Ioanna D. Pavlopoulou

Immunization coverage and predictive factors for complete and age-appropriate vaccination among preschoolers in Athens, Greece: a cross- sectional study

BackgroundIn Greece, several new childhood vaccines were introduced recently but were reimbursed gradually and at different time points. The aim of this study was to assess immunization coverage and identify factors influencing complete and age-appropriate vaccination among children attending public nurseries in the municipal district of Athens.MethodsA cross-sectional study, using stratified sampling was performed. Immunization history was obtained from vaccination booklets. Demographic and socioeconomic data were obtained from school registries and telephone interviews. Vaccination rates were estimated by sample weighted proportions while associations between complete and age-appropriate immunization and potential determinants by logistic regression analysis.ResultsA total of 731 children (mean age: 46, median: 48, range: 10–65 months) were included. Overall immunization coverage with traditional vaccines (DTP, polio, Hib, HBV, 1st dose MMR) was satisfactory, exceeding 90%, but the administration of booster doses was delayed (range: 33.7- 97.4%, at 60 months of age). Complete vaccination rates were lower for new vaccines (Men C, PCV7, varicella, hepatitis A), ranging between 61-92%. In addition, a significant delay in timely administration of Men C, PCV7, as well as HBV was noted (22.9%, 16.0% and 27.7% at 12 months of age, respectively). Child’s age was strongly associated with incomplete vaccination with all vaccines (p< 0.001), while as immigrant status was a predictor of incomplete (p=0.034) and delayed vaccination (p<0.001) with traditional vaccines. Increasing household size and higher maternal education were negatively associated with the receipt of all and newly licensed vaccines, respectively (p=0.035).ConclusionsOur findings highlight the need to monitor uptake of new vaccines and improve age- appropriate administration of booster doses as well as early vaccination against hepatitis B. Immigrant status, increased household size and high maternal education may warrant targeted intervention.

Carbapenemase-producing Klebsiella pneumoniae bloodstream infections in neutropenic patients with haematological malignancies or aplastic anaemia: Analysis of 50 cases.

Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) are currently among the most important nosocomial pathogens in many geographic regions. A retrospective study was conducted between 2010 and 2014 in four hospitals located in a high-prevalence area (Athens, Greece) to describe the clinical features, treatment and outcomes of neutropenic patients with haematological diseases complicated with CP-Kp bloodstream infections. A total of 50 patients were identified, including 48 with haematological malignancies and 2 with aplastic anaemia. All patients had neutropenia (<500 cells/mm(3)), of whom 40 had <100 neutrophils/mm(3). The probable source of bacteraemia was identified in 9 patients; in the remaining 41 patients the bacteraemia was considered primary. For definitive treatment, 30 patients received combination therapy (two or more active drugs), 10 received monotherapy (one active drug) and 4 received therapy with no active drug; the remaining 6 patients died within 48 h after the onset of bacteraemia. The 14-day all-cause mortality rate was 50%, 38% and 33% for those who received one, two or three active drugs respectively. In the Cox proportional hazards model, unresolved neutropenia [hazard ratio (HR)=19.28, 95% confidence interval (CI) 2.31-160.69; P=0.006], septic shock (HR=3.04, 95% CI 1.06-8.78; P=0.04) and treatment with one active drug (HR for monotherapy versus combination therapy=3.95, 95% CI 1.23-12.65; P=0.02) were independent predictors of death, whilst combination therapy was associated with lower mortality. These findings may assist physicians in making treatment decisions for neutropenic patients with CP-Kp infections.

Lead Exposure and Associated Risk Factors among New Migrant Children Arriving in Greece

Background: This study aims to assess lead exposure and associated risk factors among newly arrived migrant (M) (immigrant and refugees) children in Greece and a matched control of native (N) children. Methods: A prospective, cross-sectional study was performed in an outpatient clinic of a tertiary children’s hospital. Results: From 2010 to 2014, 598 children (M/N: 349/249) with a mean age of 6.96 years old (range 1–14, SD 3.76) were enrolled. Blood lead levels (BLLs) ranged from 0.7 to 21 μg/dL in migrant and from 0.4 to 10 μg/dL in native Greek children. Elevated BLLs ≥ 5 μg/dL were detected in 27.7% of migrants and 1.2% of natives (p < 0.001). A significant association was found between EBLLs and childrens’ age (≤5 years) (OR: 1.8, p-value 0.02) and EBLLs with Asian origin (OR: 3.63, p-value 0.023). Conclusion: New migrant children presented with increased BLLs when compared to their age- and sex-matched controls. Younger age and Asian origin were significant risk factors associated with elevated BLLs among children. Early screening, secondary prevention, and regular follow-up could prove useful in this vulnerable population.

Out-of-Hospital Administration of Medication without Prescription and Associated Factors among Preschool Children

The increasing trend of administering nonprescribed medicines in children is a significant public health issue. The aim of the present study was to assess the use of medication without a prescription (MWP), including both nonprescribed medication (NPM) and prescription-only medication (POM), and identify associated factors, among preschoolers in Athens, Greece. A predesigned questionnaire was distributed to parents from May through June 2011. Multivariable binary logistic regression analysis models were used to assess associations of interest. Results showed that 95.1% of parents reported administering at least one MWP, during the previous 12 months. Antipyretics (91%) were the most commonly NPM and bronchodilators (24.8%) and antibiotics (16.4%) the most common POM dispensed. Childs increased age group, lack of parental information, higher paternal education, and mothers foreign nationality were associated with increased antipyretic use (p < 0.05), while fathers foreign nationality and parental age were positive predictors of antibiotic administration (p < 0.05). The likelihood of consuming antipyretics and antibiotics significantly increased when information was provided by a pharmacist (p = 0.017 and p = 0.054, resp.). Conclusively, most parents have administered at least one MWP, including antibiotics, to address symptoms of common childhood diseases, highlighting the need of information campaigns concerning the consequences of their improper use.

Sleep Architecture and Epileptic Characteristics of Drug Naïve Patients in Childhood Absence Epilepsy Spectrum. A Prospective Study

PURPOSE Childhood absence epilepsy (CAE) is an epileptic syndrome presenting between 2nd-10th years. The spells are elicited with hyperventilation (HV) while sleep seems to exacerbate the electrical activity. Our aim is to describe sleep architecture and its relationship with epileptic discharges (EDs) in patients with CAE, before treatment and one year later. METHODS Twenty-eight, drug-naive children were recruited (21 girls), mean age 90.1 ± 32.6 months. Routine-EEG and overnight EEG-polygraphy were conducted upon diagnosis and one year later. Patients were separated in two groups of similar mean age, according to their clinical response at the second recording: group A: children with absolute control of absences and group B: children with partial control. Sleep parameters, EDs and arousals were measured. The effect of medication on sleep parameters was examined, according to 2 groups: valproic-treated and non valproic-treated. RESULTS Group A showed significant improvement in total sleep time, REM-sleep latency, REM-sleep, arousals-number/hour and arousals-duration/hour between the two recordings. Comparing the two groups for each recording separately, group A initially demonstrated greater epileptic activity and worse sleep parameters, whereas in the second recording exhibited total elimination of the EDs and significantly less arousals. Group B demonstrated persisting EDs and slight deterioration in some sleep parameters during the second recording, despite the lower epileptic load initially. No significant difference was identified between valproic and non-valproic treated patients, regarding the effect on sleep parameters. CONCLUSION Absolute control of absences and normalization of the electroencephalogram are accompanied by more continuous, stable and efficacious sleep in children with CAE.

Promotion of Preventive Measures in Public Nursery Schools: Lessons From the H1N1 Pandemic:

Nursery schools serve as reservoirs of transmission of infectious diseases, and teachers should be able to implement and monitor hygiene measures to prevent them. The aim of the present study was to assess the compliance of nursery school teachers on promoting preventive interventions and to identify associated factors, during the novel H1N1 influenza pandemic. A secondary objective was to evaluate their knowledge and vaccination status regarding the novel virus. A cross-sectional study was performed, with the use of a predesigned anonymous, questionnaire, and distributed to all public nursery teachers of Athens, Greece. General etiquette practices were highly acceptable to over 92% of teachers. Those with longer teaching experience promoted simple preventive measures, such as hand washing and use of hand sanitizer, more often while older children were more likely to familiarize with them. However, teachers presented inadequate knowledge concerning the novel virus and their vaccination rates with the pandemic vaccine were unacceptably low (1.1%). Our study showed that promotion of simple preventive measures is feasible and may contribute to the prevention of outbreaks in nursery schools, although knowledge gaps and fear concerning the pandemic vaccine highlight communication issues.

The increasing consumption of unprescribed antibiotics by Greek preschool children amounts to unacceptable malpractice.

In Greece, the illegal dispensing of prescription-only medicines, including antibiotics, by pharmacies without the necessary medical prescription, remains standard practice (1,2). This has continued, despite the fact that the country has the highest rates of antibiotic consumption, both in hospitals and the community, as well as antibiotic resistance, compared to other European countries (3). The frequency of antibiotic administration without a prescription, and the factors associated with this practice, was evaluated in a sample of preschool children under the age of six years (range 10–65 months) in the Municipality of Athens, Greece. Data on this practice were collected by using a questionnaire that was distributed over a two-month period from May to June 2011 to all the parents and guardians of children attending public kindergartens in the Municipal Nursery of Athens. This comprised 98 kindergartens with 5401 registered pupils from middleand low-income families. Parents were advised of the aims of the study before the questionnaire was administered, and returning a completed questionnaire was regarded as informed consent. The study protocol was approved by the Review Board of the Municipal Nursery of Athens. Associations of interest were explored using multivariable logistic regression analysis. A total of 1985 questionnaires were returned, which equated to a response rate of 43.1%. The mean age of the parents was 36.6 years ( 5.2), 88.0% were married, 74.3% were both Greek nationals, and the majority of the respondents were mothers (79.0%). Most respondents were secondary school graduates – 46.3% of the fathers and 44.7% of the mothers – and 29.0% of the parents had a higher education degree. We found that 16.4% of the parents reported administering at least one antibiotic without a medical prescription to their child in the previous 12 months to treat upper respiratory infections (45.5%), common cold symptoms (18.6%) and fever or cough (14.5%). Amoxicillin was the preferred antimicrobial (41.4%) for common colds, while second-generation cephalosporins (30.1%) and amoxicillin/clavulanate acid (29.2%) were mainly used to treat upper respiratory tract infections. Following multivariable analysis, the positive predictors for unprescribed antibiotic administration were the fathers foreign nationality, with an odds ratio (OR) of 2.22 and 95% confidence interval (95% CI) of 1.62–3.04 or their refusal to provide an answer regarding their citizenship (OR 2.62, 95% CI: 1.27–5.41). Parents were less likely to administer antibiotics if they did not agree with buying medicines using a previous prescription for the child’s similar health problems (OR 0.61, 95% CI: 0.45–0.83) and those who disagreed that familiarity of a brand name should drive its purchase without a prescription, (OR 0.60, 95% CI: 0.45–0.81). Those who disagreed that medicines should only be administered following a paediatric consultation were 2.8 times more likely to use unprescribed antibiotics (OR 2.81, 95% CI: 1.98–3.98). Moreover, the probability of antibiotic administration was significantly higher when advice was sought from a pharmacist (OR 1.31, 95%CI: 0.99–1.72). In conclusion, our study identified a number of factors associated with the unacceptable malpractice of pharmaciesdispensingunprescribed antibiotics to preschool children in Athens, Greece. Ongoing evidence shows that this problem has increased during the economic crisis (2) and these findings highlight the need to implement targeted and stricter policies for prescription-only medicines in Greece.