard of the influenza vaccine. Unawareness of influenza vaccination in pregnancy is significantly related to vaccine uptake in Japan. Patient education on knowledge of influenza and influenza vaccination has a booster effect on vaccination rates. Had the influenza vaccine been routinely administered to pregnant women in Turkey, the lives of the majority of the women who died of influenza in the influenza A (H1N1) pandemic in 2009 would have been saved. Low-risk perception is quoted as one of the main reasons for influenza vaccine refusal during pregnancy, which was also the case in our study. Concordant with the current literature, the education level and household income were correlated with the level of influenza vaccination uptake. Pregnant women's fear of adverse effects of the influenza vaccine might extend to the fear of birth defects. Conclusion The acceptance of influenza vaccines by pregnant women is a consequence of complex interactions of various factors. Giving necessary information to pregnant women is one of the most important factors that can increase influenza vaccine uptake. For this reason, it should be ensured that the efficacy and safety data of the influenza vaccine are more widely included in vocational training activities of health personnel and in prenatal care textbooks and guidelines.

Effect of sibship asthma on newborns with transient tachypnea of the newborn (TTN).

BACKGROUND: A number of studies have demonstrated that transient tachypnea of the newborn (TTN) is a risk factor for later asthma. The present study attempts to determine whether older sibling asthma is a risk factor for TTN. METHODS: Medical records of 1318 newborns from neonatal intensive care and delivery units were studied. None of the subjects were first-born, and thus, all had older siblings. Clinical data of mothers and their children were obtained from medical records. Data items included date of birth, gestational age (GA) at birth, birth weight, gender, mode of delivery including Normal Spontaneous Delivery or caesarean section (CS) and whether pre-labour CS or not, reasons for CS, number of pregnancies, number of children, asthma of mothers and siblings, whether the newborn had TTN or not. Logistic regression analysis was used to assess the association between siblings' asthma and TTN. RESULTS: Pre-labour CS, maternal asthma, GA, babies with large and small birth weight for GA, number of pregnancies and children (three and more) were found to be significantly associated with TTN. Siblings' asthma was found to be independently associated with a diagnosis of TTN. CONCLUSIONS: Both pre-labour CS and mothers with asthma were common risk factors for the development of TTN. An association was present between TTN and siblings' asthma even in infants whose mothers did not have asthma.

Parental Attitudes and Perceptions Towards Vaccines.

Objective Success of any vaccination program and uptake of children's vaccines largely depends upon the parents' perceptions and attitudes. This study provides a snapshot of parents' views towards vaccines included in the nationally-funded vaccination program, together with two unfunded vaccines in Kocaeli, Turkey. Methods Data were gathered from a convenience sample through a questionnaire that explored the socio-demographic factors of the parents and the vaccination status of their children. The survey content was based on Health Belief Model. Mann-Whitney test was used for comparisons as there is no prior information regarding data distribution and the dependent variable is represented on an ordinal scale. Out of 300 parents who brought their children into the pediatrics polyclinics, 262 parents responded positively and took part. The questionnaires were filled out by mothers alone 67.6 % (n=177), 28.6 % (n=75) by fathers and mothers (both present), 3.1% (n=8) by fathers alone and the remaining 0.8% (n=2) were filled by other relatives. Results While the majority of diseases prevented by the vaccines were perceived to be serious, pneumococcal infection and chickenpox were considered to be less serious and there was no strong opinion for the rotavirus vaccine. The main reasons that influenced parents' decisions towards unfunded vaccines were advice from a pediatrician and the cost. Lastly, demographic factors such as family income, mothers' education and job types of mothers were important in contrast to previously published studies. Conclusions The acceptance of a new vaccine depends on a complex interaction of factors, but parents' perceptions may vary considerably. The main factors influencing parental acceptance are the availability of information and the cost. Therefore, for a new vaccination program to succeed, it should be funded by the government and a specific public health education program should be undertaken.

A Study of Mortality in Cardiac Patients in a Pediatric Intensive Care Unit.

OBJECTIVE: One of the major causes of mortality in the pediatric intensive care unit (PICU) is heart disease. This study aimed to determine the causes of mortality in children with pre-existing cardiac abnormalities who were admitted into the PICU. METHODS: Data were collected through patient profile assessment and outcome and heart diseases affecting prognosis were analyzed. Medical records of children were reviewed retrospectively. The updated Pediatric Index of Mortality 2 (PIM2) scores were used. Exploratory data analysis was performed using descriptive measures. Kolmogorov-Smirnov tests were used to test the normality of data distribution. RESULTS: Out of 566 admissions into PICU, 76 (13.4%) had cardiac abnormalities. Median and range of PICU stay were 5.50 and 417.88 days. The mean PIM2 score on admission was found to be 31.05. The most common admission was due to atrioventricular septal defect (AVSD) (15.7%), cardiomyopathy (13.1%), ventricular septal defect (VSD) (11.8%), tetralogy of Fallot (10.5%) and others (48.9%). There were multiple cardiac anomalies in 3.9% of patients. The most important cause of cardiac mortality in PICU was septic shock (26.0%) followed by cardiogenic shock (20.6%), and cardiac failure (13.7%). The nosocomial infection rate of cardiac patients in PICU was 10.5%. CONCLUSIONS: Our study reconfirmed that the PIM2 score is a good indicator of cardiac diseases. Infections, nosocomial infections, pneumonia, and septic shock were the leading causes of mortality in cardiac patients. Better infection control in the PICU may have a significant impact on decreasing mortality rates.

New Risk Factors for Transient Tachypnea of the Newborn and Childhood Asthma: A Study of Clinical Data and a Survey of Parents.

OBJECTIVES: It is established that transient tachypnea of the newborn (TTN) is associated with an increased risk of early childhood asthma. However, the question remains whether both asthma and TTN have common risk factors as well as the same underlying etiology. This study aims to determine possible risk factors for TTN as well as early childhood asthma. METHODS: This study was carried out in two phases. While the first phase included medical records of 1318 newborns, the second phase consisted of a phone survey. RESULTS: Elective cesarean section (ECS), maternal asthma, gestational age (GA), babies with large and small birth weight, number of pregnancies, and number of children were found to be significantly associated with TTN. ECS, maternal asthma, length of the hospital stay due to TTN, and O2 treatment were statistically significant for asthma. TTN was found to be associated with a subsequent diagnosis of childhood asthma after adjusting for ECS and maternal asthma. CONCLUSIONS: Both ECS and maternal asthma are the common risk factors for the development of both TTN and childhood asthma as previously reported. In order to uncover this association, when ECS is taken out, it is seen that the association between TTN and asthma is stronger. Furthermore, O2 treatment and duration of hospital stay due to TTN were also found to be associated with childhood asthma. Association of maternal allergic rhinitis and eczema with TTN was investigated and there was no relationship between maternal allergic rhinitis or maternal eczema and the subsequent diagnosis of TTN.

Correlation between peak flow and body mass index in obese and non-obese children in Kocaeli, Turkey.

AIMS: To investigate the relationship between body mass index (BMI) and peak expiratory flow (PEF) values in children between the ages of 6 and 14 years. METHODS: Data were collected from 1,439 children during public health screening. Each child was classified on the basis of age- and sex-specific BMI percentile as non-obese or obese (BMI >95th percentile). PEF and BMI were compared among age-sex-BMI percentile groups. RESULTS: PEF values were lower in obese children than in non-obese children. There were also significant differences between girls and boys. CONCLUSIONS: The association of higher BMI with lower PEF may indicate that obesity is an important risk factor for reduced airflow or lung function in children. These findings emphasise the importance of the prevention of obesity in children and adolescents in order to avoid possible future respiratory problems.

Lymphadenitis as a Rare Side Effect of H1N1 Vaccine in a Child.

We present a 5-year-old boy who had the complaint of swelling and pain on the right vaccine shot and right axillary areas. The right axillary area was diagnosed as reactive lymphadenitis, which we believe is a rare local side effect of the swine flu vaccine. The key message to take away from this case is that the patient had lymphadenitis as a local side effect of the swine flu vaccine. Lymphadenitis should be reported as a possible local side effect of the swine flu vaccine.

Relationship between BMI and blood pressure in girls and boys.

AIM: To investigate the relationship between BMI and blood pressure as this is of crucial interest in evaluating both public health and the clinical impact of the so-called obesity epidemic. METHODS: Data were gathered from 1899 children aged between 6 and 14 years, analysing and evaluating a possible relationship between BMI and systolic and diastolic blood pressure values for both girls and boys. Each child was classified on the basis of age- and sex-specific BMI percentile as normal weight (<85th percentile), overweight (95th percentile). RESULTS: In comparisons among age BMI percentile groups, systolic and diastolic blood pressure values were higher in obese and overweight groups than in normal weight groups for both sexes. Although BMI among girls was higher than among boys in all three percentile groups, there were no significant differences between sexes with respect to blood pressure values. CONCLUSION: The present findings emphasize the importance of the prevention of obesity in order to prevent future related problems such as hypertension in children and adolescents.

Effect of number of BCG vaccination on tuberculin induration size.

AIM: The aim of this study is to interpret purified protein derivative (PPD) induration sizes with respect to the number of Bacillus Calmette-Guérin (BCG) scars. METHODS: We have considered 1879 school children between the ages of 7 and 14 years from seven primary schools in Kocaeli, Turkey. Children were injected with 5TU 0.1 mL PPD and induration sizes were measured at 72 h. Number of BCG scars, PPD application dates and induration sizes were recorded for each pupil. This study was also evaluated further for 312 households. RESULTS: The mean diameter of PPD induration size for 0, 1, 2 and 3 BCG vaccination scars were 1.43 mm (95% confidence interval (CI): 0.84-2.02), 6.39 mm (95% CI: 5.91-6.87), 10.46 mm (95% CI: 10.04-10.88) and 11.35 mm (95% CI: 9.36-13.34), respectively. Furthermore, 90% and 95% percentiles of PPD induration 0, 1, 2 and 3 vaccinations were 10 and 12 mm, 16 and 19 mm, 17 and 19 mm and 19.2 and 20 mm, respectively. There was evidence for a linear trend across from 0 to 3 BCG vaccinations, indicating that mean induration size increases with the number of vaccination scars. The size of indurations directly correlated with the number of vaccination scars, PPD induration size of children with no vaccination scar was quite small and it was generally less than 5 mm. CONCLUSION: This study shows the importance of the number of BCG scars in the determination of PPD induration size limit when tuberculosis infection is evaluated.