Immune-Mediated Inflammatory Diseases (IMIDs) are a group of disorders characterized by altered immune regulation causing chronic inflammation in target organs or organ systems. Patients with IMIDs are at an increased risk of infectious diseases. Examples of IMIDs include Rheumatoid arthritis (RA), the spondyloarthritis (SpA) disease spectrum, connective tissue disorders, cutaneous inflammatory conditions (including psoriasis and atopic dermatitis), inflammatory bowel disease (IBD), asthma and autoimmune neurological diseases such as multiple sclerosis. Children with immune-mediated inflammatory disorders (IMIDs) are at increased risk of infections and would therefore derive great benefit from preventive measures such as vaccination.
This project aimed to increase awareness of the need for the inclusion of essential additional vaccines in the care package for paediatric patients with IMIDs attending care in two tertiary hospitals in Nairobi. Further, we aimed to perform a structured assessment and intervention for immunization status to ensure that those who need the vaccines were offered the opportunity to receive them. We also planned to develop 3 tools for use by health workers and caregivers of children with IMIDs:
i) Immunization status Checklist
ii) Vaccination Educational tool for Caregivers of children with IMIDs
iii) Vaccination Educational tool for Health workers managing children with IMIDs
We conducted a study among caregivers of children with IMIDs to determine their knowledge, attitude towards and uptake of vaccinations as a means to ensure better health for their children. The study recruited primary caregivers of patients with IMIDs attending the dermatology, nephrology, and rheumatology clinics at the Kenyatta National Hospital and Gertrude’s Children’s Hospital. Ethical approval for the study was obtained from the Kenyatta National Hospital – University of Nairobi Ethics Review Committee.
A total of 103 primary caregivers to patients with IMIDs were recruited into the study, 90- from the KNH and 13 from Gertrude’s children’s hospital. Only 25 index participants had received additional vaccines outside the routine EPI immunization schedule. 82/103 primary caregivers affirmed their willingness to have their child receive the incentive vaccine. Among the 82 who were willing to have the children vaccinated, 66 received the vaccine while the rest failed to get the vaccine for varying reasons including the state of the patient (12 who were sick or admitted in hospital had the vaccination deferred). Two participants did not receive the vaccine because the primary caregiver was not available to give consent or authorize administration of the vaccine. Two others missed due to unfavorable clinic operation times.
Three tools for use by health workers and caregivers of children with IMIDs were developed.
Vaccine hesitancy is a major threat to attainment of optimal care outcomes even among patients with IMIDs. Therefore, greater emphasis should be put on health education for caregivers and patients to inform them of the benefits of immunization to ensure these children get maximum benefit from currently available and future vaccines.