PATHOPHYSIOLOGY, CLINICAL FEATURES, AND MANAGEMENT OF CHILDREN WITH CHRONIC INFECTIOUS DISEASES

In Italy, compulsory vaccines are generally administered in vaccination centers and complementary vaccinations are actively offered to children with chronic conditions and are included in the Essential Levels of Care (38). Despite long-standing recommendations to provide recommended vaccinations to children with chronic medical conditions, immunisation rates in these vulnerable populations remain poor (39). Several conditions hamper implementation of these vaccinations, including problems in identifying at risk children, ineffective organizational strategies and lack of awareness of disease severity or poor confidence by parents in specific recommendations (40,41). Often, the presence of a chronic condition is erroneously considered a contraindication rather than an indication to vaccination. It is important to ensure that patients comply with the vaccination schedule to the extent possible, and to provide education to parents who may have concerns about pediatric vaccinations. Goals of the thesis In this PhD thesis, the organization and management of pediatric infectious diseases, with a perspective of public health, are investigated. Specific chronic diseases, as chronic viral hepatitis and HIV infection, have been selected as models to investigate the main aspects of prevention, management and treatment. The goal is to investigate the efficiency of organization and propose interventions with specific reference to treatment of infectious diseases, their direct and indirect results and how these conditions affect quality of life of at risk children and their families. The fin