1. Digital health policies for Children’s Health: Focus on Immunization
How does this story work in your country?
GREECE
Vana Papaevangelou, MD
Professor of Pediatric Infectious Diseases
National and Kapodistrian University of Athens

2. Disclosure of conflict of interest
Have received grants/honoraria from GSK, Novartis, Sanofi
and Pfizer for services provided as an investigator, lecturer
or consultant
Member of the National Advisory Group for Immunization
There are no COI for this presentation

3. Presentation outline
• National Immunization Program
• Who vaccinates ?
• Who keeps vaccination records ?
• What is the vaccination coverage ?
• Immunization registry in Greece – where do we stand?

4. National Immunization Program

5. National Advisory Group for Immunization
• Comprises of 21 (!!) members including pediatricians, ID
specialists, public health and health economic advisors, HCDCP...
• Often consults National Ethics Committee
• Meets once a month – minutes not publicized
• COI of members are public
• NIP updated every 2 years and whenever needed
• No tender system exists: many vaccines available for same disease

6. Who vaccinates?
• Majority of children are vaccinated by private pediatricians (65-70%)
• All vaccines are for free – all you need is a SS#
• MD provides e-prescription with SS# and parents gets the vaccine
• Anthropocentric clinical practice no tender, many choices
pluralism

7. Who keeps vaccination records ?
• Parents keep home-based records …….

12. Who keeps vaccination records ?
• Few HCW keep track in their offices – no official guidelines
• School requirements :
• Pediatrician fills in health record at : pre-school, 1st 4th 7th 10th grade
• Specific question on whether child is vaccinated according to NIP
• Space to fill in details if child not fully vaccinated
• Record kept in school
• No exemption from school activities if unvaccinated

13. What is the vaccination coverage ?
National vaccination coverage study (ESDY 2012): data retrieved from
vaccination booklet from 1st grade students (1046)
• Vaccination coverage overall satisfactory
• However vaccination coverage for MMR II only 83%
• Delayed HepB vaccination: only 36% had completed vaccination at 12mos
National cross-sectional study in preschool children (2015)
• Included >2500 children 2-3 year old
• >95% vaccine coverage
• Low vaccination coverage for rotavirus (<20%) and influenza (23%)
• Delayed vaccination for HepB and 4th dose of PCV
Panagiotopoulos T et al . www.esdy.gr
Georgakopoulou T et al HVI 2017

14. Delayed administration of doses
Hepatitis B vaccination PCV immunization
Georgakopoulou T et al HVI 2017

15. Immunization registry in Greece
• Not yet available
• Not difficult to implement since e-prescription data available
as well as data from pharmacies indicating whether vaccine
was purchased
• Challenges:
• No available legislation
• To connect data from municipalities and e-prescription database
• GDPR discussions

16. Conclusions
successes - challenges - the way to go forward
• Anthropocentric way of practice – rich NIP: opportunity for high VC
• Pluralism and delayed vaccination , especially of anamnestic doses
• Vaccination registry necessary to go forward
• E-health data available
• E- patient file under way – will provide solution ????
• Only if data connected electronically – no time for MDs to fill in database