Vaccinations against influenza and pneumococcus in children with diabetes: telephone questionnaire survey
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《英国医生杂志》
1 Department of Paediatrics, Bedford Hospital NHS Trust, Bedford MK42 9DJ
Correspondence to: P Davies daviespatrick@hotmail.com
Introduction
Mass vaccination should only be advised if the benefits outweigh the risks. (About a third of children would be classified as at risk and be affected.) Healthcare advisers need to be careful when advising a population measure, as any further erosion of confidence in public health advice may lead to an irretrievably poor relationship with the public. Some non-peer reviewed reports of adverse reactions to the influenza vaccination in adults are appearing on the internet.2 3 Therefore, any such advice needs to be based on good evidence.
Although vaccinating children who have serious chronic conditions where any deterioration in lung function could be life threatening—for example, cystic fibrosis—makes sense, routine immunisation for people in the categories defined by the Department of Health has implications for resources and ethics. Paediatricians need to reach consensus.
We reviewed medical journals and found no studies of children with diabetes showing increased morbidity or mortality associated with infection by influenza or pneumoccocus. We got some references suggesting a theoretical benefit of vaccination for adults with diabetes but no reports of vaccine effectiveness from the Department of Health.4 5
Our subjects were not against vaccinations as such, as the data for routine childhood immunisations show. The median age was 13, however, so they predate the controversy surrounding the measles, mumps, and rubella vaccine.
In 9/17 hospitals the advice given by the consultant differed to that given by the nurse. This inconsistency reflects either lack of awareness or poor confidence among specialists in guidelines conceived without an evidence base. Also, communication within specialist teams is obviously lacking. Such inconsistency both within and between hospitals can only lead to confused patients and loss of trust in the medical profession.
UK healthcare providers need to reach an evidence based consensus regarding vaccination against influenza and pneumococcus in children at risk. Despite national guidelines, responsibility for patients remains with individual practitioners. Each team needs a clear policy to avoid confusing diabetic patients.
We thank Julia Brown for her help with identifying patients.
Contributors: PD had the concept, did the patient arm of the study, and drafted the paper. CN did the professional arm of the study. ML oversaw the study and is guarantor.
Funding: None.
Competing interests: None declared.
Ethical approval: Not needed.
References
Department of Health. Immunisation against infectious disease. London: Stationery Office, 1992.
Flu vaccine reaction media stories. www.whale.to/vaccine/flu6.html (accessed 30 Oct 2003).
Free case evaluation: influenza (flu) vaccine. New York: Parker and Waichman. www.yourlawyer.com/practice/overview.htm?topic=Influenza%20(Flu)%20Vaccine (accessed 30 Oct 2003).
Moss SE, Klein R, Klein BEK. Cause specific mortality in population-based study of diabetes. Am J Public Health 1991;81: 1158-62.
Bouter KP, Diepersloot RJ, van Romunde LK, Uitslager R, Masurel N, Hoekstra JB, et al. Effect of epidemic influenza on ketoacidosis, pneumonia and death in diabetes mellitus: a hospital register survey of 1976-79 in the Netherlands. Diabetes Res Clin Pract 1991;12; 61-8.(Patrick Davies, paediatri)
Correspondence to: P Davies daviespatrick@hotmail.com
Introduction
Mass vaccination should only be advised if the benefits outweigh the risks. (About a third of children would be classified as at risk and be affected.) Healthcare advisers need to be careful when advising a population measure, as any further erosion of confidence in public health advice may lead to an irretrievably poor relationship with the public. Some non-peer reviewed reports of adverse reactions to the influenza vaccination in adults are appearing on the internet.2 3 Therefore, any such advice needs to be based on good evidence.
Although vaccinating children who have serious chronic conditions where any deterioration in lung function could be life threatening—for example, cystic fibrosis—makes sense, routine immunisation for people in the categories defined by the Department of Health has implications for resources and ethics. Paediatricians need to reach consensus.
We reviewed medical journals and found no studies of children with diabetes showing increased morbidity or mortality associated with infection by influenza or pneumoccocus. We got some references suggesting a theoretical benefit of vaccination for adults with diabetes but no reports of vaccine effectiveness from the Department of Health.4 5
Our subjects were not against vaccinations as such, as the data for routine childhood immunisations show. The median age was 13, however, so they predate the controversy surrounding the measles, mumps, and rubella vaccine.
In 9/17 hospitals the advice given by the consultant differed to that given by the nurse. This inconsistency reflects either lack of awareness or poor confidence among specialists in guidelines conceived without an evidence base. Also, communication within specialist teams is obviously lacking. Such inconsistency both within and between hospitals can only lead to confused patients and loss of trust in the medical profession.
UK healthcare providers need to reach an evidence based consensus regarding vaccination against influenza and pneumococcus in children at risk. Despite national guidelines, responsibility for patients remains with individual practitioners. Each team needs a clear policy to avoid confusing diabetic patients.
We thank Julia Brown for her help with identifying patients.
Contributors: PD had the concept, did the patient arm of the study, and drafted the paper. CN did the professional arm of the study. ML oversaw the study and is guarantor.
Funding: None.
Competing interests: None declared.
Ethical approval: Not needed.
References
Department of Health. Immunisation against infectious disease. London: Stationery Office, 1992.
Flu vaccine reaction media stories. www.whale.to/vaccine/flu6.html (accessed 30 Oct 2003).
Free case evaluation: influenza (flu) vaccine. New York: Parker and Waichman. www.yourlawyer.com/practice/overview.htm?topic=Influenza%20(Flu)%20Vaccine (accessed 30 Oct 2003).
Moss SE, Klein R, Klein BEK. Cause specific mortality in population-based study of diabetes. Am J Public Health 1991;81: 1158-62.
Bouter KP, Diepersloot RJ, van Romunde LK, Uitslager R, Masurel N, Hoekstra JB, et al. Effect of epidemic influenza on ketoacidosis, pneumonia and death in diabetes mellitus: a hospital register survey of 1976-79 in the Netherlands. Diabetes Res Clin Pract 1991;12; 61-8.(Patrick Davies, paediatri)