82. Influenza Vaccination of Children with Neurologic and Neurodevelopmental Disorders
Session: Oral Abstract Session: Influenza Vaccine - Clinical Impact and Vaccine Response
Thursday, October 3, 2013: 9:15 AM
Room: The Moscone Center: 200-212
Background: During the 2009 influenza pandemic, 336 pediatric deaths had laboratory confirmation of 2009 H1N1 and were reported to CDC. 146 occurred in children with underlying neurologic and neurodevelopmental disorders (NNDDs).  Although NNDDs have been ACIP high-risk conditions since 2005, little is known about vaccination practices of children with NNDDs 

Methods: CDC collaborated with Family Voices, a national advocacy group for children with special healthcare needs. On-line surveys were distributed to members regarding their practices related to having their children vaccinated against influenza.  Logistic regression models assessed the association between vaccination and prior receipt, specific NNDD, presence of a chronic respiratory condition and preferred language. Interaction terms between respiratory diagnoses and each NNDD were explored.

Results: 2138 parental surveys were completed.  1143 children had at least one NNDD; 516 had more than one.  Specifically, 271 had cerebral palsy (CP), 351 had epilepsy (EP), and 950 had intellectual disability (ID).  524/2138 children had an underlying chronic respiratory condition.  Immunization rates by NNDD are presented in the table.

CONDITION

VACCINATION RATE (%)*

OVERALL

NO PULMONARY CONDITION

PULMONARY CONDITION PRESENT

NO NND

42.5

38.1

55.0

ID ALONE

46.1

40.7

67.2

CP and EP

46.1

45.8

46.7

EP ALONE

48.1

50.0

36.4

ID AND EP

51.4

42.3

81.8

CP ALONE

56.0

54.8

63.6

CP AND ID

57.8

46.5

81.0

ALL 3

71.6

64.1

81.0

* Number of children reported to have been vaccinated or for whom a vaccination appointment was scheduled

In the logistic model vaccination status was independently associated with prior receipt (OR 7.5, 95% CI 6.2-9.4), presence of a chronic respiratory condition (OR 1.5, 95% CI 1.1-2.0), and Spanish speaking (OR 1.4, 95% CI 1.1-2.9).  Presence of CP, EP or ID was not associated with vaccination.  Children with a respiratory condition and ID were more likely (OR 1.9, 95% CI 1.1-3.0) to be vaccinated, but no other interaction terms were significant.

Conclusion: Although NNDDs are independent risk factors for poor outcomes from influenza infection, vaccination in children with NNDDs appears to be largely driven by concomitant respiratory conditions, especially among children with ID.  Further research into barriers to influenza vaccination of this population is warranted.

Michael Smith, MD, MSCE, University of Louisville, Louisville, KY, Georgina Peacock, MD, MPH, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, Janice Watkins, M.S., M.A., Oewh, Orau, Oak Ridge, TN, Adina De Coteau, MPH, Oak Ridge Institute for Science and Education, Atlanta, GA, Richard Tardif, Ph.D., Health Communication and Technical Training, Oak Ridge Institute for Science and Education, Oak Ridge, TN and Cynthia Moore, MD, PhD, Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

M. Smith, Novartis: Investigator, Research support
Sanofi Pasteur: Investigator, Research support

G. Peacock, None

J. Watkins, None

A. De Coteau, None

R. Tardif, None

C. Moore, None

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