FRI0563 A NATIONAL SURVEY ACROSS GENERAL PAEDIATRICIANS REGARDING IMMUNIZATION PRACTICES IN CHILDREN WITH RHEUMATIC DISEASES
Authors: Despoina Maritsi, Irene Eleftheriou, Katerina Markante, Olga Vougiouka, Maria Tsolia
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Robust scientific evidence on the safety and efficacy of certain vaccines in patients with rheumatic diseases is available; therefore guidelines regarding immunizations in this vulnerable group of children are published via a variety of official health organizations/societies including the Greek Rheumatology Society. Nonetheless, the uptake of specific immunizations is suboptimal. In Greece, vaccinations are mainly delivered by primary care Paediatricians. <h3>Objectives</h3> The purpose of this study was to describe the knowledge, attitude and current practice of General Paediatricians working in primary care regarding vaccination in children with rheumatic diseases on immunosuppressive medication across Greece and to identify barriers and facilitators that could be used to promote uptake. <h3>Methods</h3> This was a cross-sectional survey, conducted with an anonymous questionnaire of 25 items distributed to Paediatricians via an online platform. Data collected included demographics, questions on knowledge, perceptions and opinions as well as advice given to families. Additionally, questions addressed three specific categories: live-vaccines, non-live vaccines and annual influenza vaccine. This study was approved by the "P. &amp; A. Kyriakou" Children's Hospital Research and Ethics Committee. <h3>Results</h3> Out of 400 questionnaires sent out, 256 were returned. Mean age was 48 years age ((+/-8.2) mean duration of working as a Pediatrician was 15 years (+/-6.7). 25% of the responders worked in rural areas and the remaining in urban areas. 67% worked in the private sector. The majority (78%) of doctors felt that vaccination in children with rheumatic diseases is of pivotal importance. 50% gave specific advice on immunisations at initial diagnosis and 25% checked vaccination status at regular intervals. Responders were using a variety of guidelines in order to reach a clinical decision; still 45% were unaware of the existing national guidelines. 50% were hesitant to adhere to the national vaccination scheme without expert input. Reasons were: not convinced from current literature that the vaccine is safe (32%), afraid to cause disease flare (43%), unable to deal with parental concerns/refusal (54%). 12% of responders felt that the rheumatic disease may have been triggered by a vaccine. The majority (95%) were pro annual influenza vaccination, while a minority (15%) was against live vaccines administration even if the patient was not on immunosuppressive treatment. 75% of doctors were keener to administer booster doses rather than primary ones, whlie 75% of respondents would postpone vaccinations in all cases if disease was active. <h3>Conclusion</h3> Variation in opinion and clinical practice exists. Overall, although Greek Paediatricians are well informed regarding efficacy and side effects of immunizations, there are steps to be made form principle to practice. Further research will allow the development of clear guidelines to aid in the management of increasing numbers of children with rheumatic diseases. <h3>Acknowledgement</h3> None <h3>Disclosure of Interests</h3> None declared