Vaccine preventable diseases in palliative treated children – Report of the PalliVac study group

Abstract

Context: In Germany, 33 pediatric specialized home palliative care (SHPC) teams provide support for children with life-limiting diseases. In 2017, a 12-year old, not vaccinated boy with severe delay of neurological development suffered from varicella infection with severe deterioration of general condition and dyspnea due to a pneumonia. According to our knowledge this was the first reported SHPC patient with a vaccine preventable disease (VPD) so far. Methods: Retrospective analysis of other VPD cases. All physicians of SHPC and hospices are asked to complete to a questionnaire. Results: 34 physicians (32 SHPC and 2 hospices) answered. Overall, 25 patients with a diagnosed VPD (group 1) were reported. The most frequent VPDs were influenza (44%), varicella (16%) followed by one case of diphtheria, hepatitis A/B, measles, meningococci, pertussis, pneumococci, rotavirus, respiratory syncytial virus (RSV), and rubella. Suspicions of VPDs (group 2) were reported in another 22 cases. Influenza (56%), pertussis (14%), rotavirus (14%) followed by one case of meningococci, measles, RSV and varicella with one case each. Severe symptoms like dyspnea and deterioration of general health occurred in both groups. Main complications were admission to intensive care unit (ICU) in 21,3%, ventilation in 14,9%, death in 4,3% and infection of a health care professional in 10,6%. Physicians agreed it could be helpful to prevent VPD. Conclusion: VPDs appear to play a certain role in SHPC in Germany. They can cause distressing symptoms up to ICU treatment and death. Further investigations are warranted.