Parent and healthcare provider views of live varicella vaccination of pediatric solid organ transplant recipients

Brian Condran; Melissa Kervin; Catherine Burton; Tom D Blydt-Hansen; Shaun K Morris; Manish Sadarangani; Anthony Otley; Elaine Yong; Hana Mitchell; Julie A Bettinger; Karina A Top; Special Immunization Clinic Network Investigators

doi:10.1111/petr.14609

Parent and healthcare provider views of live varicella vaccination of pediatric solid organ transplant recipients

Pediatr Transplant. 2023 Dec;27(8):e14609. doi: 10.1111/petr.14609. Epub 2023 Sep 25.

Authors

Collaborators

Special Immunization Clinic Network Investigators:
Susan Gilmour, Vicky Ng, Chia Wei Teoh, Pierre-Philippe Piché-Renaud, Anne Pham-Huy, Bruce Tapiéro, Soren Gantt, James Tee, Alberto Severini

Affiliations

¹ Canadian Center for Vaccinology, IWK Health, Halifax, Nova Scotia, Canada.
² Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
³ Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Clinical Public Health and Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁵ Division of Infectious Diseases and Child Health Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
⁶ Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
⁷ Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.

PMID: 37746885
DOI: 10.1111/petr.14609

Abstract

Background: Live attenuated varicella vaccine (LAVV) has historically been contraindicated in children who are immunocompromised due to solid organ transplant (SOT) because of safety concerns. Recently, clinical guidelines were developed that support post-transplant varicella vaccination in selected SOT recipients based on emerging evidence of LAVV safety. This qualitative study sought to explore barriers and facilitators to implementing the new guidelines, as well as acceptability of LAVV among healthcare providers (HCPs) and parents.

Methods: HCPs and parents of transplant recipients were recruited from four sites using purposive sampling. Data from semi-structured interviews were analyzed using an Interpretive Description approach that incorporated data from the interviews, academic knowledge and clinical experience, and drew from Grounded Theory and Thematic Analysis. The theoretical framework used was Adaptive Leadership.

Results: Thirty-four participants (16 HCPs and 18 parents) were included in the analysis. Parents developed skills in adaptive leadership that included strategies to protect their child against infectious diseases. Foundational information that live vaccines were absolutely contraindicated post-transplant "stuck" with parents and led them to develop strategies other than vaccination to keep their child safe. Some parents struggled to understand that information previously presented as a certainty (contraindication of LAVV) could change. Their approach to adaptive leadership informed their appraisal of the new vaccination guidelines and willingness to accept vaccination.

Conclusions: HCPs should adopt a family-centered approach to communicating changing guidelines that considers parents' approach to adaptive leadership and discusses the changing nature of medical evidence. Trust between HCPs and parents can facilitate these conversations.

Keywords: adaptive leadership; health communication; immunization; immunocompromised; vaccine safety.

MeSH terms

Chickenpox* / prevention & control
Child
Health Personnel
Humans
Organ Transplantation*
Parents
Transplant Recipients
Vaccination
Vaccines, Attenuated

Substances

Vaccines, Attenuated

Abstract

MeSH terms

Substances

Grants and funding