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Obtaining resistance to a given pathogen is a combination of many factors, and it will not always be a lifelong immunity. Do the vaccines we took as children still protect us? What is their effectiveness? Should we repeat some vaccinations? Doubts regarding the operation of vaccines are dispelled by Maciej Pawłowski, MD, PhD, a pediatrician who also deals with travel medicine.
- The Polish calendar of compulsory vaccinations for children for 2022 includes the administration of eight vaccines. They protect against tuberculosis, hepatitis B, rotavirus, diphtheria, tetanus and whooping cough, polio, Hib, pneumococcus, measles, mumps and rubella
- Vaccination schedules differ, because, for example, tuberculosis requires one dose of the vaccine, and we will have full immunity to polio after taking four doses.
- The doctor explains what about our resistance to diseases against which we were vaccinated in childhood
- The expert also advises on what to get vaccinated on in adulthood
- You can find more such stories on the TvoiLokony home page
Monika Zieleniewska, Medonet: The effects of various types of vaccines are still the subject of intense research, and scientists are also constantly working on understanding the behavior of our immune system. How could we easily explain what makes some vaccines protect us for life and others don’t?
Dr. Maciej Pawłowski: This is quite a difficult question, it depends on the type of vaccine, the mutation of the virus, the need to protect certain social groups, not the entire population, etc. In simple terms, depending on the pathogen and the type of vaccine (containing live or inactivated bacteria or viruses), vaccine antibodies persist for different period. It is not that these preparations immunize us against all diseases. This value is variable, let’s take e.g. influenza viruses that mutate and therefore have to be vaccinated every year.
Which preparations given in childhood give us the longest protection?
It is generally accepted that after adopting the full childhood immunization regimen, we gain lifelong protection against: tuberculosis (BCG – single dose); hepatitis B (HBV – three doses); measles, mumps and rubella (MMR – two doses); Haemophilus influenzae type B (Hib – four doses).
I can see a lot of changes compared to my immunization schedule.
The vaccines I have listed have been used before and are well tested. This year, nothing has been added to the compulsory vaccination calendar. However, this calendar is changing, maybe not from year to year, but still. In 2017, pneumococcus was vaccinated with a 10-component preparation that is not vaccinated in adults. For adults, it is intended for 13 components. You can also vaccinate children with it, but it is a paid vaccination, we will vaccinate children belonging to risk groups for free. I mean, for example, premature babies with low birth weight. Last year, there was also vaccination against rotavirus (RV), a three-dose oral vaccine. We have been using the remaining vaccines listed in the calendar for over a dozen years. Thus, measles with mumps and rubella entered the vaccination calendar in 2004, Haemophilus influenzae in 2007, and hepatitis B in the 90s. In a word, most vaccines have been used for at least a dozen or so years.
So is there a possibility that some vaccinations will soon be removed from the calendar?
So far, the diseases for which we must vaccinate are present in Poland, although the incidence of some is decreasing. That is why we will probably abandon tuberculosis vaccination one day. There is a chance if the incidence does not exceed five cases per 100. If it is low enough, compulsory vaccinations are dispensed with, and only performed in children at risk or at the parents’ request.
In some Western European countries, there are no vaccinations for tuberculosis, because this disease hardly happens there. For example, if there are one in a million cases, there is no need to vaccinate the entire population, but when there are XNUMX out of a million cases, then you have to.
It seems to me that, apart from the vaccination against tuberculosis, also the hepatitis B vaccination may soon be optional. However, I do not think that we will give up on it in a year or two, because we vaccinate after birth since 1996 (with some of the older years vaccinated) and still a large percentage of Poles are not vaccinated.
Were the groups that were not required to be vaccinated in childhood, because they were entered on the list later, vaccinated?
This was the case, for example, after compulsory vaccination against hepatitis B was introduced in the 90s, and a catch-up vaccination program was carried out. Catch-up vaccinations, or those administered later, were administered to people born after 1986. Currently, according to the calendar, they are administered in the first year of life. I was born in 1988 so I was not vaccinated at birth. I was vaccinated when I was nine. However, those who were born even earlier did not get it at all. Therefore, it is worth supplementing this vaccination, especially since it is recommended by surgeons before surgery.
Let us now list vaccinations that should be repeated, because our body loses the immunity acquired in childhood over time.
Vaccination against diphtheria, tetanus and pertussis should be repeated every 10 years. The last dose of whooping cough vaccine is given to children between 13 and 14 years of age, and in fact in some cases the immunity wears off even after five years. The last compulsory vaccination is scheduled for 18 years of age, but only for diphtheria and tetanus, already without whooping cough. Of course, after the age of 18, vaccinations are paid. A similar dose of the vaccine for diphtheria, tetanus and whooping cough is also recommended for women of any pregnancy. The idea is that whooping cough can be severe in newborns and breastfed infants whose mother does not have antibodies, and babies are not first immunized until they are six weeks old. In Poland, whooping cough is still present, but it is underdiagnosed. There are many people with chronic cough, usually such patients are given an antibiotic without testing for antibodies, because the diagnosis would take several days and would be fully paid.
What is the situation with polio?
It is not necessary to remind the vaccination, but if someone has not been vaccinated, it should be done due to the increasing migration of people and the possibility of bringing the disease from another country.
As for the triple vaccine against diphtheria, tetanus and pertussis, we should take a booster dose for tetanus after five years. Anyway, if we step on a rusty nail, we will get a vaccine at the HED or emergency room. I repeat, the vaccine is recommended to be taken every 10 years, but you can get vaccinated after five.
Check it out – do a pack of six blood tests to check your immune system
What about measles?
From 1975, vaccination against measles was compulsory in Poland, but only against it. Now children receive a combination preparation for measles, mumps and rubella, there is no vaccine on the market, only for measles. Those who were vaccinated only for measles in their childhood were vaccinated with a second dose of this combination preparation. Now the children get two doses of the measles, mumps and rubella vaccine, and no vaccinations are needed.
In contrast, people who have been vaccinated only for measles should get vaccinated against mumps and rubella. If you are not sure if you have had measles, mumps or rubella, for example, because you may have been poorly or asymptomatic, you can test the antibodies in your blood. Taking the vaccine, even if someone was ill 40 years ago, is not a mistake, but you will have to pay for the preparation.
What is the probability that an unvaccinated adult will now contract measles, mumps or rubella?
As for measles, the incidence is increasing because immunization of young children is decreasing. In the past, the percentage of vaccinated persons was over 95%, and now about 90. Fewer and fewer parents are vaccinating their children, which is why measles is more common. The disease can be severe in people who are immunocompromised, debilitated or taking immunosuppressive drugs. The vaccine is registered for adults. However, it cannot be given during pregnancy, because it is a live vaccine, similar to the one for chickenpox, so it is worth getting vaccinated before a planned pregnancy, if the woman has not been fully vaccinated before. There are also no contraindications when it comes to age.
In that case, let us remind you which vaccinations and when can we take for free?
We will get vaccinated against tuberculosis free of charge in Poland up to the age of 15. This is important because someone might not have had this vaccine, for example because they lived as a child in England or Denmark, where there is no obligation to vaccinate against tuberculosis. If this person will live in Poland for more than three months, he or she is obliged to undergo vaccinations in force in our country. These are the rules. Up to the age of 15, this vaccination is free, if a 13-year-old with his parents comes to Poland, they can get it free of charge, but a 17-year-old who has not been vaccinated before cannot.
The rest of the vaccinations are free until the age of 19. So, for example, a person who turns 18, and their parents did not want to vaccinate them for some reason, decides that they want to get vaccinated against measles, mumps and rubella can do it free of charge until they turn 19. In addition, if she starts the regimen before the age of 19, she will also receive the second dose (the dosing interval is at least four weeks) free of charge.
Which diseases should we especially vaccinate against in adulthood?
It is known that our wallets will not withstand all vaccinations, so I would suggest you think about getting vaccinated for diphtheria, tetanus and whooping cough every 10 years. In addition, if someone has not been vaccinated against hepatitis B, they should also get vaccinated.
In addition, I would recommend the elderly to vaccinate against pneumococci, due to the dangers of infection, including pneumonia. And, of course, let’s not forget the flu vaccination. It is worth getting vaccinated against the flu every year, although few people do it, despite the recommendations.
People over 50, especially those with comorbidities such as: asthma, COPD, renal failure, heart disease, should take a pneumococcal preparation. There are two 13- and 23-component vaccines on the market. The regimens vary, but in simplified terms, this is the administration of two doses of the vaccine (13- and 23-component) in succession. You can also get vaccinated against hepatitis A, i.e. food jaundice. In this case, there are no compulsory vaccinations. Two doses are taken and the vaccination will last a lifetime.
We still have a preparation against Hib to discuss.
Haemophilus influenzae type B is a bacterial infection that can cause inflammation of the meninges, lungs, middle ear, epiglottis, and general bacterial infections. They can be severe in young children. Until recently, Haemophilus influenzae type B was a fairly common cause of sepsis, now sepsis is most often caused by meningococci. We also have meningococcal vaccination, but it is optional and quite expensive. We are giving two different vaccines as there is no one that provides protection against all serotypes. You have to give the preparation for serotype B separately and the preparation for A, C, W-135 and Y separately. In Poland, serotype B is dominant, it is responsible for about 60-70 percent. meningococcal sepsis in young children.
We administer the vaccine according to a multi-dose schedule, depending on the patient’s age and the type of preparation. The rule is: the smaller the child, the more doses. If each costs about PLN 300, it is a considerable expense, although it is definitely better always to get vaccinated than to be exposed. Pneumococcal sepsis is not common, precisely because we have vaccinations. Also, Haemophilus influenzae sepsis, which was once frequent, is expiring because of vaccination. Currently, we have meningococcal sepsis, which is associated with the lack of compulsory vaccinations. The Haemophilus influenzae type B vaccine is approved until the age of six, as young children are particularly prone to this type of sepsis. There are no recommendations regarding the administration of booster doses to adults.