Facilitators and barriers to revaccination after hematopoietic stem cell transplantation among pediatric patients in Ecuador
Bibliographic record
Abstract
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).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".