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Although important, parental anxiety, health literacy and need-for-information in pediatric surgery outpatient clinics have not been extensively studied. Lower educational attainments, minorities and lower socioeconomic status have been associated with limited health literacy. Parental anxiety has been related to health literacy, sex, education and information needs. The aim of this study is to investigate health literacy and need-for-information and their association to parental anxiety in consultations of pediatric surgery.We conducted an observational, cross-sectional study in the outpatient pediatric surgery clinic from December 2016 to October 2017. Health literacy, anxiety and need-for-information of parents/guardians of children waiting for pediatric surgical consultation were evaluated. Multivariate regression analysis was used to examine the impact of health literacy and need-for-information on parental/guardian anxiety considering sociodemographic and clinical characteristics of the participants.Almost half (46.1%) of the 664 parents/guardians recruited had limited or problematic health literacy and 79.8% of the sample was classified as being anxious. Parental/guardian anxiety was associated at the multiple regression analysis with parental health literacy level (β = -0.282, p 0.001), need-for-information preoperatively (β = 0.907, p 0.001), educational level (β = -0.716, p = 0.001), sex (β = 1.563, p 0.001), and severity of the condition of the child (β = 0.379, p 0.001).Parents/guardians experience high levels of anxiety, which is associated to health literacy and need-for-information. These factors should be considered in pediatric surgical consultations, aiming to reduce parental anxiety.Retrospective Study.Level II.

Due to their higher risk of developing life-threatening COVID-19 disease, solid organ transplant (SOT) recipients have been prioritized in the vaccination programs of many countries. However, there is increasing evidence of reduced immunogenicity to SARS-CοV-2 vaccination. The present study investigated humoral response, safety, and effectiveness after the two mRNA vaccines in 455 SOT recipients. Overall, the antibody response rate was low, at 39.6%. Higher immunogenicity was detected among individuals vaccinated with the mRNA1273 compared to those with the BNT162b2 vaccine (47% vs. 36%, respectively, p = 0.025) as well as higher median antibody levels of 31 (7, 372) (AU/mL) vs. 11 (7, 215) AU/mL, respectively. Among the covariates assessed, vaccination with the BNT162b2 vaccine, antimetabolite- and steroid-containing immunosuppression, female gender, the type of transplanted organ and older age were factors that negatively influenced immune response. Only mild adverse effects were observed. Our findings confirm poor immunogenicity after vaccination, implicating a reevaluation of vaccination policy in SOT recipients.

Objectives The aim of this study was to assess the rate of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) and the population structure of MRSA isolates recovered between 2000–2015 in a tertiary-care hospital in Athens, Greece. Methods Non-duplicate MRSA blood isolates recovered during the study period were examined. Antimicrobial susceptibility testing was performed by Kirby–Bauer and gradient strip methods. Carriage of PVL and mecA genes was examined by PCR. Genetic relatedness of the isolates was studied by SCCmec, spa and multilocus sequence typing. Results A total of 398 MRSA BSI cases were identified. A decreasing trend in incidence from 1.69/10 000 patient-days in 2000 to 1.39/10 000 patient-days in 2015 (P = 0.038) and in prevalence from 64.7% to 36.4% (P = 0.008), respectively, was observed, whereas the incidence of methicillin-susceptible S. aureus BSI increased. MRSA isolates exhibiting resistance to common antistaphylococcal agents (excluding glycopeptides and the newer antistaphylococcals) decreased from 84.8% in 2000 to 0% in 2011 and were progressively ‘replaced’ by more susceptible phenotypes. A strong association between antimicrobial resistance phenotype and molecular type was observed. The pandemic HA-MRSA clone ST239-III progressively declined in parallel with increasing isolation frequency of two clonal complexes (CCs): HA-MRSA CC5, with the majority of isolates belonging to ST5-II; and CA-MRSA CC80, represented mainly by ST80-IV-t044, PVL+. Conclusion The decline in MRSA BSI rates observed in our institution was associated with changes in population structure of the organism. This decline may be related to biological properties of the prevailing MRSA clones.

Background The Quality of Life in Short Stature Youth (QoLISSY) questionnaire is a condition-specific instrument for measuring the health-related quality of life (HRQoL) in short statured children/adolescents from patients’ and parents’ perspectives. The aim of this study was to investigate the psychometric properties of the Greek version of the QoLISSY questionnaire. Methods The original European QoLISSY scales were translated into Greek following the guidelines for linguistic validation and applied to 184 dyads of children 8–18 years old and their parents, as well as to 14 parents of children 4–7 years old in Greece. The field testing responses to the Greek version of QoLISSY were analyzed. Results The qualitative analysis of the Greek data provided results consistent with the European sample. The subsequent field test showed acceptable internal consistency (Cronbach α between 0.67–0.93) and high test-retest reliability (intraclass correlation coefficients [ICC] ≥0.70). Correlations with the generic KIDSCREEN questionnaire indicated good convergent validity. Confirmatory factor analysis (CFA) also yielded acceptable results. Higher HRQoL for taller children suggests that QoLISSY was able to detect significant height-related differences. Conclusions The Greek version of the QoLISSY questionnaire is psychometrically sound and its use is recommended in further clinical research to ascertain the impact of short stature (SS) and treatments in Greek children/adolescents and families.

The human immunodeficiency virus (HIV) outbreak among people who inject drugs (PWID) in Athens, Greece in 2011-13 was the largest recent epidemic in Europe and North America. We aimed to assess trends in HIV prevalence, drug use and access to prevention among PWID in Athens to estimate HIV incidence and identify risk factors and to explore HIV-1 dispersal using molecular methods during 2014-20.Two community-based HIV/hepatitis C programmes on PWID were implemented in 2012-13 (n = 3320) and 2018-20 (n = 1635) through consecutive respondent-driven sampling (RDS) rounds. PWID were uniquely identified among rounds/programmes. We obtained RDS-weighted HIV prevalence estimates per round for 2018-20 and compared them to 2012-13. We assessed changes in HIV status, behaviours and access to prevention in PWID participating in both periods. We estimated HIV incidence in a cohort of seronegative PWID as the number of HIV seroconversions/100 person-years during 2014-20 and used Cox regression to identify associated risk factors. Molecular sequencing and phylogenetic analysis were performed in HIV seroconverters.HIV prevalence per round ranged between 12.0 and 16.2% in 2012-13 and 10.7 and 11.3% in 2018-20 with overlapping 95% confidence intervals (95% CI). Among PWID participating in both programmes, HIV prevalence (95% CI) increased from 14.2% (11.7-17.1%) in 2012-13 to 22.0% (19.0-25.3%) in 2018-20 (P 0.001). There was a deterioration in socio-economic characteristics such as homelessness [from 16.2% (95% CI = 13.5-19.2%) to 25.6% (22.3-29.0%)], a shift in cocaine use [16.6% (13.9-19.6%) versus 28.1% (24.7-31.7%], reduced access to free syringes [51.8% (48.0-55.7%) versus 44.5% (40.7-48.3%)] and a decrease in daily injecting [36.2% (32.6-39.9%) versus 28.5% (25.2-32.1%)]. HIV incidence (95% CI) in 2014-20 was 1.94 (1.50-2.52) new cases/100 person-years and younger age, lower educational level, larger injection network and daily injecting were risk factors. Almost 9% of HIV seroconversions occurred within a newly expanding phylogenetic cluster.In Athens, Greece, compared with the period 2012-13, in the period 2018-20 there was a deterioration in socio-economic conditions among people who inject drugs, an increase in the use of cocaine, reduced access to needle and syringe programmes and stable low levels of human immunodeficiency virus testing. Ongoing human immunodeficiency virus transmission was documented during 2014-20 in existing as well as new transmission clusters.

Background and AimsThe HIV outbreak among People Who Inject Drugs (PWID) in Athens, Greece in 2011-2013 was the largest recent epidemic in Europe and North America. We aim to assess trends in HIV prevalence, drug use and access to prevention among PWID in Athens, to estimate HIV incidence and identify risk factors and to explore HIV-1 dispersal using molecular methods during 2014-2020.MethodsTwo community-based HIV/hepatitis C programs on PWID were implemented in 2012-2013 (N=3,320) and 2018-2020 (N=1,635) through consecutive Respondent-Driven Sampling (RDS) rounds. PWID were uniquely identified across rounds/programs. We obtained RDS-weighted HIV prevalence estimates per round for 2018-2020 and compared them to 2012-2013. We assessed changes in HIV status, behaviours, and access to prevention in PWID participating in both periods. We estimated HIV incidence in a cohort of seronegative PWID as the number of HIV seroconversions/100 persons-years during 2014-2020 and used Cox regression to identify associated risk factors. Molecular sequencing and phylogenetic analysis were performed in HIV seroconverters.ResultsHIV prevalence per round ranged between 12.0%-16.2% in 2012-2013 and 10.7%-11.3% in 2018-2020 with overlapping 95% Confidence Intervals (95% CI). Among PWID participating in both programs, HIV prevalence[95% CI] increased from 14.2%[11.7%-17.1%] in 2012-2013 to 22.0%[19.0%-25.3%] in 2018-2020 (pConclusionsThe ongoing HIV transmission among PWID in Athens provides empirical evidence that the current levels of prevention and treatment are inadequate to control the epidemic. Re-evaluation of prevention programs is urgently needed.

The mRNA vaccine BNT162b2 has proven highly effective and currently many millions are being vaccinated. There are limited and conflicting data from immunogenicity studies on the effects of age, gender, vaccination side effects (VSE), risk factors for severe COVID-19 (RFS-COV), obesity (BMI) and previous SARS-CoV-2 (Pr-CoV) Moreover, immunogenicity data from COVID-19 patients comparing various disease categories of natural infection i.e. asymptomatic vs mild vs moderate vs severe infection are sparse, and include limited number of individuals.This study included 871 vaccinated health care workers (HCW) and 181 patients with natural infection. Immunogenicity was assessed by a quantative assay measuring anti-SARS-CoV-2 against the RBD domain of the spike protein (anti-RBD) and anti-SARS-CoV-2 against nucleocapsid protein (anti-N). Samples were collected 1-2 weeks after completion of the 2nd dose in the vaccinated HCWs and 15-59 days post symptoms onset in patients with natural infection.The concentration of anti-RBD in vaccinated individuals after multivariable analysis was significantly associated with age, gender, VSE and Pr-CoV. Specifically, anti-RBD median levels (95% CI) were lower by 2,466 (651-5,583), 6,228 (3,254-9,203) and 7,651 (4,479-10,823) AU/ml in 35-44, 45-54, 55-70 yrs respectively, compared with 18-34 yrs group. In females, median levels of anti-RBD were higher by 2,823 (859-4,787) compared with males, in individuals with VSE were higher by 5,024 (3,122-6,926) compared with no VSE, and in HCWs with Pr-CoV were higher by 9,971 (5,158-14,783) AU/ml compared with HCWs without Pr-CoV.Among individuals with natural infection, the median anti-RBD levels were 14.8 times higher in patients with critical COVID-19 infection compared with non-hospitalized individuals. The ratio of anti-RBD in vaccinated individuals versus those with natural infection varied from 1.0 up to 19.4 according to the clinical subgroup of natural infection.This study proves the high immunogenicity of BNT162b2 vaccine although its sustainability remains to be seen. The use of comparative data from natural infection serological panels, expressing the clinical heterogeneity of natural infection may facilitate early decisions for vaccine evaluation in clinical trials.

Background: Structural properties of sociometric networks have been associated with behaviors related to HIV transmission. Very few studies, however, have explored the correlation between sociometr...

Purpose: There is a paucity of studies concerning health literacy (HL) of parents/guardians of patients in paediatric surgery. The purpose of our study is to measure HL levels of parents/guardians of paediatric surgery patients and to explore the determinants of low HL levels in this population. Materials and Methods: We conducted a cross-sectional study from December 2016 to July 2018 through in-person interviews of parents/guardians of paediatric surgical patients. Sociodemographic and clinical data were recorded, and HL levels were calculated using a validated tool (HLS-EU-Q16). In order to examine the impact of various sociodemographic variables and clinical data on HL, a multivariate regression model was run. Results: A total of 1000 participants were recruited (recruitment rate 93.5%). Slightly less than half (44.2%) presented problematic or inadequate HL levels. The results of the regression analysis showed that nationality other than Greek (β = −2.180, P < 0.001) and lower health insurance status (β = −0.461, P < 0.05) were associated with lower HL levels. HL was found positively associated with the educational level of the parent (β = −0.775, P < 0.001) and being a health professional (β = 1.791, P < 0.001). Conclusion: The prevalence of low HL levels in the parents/guardians of paediatric surgical patients is high and should not be neglected both in the pre-operative and post-operative setting. Communication should be tailored to the specific needs of each individual to achieve better engagement and quality of care.

Migration-flows pose the risk of poliovirus reintroduction from endemic countries to Greece. This study aims to evaluate serologic-immunity/vaccination against poliomyelitis in newly-arriving migrant children.Demographic-immunisation data and blood-serum were obtained from migrants 1-14years-old, referred to a hospital-clinic in Athens-Greece within three months from arrival. Immunity to polioviruses-1-3 was determined by serum-neutralizing-antibodies(WHO guidelines). Titers ≥ 1:8 were considered positive.From 9/2010 to 9/2013, 274 children(150 refugees/124 immigrants), mean age 7.1years-old, were enrolled. Only 57(20.8%) of them presented with vaccination-records. Children originated mainly from Asia(n = 198), Eastern Europe(n = 28), Middle East(n = 24) and Africa(n = 24) with 160(58.4%) from polio-endemic-countries(Afghanistan-112(40.8%), Pakistan-24(8.8%) and India-24(8.8%)). Seropositivity against polio-1-23 was 84.3%, 86.1% and 74.5%, respectively. Immigrants, had higher seroprotective rates against polioviruses-1-23 than refugees(polio-1:p = 0.002;polio-2:p = 0.004,polio-3:p 0.001). Seronegativity to 1PVs-2PVs and all three polio serotypes was found in 37(13.5%),12 (4.4%), and 30 children(10.9%) respectively. Increasing number of vaccine-doses, and younger-age, were positively-associated with seropositivity.A remarkable fraction of newly-arrived migrant-children were seronegative to one or more polioviruses.

Background Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the developed countries. The aim of this study was to evaluate the NAFLD prevalence in European adults and children/adolescents of the general population and specific subgroups. Method Search for all articles published between 01/1990-06/2019 reporting NAFLD prevalence from European countries. Results Nineteen studies with adults and 9 with children/adolescents were included. Pooled NAFLD prevalence in adults was 26.9%, being higher in studies using ultrasonography (27.2%) or fatty liver index (FLI) (30.1%) than liver biochemical tests (19.1%) and without differences between Mediterranean and non-Mediterranean countries or publication periods. Pooled NAFLD prevalence was higher in men than women (32.8% vs. 19.6%) and in patients with than those without metabolic syndrome (75.3% vs. 17.9%) or any of its components (always P

Drug use involves social interactions. Therefore, norms in the proximal environment of people who inject drugs (PWID) can favor behaviors that may result in HIV transmission. This work aimed at studying drug injection-related norms and their potential association with risky behaviors among PWID in Athens, Greece, in the context of economic recession and political activism that followed the fiscal crisis and soon after a recent HIV outbreak had leveled off. The Transmission Reduction Intervention Project (TRIP) was a social network-based approach (June 2013 to July 2015) that involved two groups of PWID seeds—with recent HIV infection and with long-term HIV infection and one control group of HIV-negative PWID. Network contacts of seeds were also enrolled. TRIP participants answered a questionnaire that included items on injection-related norms and behaviors. TRIP recruited 320 PWID (HIV positive, 44.4%). TRIP participants, especially those without HIV, often recalled or perceived as normative among their partners and in their networks some behaviors that can lead to HIV transmission. TRIP participants who recalled that they were encouraged by their regular drug partners to use an unclean syringe were almost twice as likely to report that they share syringes [odds ratio (OR) = 2.03; 95% confidence interval (CI) = 1.86–2.21], or give syringes to someone else (OR = 1.70; 95% CI = 1.42–2.04) as those who did not recall such an encouragement. Associations were modified by HIV status. HIV negatives, who were reportedly encouraged to share nonsyringe injecting equipment, were almost 4.5 times as likely to share that material as HIV-negative participants who were not encouraged (OR = 4.59, 95% CI = 4.12–5.11). Further research is needed on the multiple determinants (social, economic, and political) of norms in the social environments of PWID. Since peer norms are associated with risky behaviors, interventions should be developed to encourage norms and peer pressure against the sharing of injection equipment.

Background Kidney transplant recipients (KTRs) are at increased risk of infections. Methods The aims of this study were to describe the incidence of bloodstream infections (BSIs) by gram-negative bacteria in a cohort of KTRs, the risk factors for BSI due to multi-drug-resistant (MDR) gram-negative bacteria, and the predictors for unfavorable outcome, defined as death or nephrectomy or return to dialysis, within 30 days from BSI. We conducted a retrospective cohort study at the renal transplant unit of a tertiary care hospital in Athens, Greece. Results In a total of 1962 KTRs, we recorded 195 BSI episodes in 182 single patients (male/female = 97/85), with a median (interquartile range) age of 57.2 (44-64.9) years. The incidence was 1.393/100 patient-years. The most common source of infection was urinary tract (70.9%), and Escherichia coli (63.7%) was the most common pathogen. 19.2% of the infecting organisms were MDR; previous antibiotic use (OR 8.2; CI 2.1-32.9) and previous stay in the intensive care unit (OR 34.2; CI 1.6-730.2) were associated with MDR BSIs. 6% of patients died, and 2.2% underwent nephrectomy, while no patients had to return to dialysis. Diabetes mellitus (OR 8.1; 95% CI 1.3-50.3), Pseudomonas aeruginosa BSI (OR 46.1; 95% CI 3.9-552.3), and septic shock (OR 46.7; 95% CI 1.7-1304.9) were independent predictors of unfavorable outcome. Conclusion Bloodstream infections in KTRs have a significant impact on allograft and patients outcome.

Introduction The impact of cardiac myxomas on the immune response is still indefinite, although laboratory tests and histological findings suggest that there is a correlation between myxomas and inflammatory reaction. Objectives Our study speculates that cardiac myxomas are associated with inflammatory response and investigates potential elements of inflammation in the histopathological examination and biomarkers from laboratory tests. Methods It is a retrospective study and data were collected from a single center between May 2010 to May 2018. Autopsies and laboratory tests of 54 cases were analyzed. Results In 20,4% of the autopsies, inflammatory elements were identified. The neutrophil/lymphocyte ratio (NLR) preoperatively is elevated in patients suffering from cardiac myxoma while its value is correlated to the tumor size. Conclusions Cardiac myxoma is an entity that affects the immune response of patients. The biomarker NLR could be utilized as a prognostic factor regarding enlarged cardiac myxomas. Future studies still need to be conducted in order to confirm the usefulness of this biomarker on cardiac myxomas., Cardiology; Immunology; Pathology; Pathophysiology; Cardiac myxoma; Neutrophil/lymphocyte ratio; NLR; Inflammatory response; Biomarker.

Purpose Childhood absence epilepsy (CAE) is an epileptic syndrome presenting between 2nd–10th years. The spells are elicited with hyperventilation (HV) while sleep seems to exacerbate the electrical activity. Our aim is to describe sleep architecture and its relationship with epileptic discharges (EDs) in patients with CAE, before treatment and one year later. Methods Twenty-eight, drug-naive children were recruited (21 girls), mean age 90.1 ± 32.6 months. Routine-EEG and overnight EEG-polygraphy were conducted upon diagnosis and one year later. Patients were separated in two groups of similar mean age, according to their clinical response at the second recording: group A : children with absolute control of absences and group B : children with partial control. Sleep parameters, EDs and arousals were measured. The effect of medication on sleep parameters was examined, according to 2 groups: valproic-treated and non valproic-treated. Results Group A showed significant improvement in total sleep time, REM-sleep latency, REM-sleep, arousals-number/hour and arousals-duration/hour between the two recordings. Comparing the two groups for each recording separately, group A initially demonstrated greater epileptic activity and worse sleep parameters, whereas in the second recording exhibited total elimination of the EDs and significantly less arousals. Group B demonstrated persisting EDs and slight deterioration in some sleep parameters during the second recording, despite the lower epileptic load initially. No significant difference was identified between valproic and non-valproic treated patients, regarding the effect on sleep parameters. Conclusion Absolute control of absences and normalization of the electroencephalogram are accompanied by more continuous, stable and efficacious sleep in children with CAE.

BNT162b2 has proven to be highly effective, but there is a paucity of data regarding immunogenicity factors and comparison between response to vaccination and natural infection. This study included 871 vaccinated healthcare workers (HCW) and 181 patients with natural infection. Immunogenicity was assessed by measuring anti-SARS-CoV-2 against the RBD domain of the spike protein (anti-RBD). Samples were collected 1–2 weeks after vaccination or 15–59 days post-onset of symptoms. Post-vaccine anti-RBD concentrations were associated with age, gender, vaccination side-effects (VSE) and prior infection (Pr-CoV). Anti-RBD median levels (95%CI) were lower by 2466 (651–5583), 6228 (3254–9203) and 7651 (4479–10,823) AU/mL in 35–44, 45–54, 55–70 yrs, respectively, compared with the 18–34 yrs group. In females, the median levels were higher by 2823 (859–4787), 5024 (3122–6926) in individuals with VSE, and 9971 (5158–14,783) AU/mL in HCWs with Pr-CoV. The ratio of anti-RBD in vaccinated individuals versus those with natural infection varied from 1.0 to 19.4. The high immunogenicity of BNT162b2 is verified, although its sustainability has yet to be elucidated. The use of comparative data from natural infection serological panels, expressing the clinical heterogeneity of natural infection, may facilitate early decisions for candidate vaccines to be evaluated in clinical trials.

Background Infection by Nocardia species is an uncommon cause of severe clinical syndromes, particularly in immunocompromised patients, and solid-organ transplantation is the most common underlying condition. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) has been described thus far in lung and stem cell transplants with systemic nocardiosis. Case Report We report the first case of SIADH in a female elderly renal transplant recipient diagnosed with systemic nocardiosis 2 years after transplantation. The SIADH was managed appropriately, and her immunosuppressive regimen remained unchanged but was adjusted at a lower level. The systemic Nocardia infection was successfully treated with intravenous administration of trimethoprim-sulfamethoxazole and imipenem for 2 weeks followed by oral trimethoprim-sulfamethoxazole for a total of 12 months. Conclusions The SIADH syndrome is a recognizable complication of Nocardia infection in renal transplant recipients. Prompt identification along with proper management and prolonged antimicrobial treatment are essential to improve patients' outcome.

BackgroundAristotle was a seek-test-treat intervention during an outbreak of human immunodeficiency virus (HIV) infection among people who inject drugs (PWID) in Athens, Greece that started in 2011. The aims of this analysis were: (1) to study changes of drug injection-related and sexual behaviors over the course of Aristotle; and (2) to compare the likelihood of risky behaviors among PWID who were aware and unaware of their HIV status.MethodsAristotle (2012–2013) involved five successive respondent-driven sampling rounds of approximately 1400 PWID each; eligible PWID could participate in multiple rounds. Participants were interviewed using a questionnaire, were tested for HIV, and were classified as HIV-positive aware of their status (AHS), HIV-positive unaware of their status (UHS), and HIV-negative. Piecewise linear generalized estimating equation models were used to regress repeatedly measured binary outcomes (high-risk behaviors) against covariates.ResultsAristotle recruited 3320 PWID (84.5% males, median age 34.2 years). Overall, 7110 interviews and blood samples were collected. The proportion of HIV-positive first-time participants who were aware of their HIV infection increased from 21.8% in round A to 36.4% in the last round. The odds of dividing drugs at least half of the time in the past 12 months with a syringe someone else had already used fell from round A to B by 90% [Odds Ratio (OR) (95% Confidence Interval-CI): 0.10 (0.04, 0.23)] among AHS and by 63% among UHS [OR (95% CI): 0.37 (0.19, 0.72)]. This drop was significantly larger (p = 0.02) among AHS. There were also decreases in frequency of injection and in receptive syringe sharing in the past 12 months but they were not significantly different between AHS (66 and 47%, respectively) and UHS (63 and 33%, respectively). Condom use increased only among male AHS from round B to the last round [OR (95% CI): 1.24 (1.01, 1.52)].ConclusionsThe prevalence of risky behaviors related to drug injection decreased in the context of Aristotle. Knowledge of HIV infection was associated with safer drug injection-related behaviors among PWID. This highlights the need for comprehensive interventions that scale-up HIV testing and help PWID become aware of their HIV status.

Background The recent interferon-free direct-acting antiviral (DAA) regimens have very good safety and efficacy profiles and are highly recommended for kidney transplant (KT) recipients with chronic hepatitis C (CHC). Methods All KT recipients with CHC followed at our hospital and who received therapy with the current DAAs were included. At the baseline visit, demographic, clinical and laboratory variables before and after KT, as well as at the commencement of DAAs, at the end of antiviral therapy and the end of follow up, were recorded, including assessment of glomerular filtration rate (eGFR). The changes in eGFR (DGFR) between baseline and end of therapy (1st period), and between end of therapy and end of follow up (2nd period), were evaluated. Results Twelve KT recipients were retrospectively evaluated: 2 had received antiviral therapy in the past; 4 (33.3%) patients had genotype 1 and 3 (25%) genotype 4 CHC. The median stiffness was 11.9 kPa (range 5-16.8), while 5 patients, none with decompensated cirrhosis, had stiffness >12.5 kPa. Eight patients received a sofosbuvir-containing antiviral regimen (Group 1) and 4 patients received an antiviral regimen without sofosbuvir (Group 2). Eleven (91.7%) patients achieved a sustained virological response (SVR). One patient discontinued DAAs early after treatment and did not achieve SVR. Otherwise, DAAs were well tolerated and no rejection episode was recorded. The DGFRs in the 1st period and 2nd period did not differ significantly between Group 1 and Group 2 patients. Conclusion In this real-world study of KT recipients with CHC, the high efficacy and clinically acceptable tolerability of DAAs were confirmed.

After the 2016 Balkan route border closures, vaccination of refugee children in Greece was mainly performed by non-governmental organisations. Activities varied between camps, resulting in heterogeneity of vaccination coverage (VC). In April 2017, the European programme ‘PHILOS - Emergency health response to refugee crisis’ took over vaccination coordination. Interventions were planned for the first time for refugee children in the community and unaccompanied minors at safe zones. From April 2017–April 2018, 57,615 vaccinations were performed against measles-mumps-rubella (MMR) (21,031), diphtheria-tetanus-pertussis (7,341), poliomyelitis (7,652), pneumococcal disease (5,938), Haemophilus influenzae type b (7,179) and hepatitis B (8,474). In April 2018, the vaccination status of children at camps (reception and identification centres and community facilities such as hostels/hotels were excluded) was recorded and VC for each disease, stratified by dose, nationality and camp size, was calculated. More than 80% of the children received the first MMR dose, with VC dropping to 45% for the second dose. For all other vaccines, VC was

The increasing trend of administering nonprescribed medicines in children is a significant public health issue. The aim of the present study was to assess the use of medication without a prescription (MWP), including both nonprescribed medication (NPM) and prescription-only medication (POM), and identify associated factors, among preschoolers in Athens, Greece. A predesigned questionnaire was distributed to parents from May through June 2011. Multivariable binary logistic regression analysis models were used to assess associations of interest. Results showed that 95.1% of parents reported administering at least one MWP, during the previous 12 months. Antipyretics (91%) were the most commonly NPM and bronchodilators (24.8%) and antibiotics (16.4%) the most common POM dispensed. Child’s increased age group, lack of parental information, higher paternal education, and mother’s foreign nationality were associated with increased antipyretic use (p<0.05), while father’s foreign nationality and parental age were positive predictors of antibiotic administration (p<0.05). The likelihood of consuming antipyretics and antibiotics significantly increased when information was provided by a pharmacist (p=0.017 and p=0.054, resp.). Conclusively, most parents have administered at least one MWP, including antibiotics, to address symptoms of common childhood diseases, highlighting the need of information campaigns concerning the consequences of their improper use.

Nursery schools serve as reservoirs of transmission of infectious diseases, and teachers should be able to implement and monitor hygiene measures to prevent them. The aim of the present study was to assess the compliance of nursery school teachers on promoting preventive interventions and to identify associated factors, during the novel H1N1 influenza pandemic. A secondary objective was to evaluate their knowledge and vaccination status regarding the novel virus. A cross-sectional study was performed, with the use of a predesigned anonymous, questionnaire, and distributed to all public nursery teachers of Athens, Greece. General etiquette practices were highly acceptable to over 92% of teachers. Those with longer teaching experience promoted simple preventive measures, such as hand washing and use of hand sanitizer, more often while older children were more likely to familiarize with them. However, teachers presented inadequate knowledge concerning the novel virus and their vaccination rates with the pandemic vaccine were unacceptably low (1.1%). Our study showed that promotion of simple preventive measures is feasible and may contribute to the prevention of outbreaks in nursery schools, although knowledge gaps and fear concerning the pandemic vaccine highlight communication issues.

BACKGROUND/AIM Two-dimensional shear-wave elastography (2D-SWE) is a new elastographic technique that is increasingly being used across several indications. We assessed the reliability and applicability of 2D-SWE in patients with various chronic liver diseases and attempted to identify parameters potentially affecting liver stiffness. METHODS We included all patients with chronic liver disease who underwent 2D-SWE examination over a 15-month period. Patients with acute hepatitis, active cholestatic disease, or severe heart failure were excluded. The procedures were performed by three adequately trained operators. Standard operating procedures for liver ultrasonography and elastography were followed. RESULTS 2D-SWE was reliable in 98% of 605 patients. SD to mean liver stiffness value ratio greater than 9.14%, which was considered an indicator of reliability, was associated independently with age more than 50 years, obesity, or overweight, and use of statins for hyperlipidemia. 2D-SWE was applicable, requiring a median time of 7 min per examination and exceeding 15 min in only 5.5% of patients. Worse applicability expressed as duration more than 0.7 min per reliable measurement was associated independently with age more than 50 years and obesity. The mean and median liver stiffness values were 11.6 and 7.7 kPa, respectively. Liver stiffness more than 7.7 kPa was associated independently with age more than 50 years and increased waist circumference. CONCLUSION 2D-SWE represents an applicable method of assessment of liver fibrosis that can provide reliable results in the vast majority of patients with chronic liver diseases. Older age and obesity may affect the reliability and applicability of the method as well as the severity of liver fibrosis.

Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) are currently among the most important nosocomial pathogens in many geographic regions. A retrospective study was conducted between 2010 and 2014 in four hospitals located in a high-prevalence area (Athens, Greece) to describe the clinical features, treatment and outcomes of neutropenic patients with haematological diseases complicated with CP-Kp bloodstream infections. A total of 50 patients were identified, including 48 with haematological malignancies and 2 with aplastic anaemia. All patients had neutropenia (

BACKGROUND Viral infections are a significant cause of morbidity and mortality in pediatric transplant populations. We analyzed the epidemiology of viral infections in pediatric hematopoietic stem cell transplant (HSCT) patients, including their incidence, associated risk factors, and outcome. METHODS In a prospective study from September 2011 to September 2015, blood, urine, and stool specimens were monitored weekly from transplantation to day 100 or after if clinically suspected, by use of real-time polymerase chain reaction. Cytomegalovirus (CMV), Epstein-Barr virus (EBV), BK polyomavirus (BKV), Herpes simplex virus-1,2, Varicella zoster virus, Human herpes virus-6,7, and Adenovirus infections were monitored. All children and adolescents who underwent HSCT received long-term follow up in the regular outpatient clinics (range 2-48 months). RESULTS A total of 192 HSCTs (autologous/allogeneic: 53/139) were performed in 165 subjects (median age: 5.6 years). Viruses most commonly isolated were CMV (46.1%), BKV (25.9%) and EBV (22.6%) and were more frequent in allogeneic versus autologous transplants (P

Background Kidney transplant recipients are at increased risk for infections. The aims of this study were: i) to estimate the incidence of bloodstream infections (BSI) caused by Gram(−) bacteria in kidney transplant recipients, ii) to identify risk factors for BSI by multidrug-resistant Gram(−) bacteria, and iii) to identify predictors for outcome (death/loss of transplanted kidney). Methods We conducted a retrospective cohort study at the renal transplant unit (RTU) of a tertiary care hospital located in Athens, Greece, between September 2008 and September 2018. Kidney transplant recipients with Gram(−) BSIs were identified from the microbiology laboratory electronic records. Patient-, infection-, and treatment-related factors were extracted from the medical records. Species identification and susceptibility testing were performed by MicroScan automated system. The statistical analysis was performed using IBM SPSS Statistics v20. Results During the study period, 1962 kidney transplant patients were followed at our RTU. A total of 195 BSI episodes were recorded in 182 patients (male/female=97/85), with median (25th, 75th) age 57.2 (44, 64.9) years. The incidence of BSI was 1.393/100 patient-years. Median (25th, 75th) time interval between transplantation date and onset of BSI was 67.67 (8.3, 148) months. Escherichia coli was the most common cause (64.3%, 117/182), while the most common source of infection was urinary tract (70.9%, 129/182). 19.2% (53/182) of BSIs were caused by multidrug-resistant organisms (MDR). 6% (11/182) of patients died and 2.2% (4/182) were subjected to nephrectomy. Multivariate logistic regression showed that diabetes mellitus (odds ratio [OR] 7.714; 95% confidence interval [CI] 1.311–45.385), Pseudomonas aeruginosa BSI (OR 35.788; CI 3.3–388.182) and septic shock (OR 74.468; CI 3.513–1578.513) were predictors of an unfavorable outcome. Previous antibiotic use (OR 11.964; CI 2.686–53.293) and previous stay in Intensive Care Unit (OR 18.055; CI 1.046–311.536) were associated with MDR BSIs. Conclusion BSIs in kidney transplant recipients is a critical factor of morbidity and mortality. Recognizing the risk factors for unfavorable outcome and emergence of MDR bacteria could offer a significant advantage in early diagnosis and appropriate treatment. Disclosures All authors: No reported disclosures.

Introduction: Alcohol use during adolescence remains a prominent public health problem with short- and long-term consequences. The study aims at investigating the epidemiological characteristics of alcohol use among Greek adolescents. Important parallel aims were to identify alcohol-related problems and its consequences experienced by the adolescence. Methods: The study population was a convenience sample of 1100 students of secondary education (junior and senior high school) from 12 public and private schools in Athens. 573 boys and 527 girls aged 12 to 19 years old [mean age 15.3 (±1.7)] answered a specially structured anonymous questionnaire. Results: Recent alcohol consumption was reported by more than the half of students (57.3%) and was more prevalent among adolescents over 15 years old (67.3%) and among boys (59.3%). Beer was the most popular type of alcoholic beverage (65.9%) at all ages. On average, both males and females stated the onset of alcohol at the age of 12 years. Boys reported being drunk more often than girls (25.7% versus 14.9%). However, more girls reported being drunk at least once a year than boys (27.1% versus 17.6%). The vast majority of the participants stated that they were informed about the possible addiction to alcohol (86.2%) and its negative consequences. A statistically significant correlation was found between age and hangover (p < 0.001). Conclusion: Alcohol consumption remains a serious problem among adolescents. There is a need to implement preventive measures and counseling approaches in school. The study will contribute to the public awareness concerning adolescent’s drinking behavior in Greece.

Background Migrant children are a population at risk for various health problems. Despite the increased inflow of migrants in Greece, data regarding their health assessment are lacking. This study aims to describe the clinical and certain laboratory characteristics and identify possible associations in a group of new immigrant (I) and refugee (R) children, arriving in Athens, Greece. Methods A prospective, cross- sectional study was performed in a migrant outpatient clinic of a tertiary Children’s hospital. All immigrant and refugee children, examined to obtain a health certificate, within 3 months of their arrival in the country, were enrolled. Clinical and laboratory information was collected in a pre- designed form. We applied multiple logistic regression models to investigate the association between the child’s status (immigrant vs refugee) and health indicators controlling for possible confounding effects, mainly of age and area of origin. Results From 2010 to 2013, a total of 300 children (I/R:138/162) with a mean age of 7.08 (range 1–14) years were included. Overall, 79.3% presented unknown vaccination status, 21.3% dental and 7.3% additional clinical problems. Latent tuberculosis was identified in 2.7%, while anemia, low serum ferritin and eosinophilia were found in 13.7%, 17.3%, and 22.7% of subjects, respectively. 57.7% had protective antibodies to hepatitis B surface antigen (anti-HBs ≥ 10 IU/L) and 30.6% elevated blood lead levels (EBLLs). Immigrants had less likely unknown immunization (OR = 0.25, p

Background: Dog bites represent a significant health concern leading to a variety of consequences. Nursing students should be appropriately educated in order to manage and help prevent such injuries. Aim: This paper is the first to report the lifetime experience and characteristics of dog bites among Greek nursing students and their knowledge in managing the above injuries. Methods: A cross-sectional quantitative study was performed using an anonymous questionnaire distributed to first and fourth year nursing students from April though June 2009. A knowledge score based on key questions was set on a scale from 0 to 7, to assess their competence on bite injuries management. Results: Of 237 nursing students recruited, 56 (23.6%) had experienced a dog bite. Men outnumbered women as dog bite victims [n = 15 (39.5%) vs. n = 41 (20.6%), P = 0.012]. Mean age at the attack was 11.1 (standard deviation = 5.6) years and legs sustained the majority of injuries (n = 31; 55.4%). Most bites (n = 39; 69.9%) involved a dog known to the victim, were provoked (n = 30; 53.6%) and occurred in a public place (n = 35; 62.5%). Ten (17.9%) of the victims sustained a moderate or severe injury. The majority (67.9%) of students answered correctly to less than or equal to three out of seven key knowledge questions. After multiple linear regression analysis, previous educational course attendance was the only factor associated with increased score (b = 0.48, standard deviation = 0.17, 95% confidence interval = 0.12-0.84, P = 0.009). Conclusions: Dog bites were common and presented characteristic patterns among nursing students, but knowledge in their management was suboptimal. Improved education should be provided during undergraduate studies. Language: en

Health literacy (HL) in the pediatric setting has been associated with poor health outcomes and plays an important role in the existing health disparities. Low parents caregivers HL influences health outcomes mainly in chronically ill children. Trying to identify the role of HL in the pediatric surgical and dentistry setting, we conducted a review of the relevant literature. The paucity of studies and the heterogeneity of the methodology do not lead to specific results. The need for more and larger studies in the field is evident and crucial in order to ameliorate the quality of surgical care in pediatric patients.

Background: This study aims to assess lead exposure and associated risk factors among newly arrived migrant (M) (immigrant and refugees) children in Greece and a matched control of native (N) children. Methods: A prospective, cross-sectional study was performed in an outpatient clinic of a tertiary children’s hospital. Results: From 2010 to 2014, 598 children (M/N: 349/249) with a mean age of 6.96 years old (range 1–14, SD 3.76) were enrolled. Blood lead levels (BLLs) ranged from 0.7 to 21 μg/dL in migrant and from 0.4 to 10 μg/dL in native Greek children. Elevated BLLs ≥ 5 μg/dL were detected in 27.7% of migrants and 1.2% of natives (p < 0.001). A significant association was found between EBLLs and childrens’ age (≤5 years) (OR: 1.8, p-value 0.02) and EBLLs with Asian origin (OR: 3.63, p-value 0.023). Conclusion: New migrant children presented with increased BLLs when compared to their age- and sex-matched controls. Younger age and Asian origin were significant risk factors associated with elevated BLLs among children. Early screening, secondary prevention, and regular follow-up could prove useful in this vulnerable population.

In order to target the appropriate age population for booster vaccination, we examined the antibody titres against pertussis toxin (PT) in different age groups in immunized and non-immunized individuals. In the immunized population, the highest anti-PT levels were observed in the 0- to 2-y age group and the lowest in the teenager and young adult groups. In contrast, in the control group, anti-PT levels were minimal in infants and young children, increasing in adolescence and early adulthood, and waning after 30 y of age. Antibody levels >30 U/ml were observed with higher frequency in children

Oropharyngeal swabs were cultured from 554 children aged 2–19 years attending nurseries, primary schools and secondary schools in the central Athens area. A questionnaire was completed to identify risk factors for carriage. Susceptibility to antimicrobial agents was determined by Etest. The genetic relatedness of the strains was examined by pulsed-field gel electrophoresis (PFGE), and isolate serogrouping was performed by slide agglutination. Twenty-two (4%) children were carriers of Neisseria meningitidis; seven isolates belonged to serogroup C, and five to serogroup B. One isolate was resistant to co-trimoxazole, and five showed intermediate resistance to penicillin. DNA analysis of 16 isolates revealed six distinct PFGE patterns. Clusters with indistinguishable PFGE patterns were noted in the same school. More than one serogroup was included in the same clonal group. On multivariate logistic regression analysis, only age > 12 years remained independently associated with the carrier state (odds ratio, 7.96; 95% CI, 2.24–28.33; p < 0.001). Overall, the N. meningitidis carriage rate among Greek schoolchildren increased with age, and the predominant serogroups in the Athens region were groups C and B. These findings may have important implications for future immunisation strategies with conjugate vaccines.

Purpose The purpose of this study was to present a fatal case of fulminant hepatitis B (FHB) that developed in a renal transplant recipient, immunized against hepatitis B, 1 year post transplantation. Methods Polymerase chain reaction amplification and full genome sequencing were performed to investigate whether specific mutations were associated with hepatitis B virus (HBV) transmission and FHB. Results Molecular analysis revealed multiple mutations in various open reading frames of HBV, the most important being the G145R escape mutation and a frameshift mutation–insertion (1838insA) within the pre-C/C reading frame. Conclusions Our results highlight the possibility of developing FHB, despite previous immunization against HBV or administration of hyperimmune gammaglobulin, because of the selection of escape virus mutants. The current literature and guidelines regarding renal transplantation from hepatitis B surface antigen (HBsAg)-positive to HBsAg-negative patients were also reviewed.

The impact of prioritization and of timing of vaccination strategies on reducing transmission of pandemic influenza A(H1N1) was evaluated in a community with the structure of the Greek population using a stochastic simulation model. Prioritization scenarios were based on the recommendations of the United States Centers for Disease Control and Prevention Advisory Committee on Immunization Practices and vaccination was assumed to initiate either before or during the ongoing epidemic. In the absence of intervention, an illness attack rate (AR) of 34.5% is anticipated. Vaccinating the priority groups before the epidemic (pregnant women, people who live with or care for children

An open, prospective, randomised study was conducted to compare the safety and efficacy of valacyclovir vs. oral ganciclovir for cytomegalovirus (CMV) prophylaxis in renal transplant recipients. Eighty-three renal transplant recipients were assigned randomly to receive valacyclovir ( n = 43) or oral ganciclovir ( n = 40) for the first 3 months after transplantation. Both groups were similar in terms of demographics, primary renal disease, graft source, HLA matching, immunosuppressive therapy and donor–recipient CMV antibody status. CMV infection was diagnosed by detection of virus DNA in plasma with the Amplicor CMV Test. CMV disease was observed in only one patient belonging to the ganciclovir group, who developed enterocolitis 6 months post-transplantation. No difference was observed between the two treatment groups with respect to detection of CMV DNA, virus infections other than CMV, acute rejection episodes, and serum creatinine levels at 3 and 6 months following transplantation. An increased number of bacterial infections was noted in the ganciclovir group (p 0.003). No adverse reactions with either treatment were reported. The estimated cost of valacyclovir treatment was 20% higher than that of ganciclovir treatment. Overall, both valacyclovir and oral ganciclovir were found to be effective and safe for CMV prophylaxis in renal transplant recipients. Decisions regarding prophylactic regimens should include additional criteria, such as cost or possible development of resistance.

To determine the rate of mother-to-child transmission of hepatitis C virus (HCV) and identify risk factors associated with HCV transmission we prospectively studied 86 infants born to anti-HCV positive mothers. HCV infection was verified in all mothers before delivery and their HCV viral load was measured at or near delivery using reverse transcription polymerase reaction. For HCV genotyping the INNO-LiPA II probe assay was used. All mothers were tested for HIV infection. Possible risk factors for vertical transmission were recorded. The children were followed up for a minimum of 18 months for evidence of HCV infection, as determined by persistent HCV antibodies, or detection of HCV-RNA. Vertical transmission was restricted to infants born to viraemic mothers and the rate was 3.6% (95% CI 0.004-0.123). The HIV-infected mothers and those using drugs intravenously were more likely to transmit HCV to their children. The infected children had the same genotype as their mothers. Although the HCV RNA titre was higher in mothers who transmitted the virus than in those who did not, the viral load had borderline significance (p=0.08). Viral transmission was not influenced by mother's age, mode of delivery, genotype or type of feeding. Mother-to-child transmission of hepatitis C virus is uncommon and restricted to infants born to HCV viraemic mothers. Active drug use and HIV coinfection increase the risk for HCV vertical transmission.

To evaluate the efficacy of a short course of a lipid formulation of amphotericin B (L-AmB) for the treatment of Mediterranean visceral leishmaniasis (VL), an open prospective study was conducted. Forty-one children with parasitologically confirmed leishmaniasis received L-AmB, 10 mg/kg daily for 2 days. The comparison groups were 30 children who, in a previous study, were treated with L-AmB, 4 mg/kg daily for 5 days, and 52 children who were treated with meglumine antimoniate. At 6 months after completion of treatment, overall treatment success was noted for 40 of 41 children treated with 2 doses of L-AmB, 27 of 30 children treated with 5 doses of L-AmB, and 47 of 52 children treated with meglumine antimoniate. Abatement of fever, reduction in spleen size, and correction of laboratory parameters occurred more quickly among the children who received 2 doses of L-AmB than among the comparison groups, and the total estimated cost of the 2-dose regimen was also lower than that of the other regimens. Two doses of L-AmB, 10 mg/kg each, is cost-effective therapy for Mediterranean VL in children.

Summary: An outbreak of enterovirus infection occurred among neonates in a maternity hospital between July 7 and 22, 1999. Twenty neonates became ill (18 confirmed and two probable), an attack rate of 33%. The incubation period ranged from three to six days (mean, 4.2). The male : female ratio was 11 : 9 and the mean age at the onset of illness was 5.5 days. All the babies had fever, eight, a maculopapular rash, and six had symptoms of gastroenteritis, 11 developed meningitis. Nineteen neonates required hospitalization for three to seven days, but all were discharged home without sequelae. Enteroviral RNA was detected in all of 18 urines, and 14 cerebrospinal fluid specimens tested. A case‐control study was conducted to determine risk factors associated with the outbreak. Rooming in the nursery ward was a significant risk factor (odds ratioa 33.35; 95% confidence interval, 3.79‐800; Pa 0.00002). No association was found between illness and other possible risk factors. Appropriate control measures resulted in resolution of the outbreak. Our findings demonstrate the potential for enteroviruses to cause widespread illness among newborns, and emphasize the usefulness of polymerase chain reaction in the early diagnosis of infection, and underline the role of effective control measures in interrupting viral transmission. & 2002 The Hospital Infection Society

UNLABELLED A retrospective study was conducted to identify the epidemiologic characteristics of invasive pneumococcal infections among children

Tuberculosis of the middle ear and mastoid is uncommon nowadays. Two cases of drug-resistant tuberculous mastoiditis in immunocompetent Greek native children are reported and the diagnostic and therapeutic difficulties of this rare condition are discussed.

Background Herpes zoster (HZ) is a significant cause of morbidity and complications in adult renal transplant recipients. We determined the incidence, complications and risk factors for the development of HZ after renal transplantation in a setting using universal antiviral prophylaxis. Methods The medical files of all adult renal transplants, performed between 2004 and 2008, were retrospectively reviewed to assess the clinical characteristics and risk factors of HZ. Incident cases of HZ were determined and the probability of developing post-transplant HZ for all subjects was calculated using the Kaplan Meier method. A multivariable Cox proportional hazards model was applied to assess the risk factors associated with the development of HZ. Results A total of 450 patients were eligible with a median follow up of 38 months. Twenty nine subjects (6.4 %) developed HZ, the median time to onset was 18 months, only three of them (10.3 %) required hospitalization, and none developed disseminated or visceral disease and death directly attributed to zoster. However, high rates of post-herpetic neuralgia (48.7 %) were observed. Overall incidence was calculated at 20.6 cases per 1000 patient-years of follow-up. Following multivariate analysis, increased age ≥ 60 years old, positive pre-transplant history of varicella related disease and administration of rejection treatment conferred an increased risk of 4.00-fold (CI: 1.79- 8.92), 16.00-fold (CI: 4.62- 55.52), and 5.57-fold (CI: 1.56- 19.84) respectively, for the development of post-transplant zoster. Conclusions HZ remains a common complication after renal transplantation in adults under current immunosuppession protocols and universal antiviral prophylaxis. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1038-1) contains supplementary material, which is available to authorized users.

Background In Greece, several new childhood vaccines were introduced recently but were reimbursed gradually and at different time points. The aim of this study was to assess immunization coverage and identify factors influencing complete and age-appropriate vaccination among children attending public nurseries in the municipal district of Athens. Methods A cross-sectional study, using stratified sampling was performed. Immunization history was obtained from vaccination booklets. Demographic and socioeconomic data were obtained from school registries and telephone interviews. Vaccination rates were estimated by sample weighted proportions while associations between complete and age-appropriate immunization and potential determinants by logistic regression analysis. Results A total of 731 children (mean age: 46, median: 48, range: 10–65 months) were included. Overall immunization coverage with traditional vaccines (DTP, polio, Hib, HBV, 1st dose MMR) was satisfactory, exceeding 90%, but the administration of booster doses was delayed (range: 33.7- 97.4%, at 60 months of age). Complete vaccination rates were lower for new vaccines (Men C, PCV7, varicella, hepatitis A), ranging between 61-92%. In addition, a significant delay in timely administration of Men C, PCV7, as well as HBV was noted (22.9%, 16.0% and 27.7% at 12 months of age, respectively). Child’s age was strongly associated with incomplete vaccination with all vaccines (p< 0.001), while as immigrant status was a predictor of incomplete (p=0.034) and delayed vaccination (p