The impact of a multidisciplinary care package for vaccination in needle phobic children: An observational study.

AIMS: Children with severe needle phobia find vaccination extremely distressing and can remain unvaccinated, which puts them at an increased risk of contracting and transmitting vaccine preventable disease. Referral to a specialist or hospital service may occur when they cannot be safely vaccinated in the community, but engagement of allied health services can be inconsistent. The aim of the study was to assess the impact of a multidisciplinary, consumer-oriented model of care on vaccinations for needle phobic children. METHODS: Needle phobic children aged between 6 and 16 years attended multidisciplinary consultation, as part of a care package, to assess previous experiences and determine the level of intervention that was required to support vaccination. A multidisciplinary case meeting followed this appointment and an individualised plan formulated for each patient. The main outcome of the project was rate of successful vaccination. RESULTS: The care package resulted in a successful vaccination rate of 83% (n = 20) with 69 vaccines administered across three clinics. Of those successful, 90% required multiple injections per visit. The majority of patients indicated moderate to high level of anxiety. Supportive care was escalated and de-escalated as tolerated. CONCLUSIONS: Results demonstrate the diversity of patients presenting with needle phobia and indicate an individualised, collaborative approach is preferable to a 'one size fits all' model of care. The study highlights a need for the development of guidelines that streamline the assessment and individualisation of procedural anxiety plans to meet patient needs and embed these processes into standard care.

In utero exposure to biologic disease-modifying anti-rheumatic drugs and effects to the infant: infectious complications, vaccine response, and safety of live vaccine administration.

INTRODUCTION: Biologic disease-modifying anti-rheumatic drugs (bDMARDS) are increasingly used in clinical practice for a variety of conditions. Due to concerns surrounding persistence of drug levels and resulting immunosuppression, current case reports recommend against live vaccine administration in the first year of life for an infant exposed to perinatal bDMARDS. As a result, this significantly impacts receipt of rotavirus vaccination, a vaccine recommended in many countries' national immunization program. Area covered: We have reviewed all available published literature to explore the effect of peripartum bDMARDS exposure on infant immune responses, safety of live vaccines, and vaccine efficacy in the first year of life. Expert opinion: We recommend that otherwise healthy newborns with a history of perinatal exposure to bDMARDS should receive rotavirus vaccinations as per the recommended schedule. Bacille Calmette et Guerin vaccine should be withheld in the first year of life. No additional booster doses of inactivated vaccines are required as they appear to mount adequate immune responses to the routine schedule.

Prospective surveillance of hospitalisations associated with varicella in New Zealand children.

AIM: Varicella is a vaccine-preventable disease not notifiable in New Zealand (NZ), and varicella vaccine is not funded in the National Immunisation Schedule (NIS). Hospitalisations can occur because of bacterial secondary infection and other complications, which can result in long-term sequelae. Varicella may not be acknowledged in discharge coding when complications occur weeks after infection. Using the New Zealand Paediatric Surveillance Unit (NZPSU), the aim of this study was to document the hospitalisation burden of this disease. METHODS: Cases (0-14 years) of varicella and post-varicella complications requiring hospitalisation, including stroke syndromes where varicella occurred in the preceding 6 months, were notified to NZPSU between 1 November 2011 and 31 October 2013. Herpes zoster cases were excluded. Questionnaires were used to capture demographics, clinical features, management and short-term outcomes. RESULTS: One hundred seventy-eight notifications were received and 144 were confirmed cases. Overall incidence was 8.3/100,000 children per year. Fifty-two percent were women with a median age of 2.4 years. Maori and Pacific Island (PI) children accounted for 74% of hospitalisations, with incidence rate ratios compared with European children of 2.8 and 3.9, respectively (P < 0.01). Complications included: infection (75%), respiratory (11%), neurological (11%), electrolyte disturbance (6%) and haemorrhagic varicella (4%). Nine percent were immunocompromised. Median duration of hospital admission was 4 days with 9% requiring intensive care admission. There were no reported deaths; however, 19% had ongoing problems at discharge. CONCLUSION: Varicella has more associated morbidity than commonly perceived in immunocompetent children. Maori and PI children are more likely to have complications. This surveillance gives support for inclusion of universal varicella vaccine in the NZ NIS.

Varicella in a Paediatric Intensive Care Unit: 10-year review from Starship Children's Hospital, New Zealand.

AIMS: Varicella is now a vaccine-preventable disease but is generally considered benign, making it a low priority for a funded universal immunisation scheme. We aimed to increase the knowledge of the severity, morbidity and mortality caused by varicella, by a review of cases requiring paediatric intensive care in New Zealand where vaccine is available but not funded. METHODS: This is a retrospective chart review of children admitted to the paediatric intensive care unit (PICU) over a 10-year period (July 2001-July 2011) identified from the PICU database with a primary or secondary code for varicella. RESULTS: Thirty-four cases were identified and 26 cases were included. Of the 26 cases, 84.6% were Maori or Pacific Island ethnicity, 54% had no preceding medical condition and 23% were immunocompromised. Main PICU admission reasons were neurologic (38.5%), secondary bacterial sepsis or shock (26.9%), respiratory (15.4%), disseminated varicella (11.5%), or other causes (7.7%). Fifty per cent of children required inotropic support and 81% invasive ventilation. Four children died (15%), three of whom were immunocompromised. A further eight children (31%) had ongoing disability at hospital discharge. CONCLUSION: Varicella, or its secondary complications, requiring paediatric intensive care, carries high mortality, particularly for immunocompromised patients, and long-term morbidities, mostly affecting previously healthy children.