# Evaluating Vaccination Status and Barriers in Children with Rheumatic Diseases

## TL;DR

This study compares vaccination rates in children with rheumatic diseases and healthy children, finding lower influenza vaccination rates and safety concerns as barriers.

## Contribution

The study provides new insights into vaccination barriers specific to children with rheumatic diseases and highlights gaps in influenza vaccination.

## Key findings

- Influenza vaccination rates were significantly lower in children with rheumatic diseases (34%) compared to healthy controls (21%).
- Vaccinations were withheld in 31% of rheumatic disease children due to disease activity, provider advice, or safety concerns.
- Over 85% of participants expressed satisfaction with the vaccination information provided by their family doctor.

## Abstract

Background: This study aims to evaluate the vaccination status of children with rheumatic diseases (RD) compared to healthy controls (HC) and immunization barriers, as studies examining the vaccination status and factors promoting or hindering vaccination among children RD remain limited. Methods: A cross-sectional study was conducted on children with RD (in a rheumatology clinic) and HC (in a fracture clinic) at a tertiary care center in Canada. Demographics, diagnosis, treatments, and vaccine status were obtained from health records and a provincial electronic vaccine database. A patient/caregiver questionnaire was used to capture perceived immunization barriers, concerns, and satisfaction. Descriptive statistical methods were used for analysis. Results: The study involved 144 children with RD and 111 HC. Data from 94 children with RD and 86 HC, all lifelong Alberta residents, were analyzed for objective vaccination status. Most vaccines were received at rates of 80% or higher, except the influenza vaccine, which had the lowest adherence (34% in RD vs. 21% in HC). In 31% of RD children, vaccinations were withheld due to active disease, healthcare provider advice, or caregiver concerns about side effects. In 27% HC, vaccinations were withheld due to side effects. Both groups primarily relied on their family doctor for vaccination information, and 85% or more expressed satisfaction with the information received. Conclusions: Most children with RD and HC received recommended vaccines, but influenza vaccination gaps were identified. Knowledge about vaccine contraindications in RD is well understood, but perceived safety concerns limit vaccination completeness. Healthcare providers, especially family doctors, pediatricians, and rheumatologists, should be providing education resources for vaccines and be proactive in discussing the safety and necessity of vaccinations.