Immunization of high-risk paediatric populations: Central European Vaccination Awareness Group recommendations

Abstract

Over the last decade, childhood immunization has substantially reduced morbidity and mortality from vaccine-preventable diseases. However, particular paediatric risk groups, such as those with comorbidities, may not be adequately vaccinated despite being more susceptible to complications and death from certain infectious diseases. This may be due to lack of immunization recommendations, lack of awareness, or incomplete adherence to existing guidelines. Furthermore, recommendations for immunization can be inconsistent across Europe. An expanded initiative from the Central European Vaccination Awareness Group aims to raise awareness of the different high-risk paediatric groups, differentiate them according to their specific risk, and formalise a guidance statement for the immunization of each population.

Keywords::

• Central Europe
• high-risk
• immunization
• paediatric
• recommendations

Acknowledgements

All authors were actively involved in the selection and review of all content and had full editorial control during the writing of the manuscript.

Financial & competing interests disclosure

D Richter has received honoraria for lectures on vaccines and respiratory drugs from GlaxoSmithKline (GSK) Croatia, MSD Idea Inc. Croatia, Pfizer and Medoka (representing Sanofi Pasteur). I Anca has been the principal investigator in clinical studies supported by GSK, Apogepha and Ferring. The author has also been a scientific consultant to GSK, Wyeth Lederle, Teva, AstraZeneca and Nestlé and has received sponsorship from GSK, Pfizer and Nestlé to attend scientific meetings. M Bakir has received sponsorship for scientific meetings from GSK, Wyeth Lederle, sanofi aventis and Merck Sharp & Dohme (MSD). R Chlibek has received lecture fees and sponsorship to attend scientific meetings from GSK, Sanofi Pasteur and Pfizer and has been principal investigator in clinical trials sponsored by GSK. M Čižman has received honoraria for lectures on vaccine use from GSK, Pfizer and MSD. A Mangarov has been a scientific consultant to GSK, Aventis Pasteur, Pfizer, Danone and Solvay Pharma and has received sponsorship from these companies to attend scientific meetings. Z Mészner is a consultant to Pfizer, GSK, MSD, Sanofi Pasteur, Novartis and Baxter on vaccination issues and has also received travel grants. M Pokorn has received lecture fees from GSK Slovenia, speaker fees from GSK and has received sponsorship from GSK and PharmaSwiss Slovenia to attend scientific meetings. R Prymula is a member of advisory boards for GSK, MSD, Pfizer, Baxter and Aventis Pasteur and has received research grants and honoraria from GSK, Pfizer, Baxter, Aventis Pasteur and Novartis. P Šimurka has received consulting fees and lecture fees from GSK, Pfizer and MSD. E Tamm has received sponsorship from GSK and PharmaSwiss to attend scientific meetings. G Tešović has received sponsorship from GSK, MSD, PharmaSwiss, and Pfizer to attend scientific meetings. I Urbančíková has been a scientific consultant to GSK and Pfizer and has received lecture fees from GSK, Pfizer, MSD and Novartis and sponsorship from GSK, Pfizer and Sanofi Pasteur to attend scientific meetings. V Usonis has been the principal investigator in clinical studies supported by GSK, Novartis and Pfizer. The author has also been a scientific consultant to Aventis Pasteur, Baxter, GSK, Merck and Pfizer and has received sponsorship from these companies to attend scientific meetings. J Wysocki has been principal investigator in clinical trials sponsored by GSK, Wyeth, Pfizer and Novartis. The author has also received sponsorship from GSK, Pfizer and Wyeth to attend scientific congresses. D Zavadska has received lecture fees from GSK, Sanofi Pasteur and Abbott and has received sponsorship from GSK and Baxter to attend scientific meetings. F Andre and N Salman have no competing interests. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Preparation of this report was supported by an educational grant from GlaxoSmithKline, Novartis and Pfizer.

Writing assistance was utilized in the production of this manuscript. Editorial assistance was provided by C Combs and Wells Healthcare Communications Ltd.

Key issues

• High-risk groups are defined as those who are more susceptible to vaccine-preventable diseases and their complications, and include those with underlying chronic diseases or comorbidities and those at increased risk of exposure to vaccine-preventable diseases.

• High-risk groups therefore require additional immunization recommendations and strategies to ensure maximum protection.

• Physicians, healthcare workers and families of infants and children need to be made aware of the infectious diseases relevant to each high-risk category.

• Neonates, infants and very young children remain the principal targets of most universal national immunization programmes (NIPs) because of the high risk of morbidity and mortality at this young age.

• Preterm and low birthweight babies are at even higher risk of complications and morbidity from vaccine-preventable diseases and should receive all routine vaccines including rotavirus and influenza, as well as respiratory syncytial virus prophylaxis.

• Vaccines against influenza, pneumococcus and rotavirus are currently the most commonly recommended for pediatric high-risk groups across Central European Vaccination Awareness Group countries.

• Children with cochlear implants are at increased risk of bacterial meningitis (pneumococcal in particular) and should receive pneumococcal, Haemophilus influenzae type b and influenza vaccines.

• Immunizations for immunocompromised children should be individually tailored according to their specific condition, disease stage and level of immunosuppression.

• Limited financial resources and lack of consistent surveillance systems may explain the practice of limited targeting of high-risk groups with vaccines that are included in NIPs in many countries.

• The decision to include a vaccine-preventable disease in the NIP could be greatly facilitated by making the disease notifiable and gathering sound evidence from surveillance.

• Expanded immunization initiatives should help prevent the disproportionate morbidity and mortality that can occur when high-risk pediatric populations contract vaccine-preventable diseases.