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Voi V, Gutierrez-Valle V, Cuzzubbo D, McMahon C, Casale M, Mañú Pereira MDM, D'Agnolo M, Inusa BPD, de Montalembert M, Colombatti R. Limited access to transcranial Doppler screening and stroke prevention for children with sickle cell disease in Europe: Results of a multinational EuroBloodNet survey. Pediatr Blood Cancer 2024; 71:e31190. [PMID: 38984411 DOI: 10.1002/pbc.31190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 06/17/2024] [Accepted: 06/25/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Ensuring equitable access to adequate standard of care for patients with rare hematological disease is one of the aims of the European Reference Network (ERN) EuroBloodNet. Stroke is one of the most devastating complications for children with sickle cell disease (SCD). For effective prevention of stroke risk, annual transcranial Doppler (TCD) according to a defined protocol is recommended for patients aged 2-16 years, with red blood cell transfusion therapy for those at risk. There is no information regarding screening for stroke risk and stroke prevention programs in Europe. METHODS Seven SCD experts of five healthcare providers (HCPs) of ERN EuroBloodNet developed an online survey to assess the access to TCD screening and stroke prevention programs for children with SCD in Europe. RESULTS Eighty-one experts in 77 HCPs from 16 European countries responded to 16 online questions. Thirty-two of 77 (51%) HCPs were EuroBloodNet reference centers, and 36% physicians reported not having a dedicated TCD/TCD imaging service for children with SCD. Only 30% of physicians provided estimates that all their patients received annual TCD according to the standard protocol due to lack of trained staff (43%), lack of TCD instruments (11%), refusal of patients due to logistical difficulties (22%), and lack of funds for dedicated staff or equipment (11%). CONCLUSIONS This multinational European survey provides the first comprehensive picture of access to TCD screening and stroke prevention in European countries. Identifying the potential underlying causes of the lack of effective standardized screening, this survey also addresses possible dedicated actions to cover these needs.
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Affiliation(s)
- Vincenzo Voi
- Centro per le Emoglobinopatie, Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Ospedale San Luigi Gonzaga, Turin, Italy
| | | | - Daniela Cuzzubbo
- Clinica di Onco-Ematologia Pediatrica, Azienda Ospedaliero Universitaria Meyer, Florence, Italy
| | | | - Maddalena Casale
- Università degli studi della Campania Luigi Vanvitelli, Naples, Italy
| | | | - Mirco D'Agnolo
- Pediatric Hematology Oncology, Department of Women's and Children's Health, Azienda Ospedale-University of Padova, Padua, Italy
| | - Baba P D Inusa
- Paediatric Haematology, Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | | | - Raffaella Colombatti
- Pediatric Hematology Oncology, Department of Women's and Children's Health, Azienda Ospedale-University of Padova, Padua, Italy
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Shi JS, Sutaria A, Lakshmanan S, Attell B, Zhou M, Tang A, Eckman J, Snyder A. Immunization adherence among children with sickle cell disease and sickle cell trait: Results of a population-based study. Pediatr Blood Cancer 2024; 71:e31042. [PMID: 38702922 DOI: 10.1002/pbc.31042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Despite the importance of timely vaccine completion for protection from infectious disease, there is limited knowledge of the immunization adherence rates of children with sickle cell disease (SCD). METHODS This is a retrospective cohort study comparing the immunization rates of children with SCD to those with sickle cell trait between 2008 and 2019 in Georgia. Completion rates for each vaccine and the proportion of children with up-to-date status at 24 and 35 months were calculated and compared between the cohorts. Chi-square tests with odds ratios (OR) for differences and 95% confidence intervals (CIs) were reported on the overall up-to-date rates and rates for individual vaccines at 24 and 35 months for the two cohorts. RESULTS Children with SCD had higher up-to-date rates than children with sickle cell trait at 24 and 35 months. At 35 months, the overall up-to-date rates (OR = 1.17; 95% CI, 1.04-1.31; p = .004) and the four-dose pneumococcal conjugate vaccine series (OR = 1.36; 95% CI, 1.18-1.57; p < .001) were significantly different between the groups. Both cohorts had the highest completion rates for the hepatitis B series and the lowest rates for the varicella vaccine. Doses of diphtheria, tetanus, and acellular pertussis vaccine; varicella; and pneumococcal conjugate vaccines were most commonly missed by children in both cohorts. CONCLUSIONS Children with SCD have better immunization coverage than children with sickle cell trait, but there is an opportunity for improvement. Policymakers and healthcare professionals should focus on increasing access to care coordination services among children with SCD to ensure on-time and preventive healthcare services.
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Affiliation(s)
- Jiajing Scarlette Shi
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
| | - Ankit Sutaria
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Sangeetha Lakshmanan
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
| | - Brandon Attell
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
| | - Mei Zhou
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
| | - Amy Tang
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - James Eckman
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Angela Snyder
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
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Hulbert ML, Manwani D, Meier ER, Alvarez OA, Brown RC, Callaghan MU, Campbell AD, Coates TD, Frei-Jones MJ, Hankins JS, Heeney MM, Hsu LL, Lebensburger JD, Quinn CT, Shah N, Smith-Whitley K, Thornburg C, Kanter J. Consensus definition of essential, optimal, and suggested components of a pediatric sickle cell disease center. Pediatr Blood Cancer 2023; 70:e29961. [PMID: 36094289 DOI: 10.1002/pbc.29961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 12/25/2022]
Abstract
Sickle cell disease (SCD) requires coordinated, specialized medical care for optimal outcomes. There are no United States (US) guidelines that define a pediatric comprehensive SCD program. We report a modified Delphi consensus-seeking process to determine essential, optimal, and suggested elements of a comprehensive pediatric SCD center. Nineteen pediatric SCD specialists participated from the US. Consensus was predefined as 2/3 agreement on each element's categorization. Twenty-six elements were considered essential (required for guideline-based SCD care), 10 were optimal (recommended but not required), and five were suggested. This work lays the foundation for a formal recognition process of pediatric comprehensive SCD centers.
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Affiliation(s)
- Monica L Hulbert
- Division of Pediatric Hematology/Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Deepa Manwani
- Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, New York, New York, USA
| | - Emily Riehm Meier
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | - Ofelia A Alvarez
- Division of Pediatric Hematology/Oncology, University of Miami School of Medicine, Miami, Florida, USA
| | - R Clark Brown
- Division of Pediatric Hematology/Oncology, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael U Callaghan
- Division of Pediatric Hematology/Oncology, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Andrew D Campbell
- Division of Pediatric Hematology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Thomas D Coates
- Cancer and Blood Disease Institute, Department of Pediatrics, Children's Hospital Los Angeles/University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Melissa J Frei-Jones
- Division of Pediatric Hematology/Oncology, University of Texas School of Medicine-San Antonio, San Antonio, Texas, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Matthew M Heeney
- Dana Farber/Boston Children's Cancer and Blood Disorders Center, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Lewis L Hsu
- Division of Pediatric Hematology/Oncology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jeffrey D Lebensburger
- Division of Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles T Quinn
- Division of Pediatric Hematology/Oncology, Cincinnati Children's Hospital Medical Center and, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nirmish Shah
- Divisions of Pediatric Hematology Oncology and Hematology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kim Smith-Whitley
- Department of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Global Blood Therapeutics, San Francisco, California, USA
| | - Courtney Thornburg
- Division of Pediatric Hematology/Oncology, Rady Children's Hospital/Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Julie Kanter
- Division of Hematology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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