Facilitators and barriers to revaccination after hematopoietic stem cell transplantation among pediatric patients in Ecuador
Notice bibliographique
Résumé
Abstract Background Revaccination after hematopoietic stem cell transplantation (HSCT) is a challenge in areas where there is variability of access to vaccines and where special schedules are unfamiliar to physicians and primary care providers. We report the experience of re-immunization practices in pediatric patients after HSCT in Ecuador. Methods The database and medical charts of pediatric patients who had been in follow after HSCT from 2021 to 2023 in Solca Guayaquil was reviewed in order to assess the completeness of the revaccination schedule and to identify facilitators and barriers in implementation of the process. Patients with pediatric infectious diseases follow up where included. Results There were 30 patients who underwent HSCT during the reviewed period. Among them, 7 were excluded because they had not been seen by pediatric infectious diseases. Four patients who had their HSCT before the studied period were later added as they received follow-up by the specialty, therefore a total of 27 patients were included. There were 16 (59.3%) boys, mean age was 11 years (SD 3.6), and 16 (59.3%) lived outside Guayaquil. The most common diseases prompting HSCT were 14 (51.9%) lymphoblastic leukemia, 4 (14.8%) myeloid leukemia, 3 (11.1%) for Hodgkin lymphoma and 3 (11.1%) aplastic anemia. HSCT was performed outside Ecuador in 15 (55.6%) cases. Reimmunization schedule had been initiated in 21 (77.7%) of patients. Public health system was used exclusively in 11 (52.4%) cases, a combination of private and public system in 8 (38.1%) cases and exclusively private system in 2 (9.5%) cases. Among them, 9 (42.9%) had completed all recommended inactivated vaccines. Mean number of visits required for this was 5.1 (SD 1.9). After completion of inactivated vaccines, live vaccines where recommended and had been completed by 2 (9.5%) patients. The main facilitator identified was vaccine confidence and adherence to physician recommendations while the main barriers identified where health system related: a) Lack of awareness in public vaccination centers about special schedules, b) lack of availability of age licensed vaccines in public system and c) Lack of documentation of immunization administrated. Conclusion Health system related logistics (vaccine availability, knowledge of special schedules, coordination with immunization centers) continues to be a main barrier to complete recommended reimmunization schedule after HSCT while confidence in vaccines and adherence is the main facilitator in Ecuador. Government interventions need to be implemented in order to facilitate the process for this population of patients. Figure 1. Revaccination after hematopoietic stem cell transplantation in Solca Guayaquil (2021 – 2023).
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».