Knowledge and practices of vaccination for children with rheumatic diseases: A single-center study in China

Figures & data

Figure 1. The flow chart of the study.

Table 1. General characteristics of the children.

Variables	All, N = 189	Complete age-appropriate vaccination		Univariate analysis
		Yes (Completed group)	No (Incomplete group)	p Value
Relationship to caregiver, n (%)
Parents	182 (96.3%)	122 (67.0%)	60 (33.0%)	^b ＞.99
Not parents	7 (3.7%)	5 (71.4%)	2 (28.6%)
Place of residence, n (%)
Chongqing	95 (50.3%)	65 (68.4%)	30 (31.6%)	^a .718
Not Chongqing	94 (49.7%)	62 (66.0%)	32 (34.0%)
Gender, n (%)
Male	96 (50.8%)	70 (72.9%)	26 (27.1%)	^a .089
Female	93 (49.2%)	57 (61.3%)	36 (38.7%)
Education level of caregiver, n (%)
Lower than elementary school	5 (2.6%)	2 (40.0%)	3 (60.0%)	N/A
Elementary school	7 (3.7%)	6 (85.7%)	1 (14.3%)
Junior high school	44 (23.3%)	30 (68.2%)	14 (31.8%)
Senior high school	21 (11.1%)	15 (71.4%)	6 (28.6%)
College	11 (5.8%)	6 (54.5%)	5 (45.5%)
Bachelor degree	17 (9.0%)	16 (94.1%)	1 (5.9%)
Master degree	1 (0.5%)	0 (0.0%)	1 (100.0%)
Not answer	83 (43.9%)	52 (52.7%)	31 (32.8%)
Age, months
Median (IQR)	109.0 (63.0–156.0)	117.0 (67.0–156.0)	93.5 (58.8–154.0)	^d .288
Age group, n (%)
＜2 years old	10 (5.3%)	7 (70.0%)	3 (30.0%)	^b ＞.99
≥2 years old	179 (94.7%)	120 (67.0%)	59 (33.0%)
＜7 years old	66 (34.9%)	40 (60.0%)	26 (39.4%)	^a .158
≥7 years old	123 (65.1%)	87 (70.7%)	36 (29.3%)
＜2 years old	10 (5.3%)	7 (70.0%)	3 (30.0%)	^a .291
2 years old ≤ age＜7 years old	56 (29.6%)	33 (58.9%)	23 (41.1%)
≥7 years old	123 (65.1%)	87 (70.7%)	36 (29.3%)

Abbreviation: IQR, percentile interquartile range.

Statistical significance was determined by: (a) Chi-square (χ2) test, (b) Continuity correction, (c) Fisher’s exact, or (d) Mann-Whitney U test.

Table 2. Clinical characteristics about diagnosis and treatment of the children.

Variables	All, N = 189	Complete age-appropriate vaccination		Univariate analysis	Multivariate analysis
		Yes (Completed group)	No (Incomplete group)	p Value	ORs	95%CI	p Value
Diagnose, n (%)
Juvenile idiopathic arthritis	56 (29.6%)	31 (55.4%)	25 (44.6%)	^a .136		－
Systemic lupus erythematosus	37 (19.6%)	25 (67.6%)	12 (32.4%)
Juvenile dermatomyositis	33 (17.5%)	22 (66.7%)	11 (33.3%)
Kawasaki disease	31 (16.4%)	25 (80.6%)	6 (19.4%)
IgA vasculitis	32 (16.9%)	24 (75.0%)	8 (25.0%)
Treatment, n (%) (^e n = 359 responses)
Glucocorticosteroids	128 (35.7%)	85 (66.4%)	43 (33.6%)	N/A		－
cDMARDs	108 (30.1%)	68 (63.0%)	40 (37.0%)
Biological agents	62 (17.3%)	35 (56.5%)	27 (43.5%)
IVIG	61 (17.0%)	46 (75.4%)	15 (24.6%)
Treatment group, n (%)
Glucocorticosteroids, n (%)
Yes	33 (17.5%)	24 (72.7%)	9 (27.3%)	^a .456		－
No	156 (82.5%)	103 (66.0%)	53 (34.0%)
cDMARDs, n (%)
Yes	9 (4.7%)	6 (66.7%)	3 (33.3%)	^b ＞ .99		－
No	180 (95.2%)	121 (67.2%)	59 (32.8%)
Biological agents, n (%)
Yes	2 (1.1%)	1 (50.0%)	1 (50.0%)	^b .550		－
No	187 (98.9%)	126 (67.4%)	61 (32.6%)
IVIG, n (%)
Yes	25 (13.2%)	19 (76.0%)	6 (24.0%)	^a .314		－
No	164 (86.8%)	108 (65.9%)	56 (34.1%)
Glucocorticosteroids & cDMARDs, n (%)
Yes	24 (12.7%)	13 (54.2%)	11 (45.8%)	^a .146		－
No	165 (87.3%)	114 (69.1%)	51 (30.9%)
Glucocorticosteroids & Biological agents, n (%)
Yes	8 (4.2%)	4 (50.0%)	4 (50.0%)	^b .500		－
No	181 (95.8%)	123 (68.0%)	58 (32.0%)
Glucocorticosteroids & IVIG, n (%)
Yes	7 (3.7%)	7 (100.0%)	0 (0.0%)	^b .141		－
No	182 (96.3%)	104 (65.8%)	54 (34.2%)
Glucocorticosteroids & cDMARDs & Biological agents, n (%)
Yes	28 (14.8%)	17 (60.7%)	11 (39.3%)	^a .429		－
No	161 (85.2%)	110 (68.3%)	51 (31.7%)
Glucocorticosteroids & cDMARDs & IVIG, n (%)
Yes	24 (12.7%)	19 (79.2%)	5 (20.8%)	^a .181		－
No	165 (87.3%)	108 (65.5%)	57 (34.5%)
Glucocorticosteroids & cDMARDs & Biological agents & IVIG, n (%)
Yes	4 (2.1%)	1 (25.0%)	3 (75.0%)	^b .201		－
No	185 (97.9%)	126 (68.1%)	59 (31.9%)
cDMARDs & Biological agents, n (%)
Yes	19 (10.1%)	12 (63.2%)	7 (36.8%)	^a .693		－
No	170 (89.9%)	11 5(67.6%)	55 (32.4%)
IVIG & Biological agents, n (%)
Yes	1 (0.5%)	0 (0.0%)	1 (100.0%)	^c .328		－
No	188 (99.5%)	127 (67.6%)	61 (32.4%)
With one-time IVIG, n (%)
Yes	42 (22.2%)	35 (83.3%)	7 (16.7%)	^a .012	1.33	0.353–5.007	.673
No	147 (77.8%)	92 (62.6%)	55 (37.4%)
Age at disease onset, months	87.0 (50.5–132.0)	97.0 (61.0–138.0)	64.0 (37.0–127.3)	^d .018	1.013	1.005–1.022	.002
Disease duration, months	9.0 (1.0–26.0)	5.0 (0.0–23.0)	16.5 (5.5–30.3)	^d ＜0.001	1.012	0.977–1.049	.513
Disease duration group (duration＜1 month), n (%)
Yes	44 (23.3%)	37 (84.1%)	7 (15.9%)	^a .006	2.538	0.517–12.466	.251
No	145 (76.7%)	90 (62.1%)	55 (37.9%)
Disease duration group (1 months ≤ duration＜3 months), n (%)
Yes	23 (12.2%)	17 (73.9%)	6 (26.1%)	^a .464		－
No	166 (87.8%)	110 (66.3%)	56 (33.7%)
Disease duration group (3 months ≤ duration＜6 months), n (%)
Yes	14 (7.4%)	12 (85.7%)	2 (14.3%)	^b .216		－
No	175 (92.6%)	115 (65.7%)	60 (34.3%)
Disease duration group (6 months ≤ duration＜12 months), n (%)
Yes	25 (13.2%)	17 (68.0%)	8 (32.0%)	^a .927		－
No	164 (86.8%)	110 (67.1%)	54 (32.9%)
Disease duration group (12 months ≤ duration＜18 months), n (%)
Yes	17 (9.0%)	8 (47.1%)	9 (52.9%)	^a .064		－
No	172 (91.0%)	119 (69.2%)	53 (30.8%)
Disease duration group (18 months ≤ duration＜24 months), n (%)
Yes	12 (6.3%)	6 (50.0%)	6 (50.0%)	^b .321		－
No	177 (93.7%)	121 (68.4%)	56 (31.6%)
Disease duration group (duration ≥24 months), n (%)
Yes	54 (28.6%)	30 (55.6%)	24 (44.4%)	^a .031	1.394	0.424–4.577	.584
No	135 (71.4%)	97 (71.9%)	38 (28.1%)
Treatment duration, months	5.0 (0.0–18.5)	3.0 (0.0–13.0)	10.0 (1.0–26.0)	^d .003	0.977	0.944–1.011	.186
Treatment duration group (duration ＜1 months), n (%)
Yes	60 (31.7%)	48 (80.0%)	12 (20.0%)	^a .011	0.566	0.108–2.961	.500
No	129 (68.3%)	79 (61.2%)	50 (38.8%)
Treatment duration group (1 months ≤ duration＜3 months), n (%)
Yes	23 (12.2%)	15 (65.2%)	8 (34.8%)	^a .829		－
No	166 (87.8%)	112 (67.5%)	54 (32.5%)
Treatment duration group (3 months ≤ duration＜6 months), n (%)
Yes	13 (6.8%)	10 (76.9%)	3 (23.1%)	^b .640		－
No	176 (93.1%)	117 (66.5%)	59 (33.5%)
Treatment duration group (6 months ≤ duration＜12 months), n (%)
Yes	28 (14.8%)	17 (60.7%)	11 (39.3%)	^a .429		－
No	161 (85.2%)	110 (68.3%)	51 (31.7%)
Treatment duration group (12 months ≤ duration＜18 months), n (%)
Yes	15 (7.9%)	9 (60.0%)	6 (40.0%)	^c .740		－
No	174 (92.1%)	118 (67.8%)	56 (32.2%)
Treatment duration group (18 months ≤ duration＜24 months), n (%)
Yes	14 (7.4%)	8 (57.1%)	6 (42.9%)	^c .591		－
No	175 (92.6%)	119 (68.0%)	56 (32.0%)
Treatment duration group (duration ≥24 months), n (%)
Yes	36 (19.0%)	16 (44.4%)	20 (55.6%)	^a .098		－
No	153 (81.0%)	46 (30.1%)	107 (69.9%)

Abbreviations: ORs, odds ratios; CI, confidence intervals.

Statistical significance was determined by: a) Chi-square (χ²) test, b) Continuity correction, c) Fisher’s exact, or d) Mann-Whitney U test. ‘e’ represents multiple response.

Table 3. Adverse events following immunization of children.

Variables		Experienced the adverse events following immunization (All, N = 32)
AEFI, n (%)		Allergy	Nausea or vomiting or diarrhea	Local redness with painful purulence or ulcerated induration	Fever, rash or headache or dizziness or fatigue or general malaise	Other AEFI
Complete age-appropriate vaccination, n (%) (^e n = 34 responses)		2 (5.9%)	1 (2.9%)	4 (11.8%)	16 (47.1%)	11 (32.4%)
Completed group	19 (55.9)	1 (5.3%)	1 (5.3%)	3 (15.8%)	10 (52.6%)	4 (21.1%)
Incomplete group	15 (44.1)	1 (6.7%)	0 (0.0%)	1 (6.7%)	6 (40.0%)	7 (46.7%)
Treatment, n (%) (^e n = 63 responses)
Glucocorticosteroids	21 (33.3%)	1 (4.8%)	1 (4.8%)	4 (19.0%)	9 (42.9%)	6 (28.6%)
cDMARDs	18 (28.6%)	1 (5.6%)	0 (0.0%)	3 (16.7%)	8 (44.4%)	6 (33.3%)
Biological agents	13 (20.6%)	2 (15.4%)	1 (7.7%)	2 (15.4%)	2 (15.4%)	6 (46.2%)
IVIG	11 (17.5%)	0 (0.0%)	0 (0.0%)	2 (18.2%)	7 (63.6%)	2 (18.2%)

‘e’ represents multiple response.

Table 4. Vaccination-related attitude information.

	Vaccination-related attitude Likert scale scores
Variables	Necessity of vaccination	Caregiver concerns about vaccination before illness	Caregiver vaccination hesitancy before illness	Caregiver concerns about vaccination after illness	Caregiver vaccination hesitancy after illness	Trust in physician recommendations
127 caregivers of the completed group, (IQR)	4.0 (4.0–5.0)	2.0 (2.0–2.0)	2.0 (1.0–2.0)	3.0 (2.0–4.0)	3.0 (2.0–4.0)	4.0 (4.0–5.0)
62 caregivers of the incomplete group, (IQR)	5.0 (4.0–5.0)	2.0 (2.0–4.0)	2.0 (1.8–2.3)	4.0 (2.8–5.0)	4.0 (2.0–5.0)	4.0 (4.0–5.0)
189 caregivers (whether patients complete age-appropriate vaccination), (IQR)	4.0 (4.0–5.0)	2.0 (2.0–2.0)	2.0 (1.0–2.0)	3.0 (2.0–4.0)	3.0 (2.0–4.0)	4.0 (4.0–5.0)
Z	−1.598	−2.866	−1.672	−3.322	−3.366	−0.111
p Value of Univariate analysis	.110	.004	.094	.001	.001	0.911
p Value of Multivariate analysis	－	.003	－	.432	.167	－
ORs	－	0.600	－	1.238	0.704	－
95%CI	－	0.428–0.840	－	0.727–2.109	0.428–1.158	－
32 caregivers of the patients with AEFI, (IQR)	5.0 (4.0–5.0)	2.0 (2.0–4.0)	2.0 (1.0–3.0)	4.0 (3.0–5.0)	4.0 (3.0–5.0)	4.0 (4.0–5.0)
Z	−0.275	−1.790	−1.448	−1.464	−1.659	−1.653
p Value	.783	.073	.148	.143	.097	.098
22 caregivers of the patients not vaccinated against varicella, (IQR)	4.0 (4.0–5.0)	3.0 (2.0–4.3)	2.0 (1.0–3.0)	5.0 (3.0–5.0)	4.0 (3.0–5.0)	4.0 (3.0–5.0)
163 caregivers of the patients vaccinated against varicella, (IQR)	4.0 (4.0–5.0)	2.0 (2.0–2.0)	2.0 (1.0–2.0)	3.0 (2.0–4.0)	3.0 (2.0–4.0)	4.0 (4.0–5.0)
185 caregivers (whether patients had received varicella vaccination), (IQR)	4.0 (4.0–5.0)	2.0 (2.0–2.0)	2.0 (1.0–2.0)	3.0 (2.0–4.0)	3.0 (2.0–4.0)	4.0 (4.0–5.0)
Z	−0.760	−3.189	−1.695	−3.365	−2.498	−0.532
p Value	.447	.001	.090	.001	.013	.595
25 caregivers of the patients infected with varicella, (IQR)	4.0 (4.0–5.0)	2.0 (2.0–2.0)	2.0 (2.0–2.0)	3.0 (2.0–4.0)	3.0 (2.0–4.0)	4.0 (3.0–4.5)
160 caregivers of the patients infected with varicella, (IQR)	4.0 (4.0–5.0)	2.0 (2.0–2.0)	2.0 (1.0–2.0)	3.0 (2.0–4.0)	3.0 (2.0–4.0)	4.0 (4.0–5.0)
185 caregivers (whether patients infected with varicella)
Z	−0.785	−0.036	−0.277	−0.758	−0.162	−2.183
p Value	.432	.972	.782	.449	.871	.029

Abbreviations: ORs, odds ratios; CI, confidence intervals.

Statistical significance of univariate analysis was determined by Mann-Whitney U test. Multivariate analysis was determined by logistic regression analysis.