Common issues and improvement solution of vaccine hesitancy in children with underlying neurological conditions: Experience from one National Children's Medical Center in China.

BACKGROUND: Parents and healthcare providers usually defer or avoid immunization for children with neurological conditions. This study was conducted to investigate the common issues of immunization among these special children and the impact of specialists' recommendation on improving immunization practice. METHOD: We included 2,221 children with underlying neurological conditions seeking vaccination consultation at the first Immunization Advisory Clinic in China during 2017-2019. The primary neurological conditions and immunization status were analyzed. All parents were informed to self-report the adverse events following catch-up immunization. For specially concerned children with hereditary disorders, immune-related encephalopathy and epilepsy, we conducted the active follow-up to monitor the compliance with recommendation and the adverse events. RESULT: All counselling children were assessed as not having any contraindication of immunization. A total of 2,019 (90.9%) children with underlying neurological conditions had delayed immunization and 99 (4.5%) had non-immunization. The coverage rate of age-appropriate vaccines was 56.1%. The most concerned vaccines were diphtheria, tetanus and acellular pertussis combined vaccine, diphtheria and tetanus combined vaccine, meningococcal polysaccharide vaccine and Japanese encephalitis vaccine. Resuming immunization was recommended for the 2,048 (92.2%) children. Most of counselling children complied with the specialists' recommendation. Neither progress nor flaring of the neurological medical conditions was reported from parents. CONCLUSION: Vaccine hesitancy was a common issue for Chinese children with all kinds of neurological conditions. Specialized consultation on immunization is helpful to build vaccine confidence for the special children. Immunization for children with underlying neurological conditions is generally safe.

Vaccination experiences of premature children in a retrospective hospital-based cohort in a Chinese metropolitan area.

BACKGROUND: In China, premature children in good health may be advised to receive routine immunization programs. However, delayed vaccination is common. This study aimed to characterize vaccination experiences of premature children and determine the impact of vaccination consultation clinic (VCC) assessment. METHODS: We performed a retrospective cohort study, including premature children visiting VCC at Children's Hospital of Fudan University in 2017-2019. Data of these children, including demographics, recommendations of vaccination after VCC assessment, vaccination records, adverse events following immunization (AEFI), and incidence of vaccine-preventable diseases in 2017-2019, were collected retrospectively. RESULTS: A total of 1124 premature children were included, with vaccination uptake of 46.3% for expanded program of immunization (EPI) vaccines and 15.1% for non-EPI vaccines before VCC assessment. Furthermore, 77.5% of premature children who had not received any EPI vaccine were vaccinated after the assessment; however, most were delayed, regardless of vaccine types and recommendations. In contrast, 67.3% was vaccinated with non-EPI vaccines after the assessment. Majority (n = 35) of recorded AEFI was mild to moderate, in addition to one allergic rash. One each case of pertussis and varicella were recorded in those who had not received the corresponding vaccines. CONCLUSION: Vaccination may be safe and epidemiological effective in premature children. However, it remains mostly delayed in premature children with recommendations of normal vaccination. It warrants improving implementation of VCC recommendations. In addition, there is a need of health promotion on more non-EPI vaccines for premature children.