Contents
Interview with prof. dr hab. n. med. Jacek Wysocki, pediatrician – vaccinologist, rector of the Medical University in Poznań
– Let’s start our conversation with the so-called swine flu. It caused a lot of fears and even panic. Emotions have subsided, but the fears are there.
There are still a lot of question marks around the AH1N1 ‘variant’ flu, the wrongly named swine flu – it actually combines swine, avian and human flu viruses – there are still many question marks. The background for all events was, and in a sense is, a pandemic. At the same time, all activities related to preventive vaccinations took place under great pressure of time. The companies declared the safety and immunogenicity of their products. The World Health Organization (WHO) and European organizations have identified vaccination as advisable. During the dynamically developing epidemiological situation, it turned out that, for example, older people tolerate the new form of flu much better than young people. Therefore, the risk groups were defined somewhat differently. Taking this into account, individual countries made a choice: we vaccinate, not vaccinate, who yes, who not? Risk groups should be prevented from an infectious disease epidemic, and opportunities should be created for everyone else.
– Fortunately, the situation did not turn out to be as dramatic as expected.
– It is not known if this is the end of the battles with AH1N1 “variant”. Typically, flu epidemics have several peaks. However, I would like to point out one thing in particular: in all this confusion – if you can say so – false information has spread, namely that seasonal flu vaccination can protect against the variant flu. Research and statistics have not confirmed this. Therefore, persuading people to vaccinate with the seasonal vaccine as an antidote to a new type of influenza was a mistake, the more so that, according to German data (we do not have such vaccines), the AH1N1 virus was definitely dominant as a pathogenic factor.
– Misinformation and distortions are a mill of various so-called anti-vaccination movements, and this is true of many infectious diseases.
– There is a so-called anti-vaccine option all over the world. Until recently, this was not a big phenomenon in Poland. Currently, however, we can see that it is growing, and the groups of people giving up vaccinations and expressing reserve towards them are growing. Particularly disturbing is the fact that this trend is finding supporters among parents. Often they connect in online communities, confirming each other in the alleged rightness of conduct. “Experts” with at least unsatisfactory competences also take the floor. As a doctor, a vaccinologist, I am concerned about this state of affairs because I know very well what the risk of disregarding infectious diseases is. The aura of reserve, or even aversion to vaccination in general, is also transferred to vaccine producers, pointing to them as specific beneficiaries of the idea of vaccination. This can cause a very negative situation for public health, and the damage caused by such thinking will take a long time to repair.
– Calendar of compulsory immunization for children. What is the? How is it assessed by specialists?
– This is the most important policy securing the health and life of children. It is worth recalling that not so long ago, in the first half of the 6th century, several dozen children in Poland died of Heine-Medin’s disease (poliomyelitis) each year, over 3000 were ill, many of them became disabled for life. Tens of thousands of children also suffered from diphtheria, and several thousand died of it. One could list: whooping cough, tuberculosis … Protective vaccinations limited and diametrically changed the causes of death of young children. Today, death from an infectious disease is very rare. Overall, it should be emphasized that the infant mortality rate has decreased fifteen-fold since the middle of the last century! Great merit in this preventive vaccinations. The check issued by the state for compulsory vaccinations is at least PLN XNUMX for one child.
– Is that enough?
– The model of compulsory vaccinations implemented in Poland is the result of a certain compromise. The state budget pays for vaccinations against hepatitis B, tuberculosis, diphtheria, tetanus, pertussis, polio, Haemophilus infuenzae type B, measles, mumps, rubella. Under special circumstances, this scope is widened. There are international recommendations indicating what each country should include in the vaccination calendar, each country also performs epidemiological analyzes identifying the areas of threats. The content and expansion of the calendar depends on budget and healthcare expenses.
– What is primarily missing from our calendar?
– There is no pneumococcal vaccine that is very useful and that you absolutely must introduce. There is no vaccine against rotavirus, which in our conditions is not fatal, but causes many health complications that require expensive hospital treatment. A vaccine for hepatitis A should also be introduced, at the moment we have apparent peace of mind when it comes to morbidity thanks to improved sanitary conditions in food trade, but the virus is there and we can deal with a compensatory epidemic at any time. There is also a lack of a meningococcal vaccine. There are no compulsory vaccinations against chickenpox, which attacks enormously every year (140 children a year, of which around 000 are treated for serious complications). It is a minor disease if a healthy preschooler falls ill with it, but if it is a child with impaired immunity, the effects can be dangerous (including death). There is a vaccine against chickenpox in Poland. It does not apply to all children for financial reasons. However, many parents decide to buy it. As you can see, our calendar of obligatory preventive vaccinations should be extended. Fortunately, vaccination against Haemophilus infuenzae type B, the so-called Hib, which are bacteria that cause severe meningitis and severe sepsis in young children.
– What do you think should be entered in the calendar first?
– You absolutely need to introduce a pneumococcal vaccine. There should also be vaccinations against chickenpox. The most important are the risk groups, especially children with immunodeficiency, premature babies, and children at risk of cancer. Combined vaccines should also be used much more widely in children, because they are modern, highly purified vaccines. In them, decreasing numbers of antigens are administered. A modern vaccine, the so-called acellular, cell-free vaccine, is based on 1-5 proteins. Combined vaccines have significantly less antigenic loads than the classic vaccines.
– There is a possibility of recommended vaccinations financed from private funds. How often do parents use it?
– It is often a serious expense, it is determined by pro-health education. More than once I have been, and still am, a witness to the following situation: here a quite poor family buys a modern vaccine for their child, for which money has been raised on the occasion of baptism, from invited guests. This is the most beautiful gift that your loved ones can give your child. Too bad it’s not that common.
– What vaccines should parents choose for their children?
– I would recommend the rotavirus vaccine in the first place due to the very short period in which this vaccine can be given to a child (from 6 to 24 weeks of age) and the pneumococcal vaccine mentioned above. As well as selected combination vaccines. The Polish Vakcynological Society is preparing indications for the needs of the Ministry of Health, in which we define what is important for today, in a year, in two. However, a multiannual program of extending the scope of vaccination must be established. We have been talking about it for a long time.
– We can calculate the cost of vaccinations, can we also answer the question of how much is not vaccinated? After all, it is also about the broad socio-economic context.
– For some disease entities, there are calculations based on pharmacological effectiveness. For example with regard to the human papilloma vaccine, which is an important causative agent of cervical cancer. In Germany, when discussing the introduction of varicella vaccination into the vaccination calendar, only the cost of treatment was considered first, which did not indicate the significant budget benefits of vaccination, when hospital treatment was added, it turned out that vaccination is profitable when the cost of maternal absence from work was recalculated. Due to childhood illness, the financially rationality of vaccination became obvious. Such analyzes are not carried out in Poland, and the holders of public money do not fully understand the fact that prophylaxis is the most profitable, and vaccination is an important and beneficial investment from the point of view of public health and state finances.
– Sometimes, after all, parents are afraid of vaccinations?
– We explain and explain that a vaccine is a substance designed to induce and strengthen the body’s defenses, so that in contact with a virus or bacteria it can cope with and fight the threat. A vaccine is either killed or live bacteria that are devoid of infectivity. Recently, vaccines with modern structures, such as acellular vaccines, have appeared. Not the entire bacterial cell is taken, but only a fraction of it. This is enough to induce the desired immunity. Over the last half-century, there has been a real revolution in the design of vaccines.
– What is it?
– There are several directions in the development of modern vaccines. First of all – combination vaccines, even 5-6 valent, ie giving several vaccines against several diseases in one dose. The world continues to move in this direction because vaccines are safe, effective, and more comfortable for children to administer. The second direction is nasal vaccines administered in drops or aerosols, for example against influenza. The third direction is oral vaccines, “encoded” in genetically modified plants, eg lettuce immunizing against hepatitis B. Today we have oral rotavirus vaccines that stimulate local immunity in the gastrointestinal tract, i.e. in the place where the infection occurs.
– Is the combination vaccine not too high a dose for a small child?
– This type of modern vaccines are highly purified. In them, decreasing numbers of antigens are administered. For example, the classic whooping cough vaccine is made up of 3000 protein substances. In contrast, the so-called acellular, cell-free vaccine is based on 1-5 proteins. Combined vaccines have significantly less antigenic loads than the classic vaccines.
– What vaccines are we waiting for?
– The search for vaccines for various diseases is expanding. The AIDS vaccine has been the most anticipated for many years.
Material prepared for the workshops in the series “Quo vadis medicina?” entitled: “Vaccinations as a pass to health”, organized by the Association “Journalists for Health”, March 2010