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Until recently, it seemed that medicine had achieved lasting success in the fight against infectious diseases. Thanks to vaccines, we have overcome polio, and thanks to antibiotics, we have overcome scarlet fever. However, we are increasingly seeing forgotten infections returning. In Poland, doctors are particularly concerned about whooping cough and measles, about which Barbara Hasiec, MD, a specialist in paediatrics and infectious diseases, talks.
- The return of diseases we considered forgotten has many causes. Among them are, among others vaccination evasion, but also climate change or immunity that disappears over time
- According to Dr. Barbara Hasiec, we currently have the greatest problem with whooping cough and measles in Poland
- Doctors are concerned that the pandemic will reduce vaccination levels. “It seems to me that the 2016 immunization rate of 86% will decline, and this will set the stage for compensatory epidemics. In the case of infectious diseases, there is no other option: we either get sick or get vaccinated »- says the expert
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Why has it not been possible to completely eliminate infectious diseases?
Here are some key reasons:
1. Resignation from vaccinations. Most parents choose to vaccinate their children, but so are the number of those who delay or stop vaccinating altogether.
Meanwhile, a high percentage of unvaccinated people in a community increases the risk of infection not only for them, but also for those who get vaccinated. This is because no vaccine is XNUMX percent effective.
2. Declining or insufficient immunity. The number of cases of measles, whooping cough and mumps is increasing worldwide. While lack of vaccination is certainly a deciding factor, there is another potential culprit: insufficient or declining immunity.
Many people who get sick have been vaccinated at least partially. For example, pertussis vaccine is effective in about 80-90 percent. after the first dose. The effectiveness of the mumps vaccine is about 88 percent. after taking two doses.
Vaccines work because they stimulate the immune system to fight a specific pathogen – a virus, bacteria or toxin. It’s a powerful weapon, but it doesn’t guarantee immediate or lifetime immunity. Our immune system, if not re-exposed to the pathogen or vaccine, can lose its ability to make antibodies and therefore not fight the infection.
Further part below the video.
4. Drug resistance. The discovery of penicillin in the late 20s made diseases that once meant certain death curable. Humans have found a way to prevent disease, but viruses and bacteria are adapting as well. Tuberculosis killed approximately one in seven patients. Successful treatment has led to a decline in incidence rates, however, drug-resistant tuberculosis is emerging worldwide. The reasons for the development of drug resistance vary, although the key issue is how and when these drugs are used.
- Also read: Tuberculosis is a forgotten disease? Poland in the infamous forefront of Europe
5. Disease-causing bacteria. Most of these bacteria respond to antibiotics, although some may be resistant. Besides, antibiotics kill both good and bad bacteria. Without the good bacteria that protect us, the bad ones can multiply and spread faster. In addition, taking antibiotics can lead to the mutation of some bad bacteria and their resistance to drugs. One of the most important steps in fighting drug resistance is changing the way you use and prescribe antibiotics.
- See also: Superbugs attack. A quiet XNUMXst century pandemic that kills millions
6. Climate change. Global warming is conducive to the recovery of many diseases. Extreme weather phenomena, always posing a threat to our health, are becoming more frequent. Heavy rains and floods can contaminate water resources and outbreak epidemics such as cholera. In addition, the warmer water temperature means that cholera bacteria are present in areas where they would not have survived before. Rising water levels are likely to move entire communities to cities where disease is spreading more easily. Health experts predict that the changing climate is likely to exacerbate current health problems, especially in areas where healthcare is less developed.
Infectious diseases in Poland. Whooping cough and measles are of the greatest concern
Monika Zieleniewska, MedTvoiLokony: Which of the recurring infectious diseases should we look at?
Dr Barbara Hasiec: Of all the viral and bacterial diseases that can be prevented through vaccination, whooping cough and measles are the most important.
Whooping cough is a highly contagious bacterial disease characterized by prolonged bouts of coughing.
Before the introduction of preventive vaccinations, we had epidemics of whooping cough in children in Poland every three to five years, and the number of accompanying cases was about 200. Vaccinations, which began in the 60s, cut infections by almost 75%. and it is a huge success of medicine. We have recognized whooping cough as a controllable disease. This was the case until the 90s, but now, due to the scale of the disease among children, we consider it a threat to public health.
- The editorial office recommends: The doctor warns: most Poles have no immunity to whooping cough
What are the reasons for the increase in whooping cough incidence do you see?
In countries that stopped seeing cases in children, doctors withdrew from vaccination for various reasons, so the percentage of vaccinated people decreased. In order to obtain population immunity, i.e. to prevent infections in a given community, it must be above 90%. In addition, we had, and this is another success of medicine, more precise laboratory diagnostics, we detected more cases. When the disease was absent, we switched to acellular vaccines which are less effective. At the same time, the pathogen began to flee from the vaccine, and new strains of Bordetella pertussis appeared, different from those used in vaccines.
Who was most at risk?
The infections affected adolescents and young adults. This was an additional problem because these young adults, often already parents, were a threat to toddlers and infants, and that is why pre-vaccinated babies constituted the largest group of patients.
Has the vaccination strategy changed as a result?
In Poland, we vaccinate from the sixth week of life. I would like to add that after a natural infection with whooping cough, the immunity is not permanent, it lasts about 10-15 years from the moment of getting sick, so those who have contracted the disease must be vaccinated anyway to maintain population immunity. At the moment, we are trying to vaccinate not only adolescents according to the vaccination schedule, but also young adults and parents. It is recommended that adults be vaccinated every 10 years. Just like health care workers, and also pregnant women, so that young mothers do not get sick and do not put their children at risk.
Probably the course of the disease in children and adults is slightly different?
Whooping cough in people who have a slightly lower immunity or in adults does not have to be typical. It may only be a paroxysmal cough, but long-lasting paroxysmal cough should be the basis for diagnosis of whooping cough.
What do our statistics say about whooping cough?
Some believe that the statistics cover 1 percent. all illnesses, and others that 36 percent.
This is a large spread …
Yes, but overall we have three times fewer whooping cough cases than the real number. And yet those who suffer from abortions in the course of the disease are a source of infection for particularly vulnerable people, i.e. young children. According to data from 2016, the vaccination rate for whooping cough in the world was 86%. In 2010, there were two compensatory epidemics in the USA. The first resulted in the death of 40 infants. Canada, Great Britain and the European continent have also suffered from similar epidemics. In Poland, the worst years were 2015 and 2016, when we recorded over 6. illnesses. The incidence was 17 cases per 100 thousand.
Supposedly, whooping cough disappeared again during the coronavirus pandemic?
The lockdown, which was supposed to limit the transmission of the coronavirus, has resulted in fewer whooping cough bacilli circulating in the population. We have fewer cases of illnesses, but at the same time I can see the dangers associated with this situation.
What?
First of all, children do not exercise their immune system, they stay at home, they do not get sick, so when they come into contact with a viable pathogen, the course of infection can be severe. We saw this between the third and fourth waves of the pandemic. Children who were admitted to the ward with infectious diseases suffered very hard from infections. The second issue is an ongoing national discussion by nonprofessionals about vaccination. It causes people to delay immunization or not get vaccinated at all. This situation is also influenced by access to health care, I suppose that preventive vaccinations in the area are now a bit worse than before the pandemic. There are many reasons – I would mention the fear of going to the clinic, the COVID-19 infection or the fear of vaccination itself. These concerns apply to all vaccinations. It seems to me that the 2016 immunization rate of 86% will decline, which will prepare the ground for compensatory epidemics. In the case of infectious diseases, there is no other option: we either get sick or get vaccinated.
So what do we know about recurring measles?
Measles, even in the period before the pandemic, aroused great emotions, because we vaccinate with live attenuated vaccine. Certain groups of society cannot be vaccinated, it is mainly about small children, because we vaccinate from 13 to 15 months of age, as well as children with reduced immunity, diagnosed with cancer, after organ transplants and after immunosuppressive treatment. We have a large group of children who cannot be immunized and who need to be secured. We protect them through the cocoon effect, in other words, through the high vaccination coverage of the population.
What percentage of the population needs to be vaccinated?
The measles virus has a high reproductive rate, so to be safe it must be around 95 percent. We have not managed to achieve such a high rate. In addition, we have different immunization rates, as some children receive one dose of the vaccine, and some receive two.
- See also: We’ve lost herd immunity to measles
And there are also anti-vaccines …
We still have a rumor linking the measles vaccine to autism. Anti-vaccine workers refer to work from the 90s, which has long ago been verified as untrue. Unfortunately, false courts have been lingering in Poland for 30 years, autism in various forms still returns and generates problems with vaccinations. Over the years, despite hundreds of studies, it has not been possible to undo it.
- Read: Anti-Vaccine Guru. It was he who linked autism with vaccinations
Were there such problems with the measles vaccination from the start?
In our country, the history of measles vaccination is quite short. General vaccinations have been in place since 1975. First it was one dose, but in 1991 we introduced a second dose for children 10 years of age, and basically from 2004, two doses are needed. However, the situation in Poland is also influenced by what is happening in Europe. In 2018, we saw a high percentage of measles cases in Ukraine, almost 32. Likewise, in Our Country, Serbia, but also in other countries – France, Greece, Italy and the UK – the statistics show the number of cases reaching thousands. Until this year, several hundred cases were registered in Poland, but in 2019 we recorded a compensatory epidemic, 1500 children contracted measles, half of which were hospitalized due to the severe course of infection and complications.
Sounds like a serious warning sign.
Let us remember that the “success” of measles is that, first of all, as a viral infection it is very difficult, it causes various types of complications in the acute stage – laryngitis, severe encephalitis or pneumonia. In addition, during the period when measles was not controlled by vaccination, we observed children developing subacute sclerosing encephalitis syndrome (SSPE) after having had measles.
Now, after the epidemiological situation with not vaccinating children has worsened, we can see that this disease is coming back. Poland and the European Union countries have quite well-set vaccination schedules, and yet SSPE cases do happen. The matter is serious because measles is one of the top five causes of death in children worldwide. And because we are active in tourism, we can transfer it to Poland from unvaccinated populations. Combined with a drop in vaccination coverage below 95 percent. it is a huge threat.
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Because?
Because the most vulnerable ones, i.e. infants up to 13 months of age and children at risk, will start to get sick, and they will be helpless in the face of this disease. We don’t have a measles cure. While young children have a good immunization rate, in the older population, especially those aged 10-14, it does not exceed 10%.
It’s very little. Are you trying to do something about it?
We arrange more and more individual vaccination calendars and I would like the reason to be e.g. return from abroad, adjustment to the vaccination schedule from the Netherlands, Italy or Great Britain, but unfortunately, more and more often we come across children without any burdens, which due to unjustified beliefs of parents were not vaccinated.
I think that infectious diseases, which are the main indicator of morbidity and mortality in the world, through lack of vaccination or interference with their programs or pathogen change, will again become a huge problem. It is said that local epidemics are a kind of litmus test of whether the healthcare system is functioning properly. And yet it takes years to get the right level of vaccination. If it falls below the established limit, we will have to fight for a renewed immunity for a year, two or even three years.
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