Vaccinations – a long life for everyone

Vaccinations are essential in the prevention of many serious diseases and in the protection of life, remind the initiators of the European Vaccination Week, which this year falls on April 24-30. He is guided by the slogan “Vaccinations – long life for everyone”.

The aim of the European Vaccination Week, celebrated on the initiative of the WHO Regional Office for Europe, is to raise awareness – among parents and carers, healthcare professionals, political, economic and economic decision-makers and the media – about the role of vaccination in protecting the health and life of children and adults.

In the last two years, this week’s celebration has taken place at a special time – the time of the COVID-19 pandemic. Therefore, in 2021, when vaccination against SARS-CoV-2 became available, much attention was paid to this topic. However, the Chief Sanitary Inspector constantly emphasized that it is also very important to vaccinate against other infectious diseases (such as whooping cough, measles, invasive pneumococcal disease, rotavirus diarrhea and chicken pox), in accordance with the Vaccination Calendar in force in Poland. This year, the celebration of the European Vaccination Week coincides in our country with the great challenge of providing vaccines to a large group of refugees from war-torn Ukraine.

NEW CHALLENGE

As announced on April 19, 2022 on Twitter by the Border Guard, about 2,84 million refugees from this country have entered Poland since the beginning of Our Country’s invasion of Ukraine. They are mainly women and children.

According to the data presented by the National Institute of Public Health – National Institute of Hygiene, it is mandatory in Ukraine to vaccinate children against: hepatitis B, tuberculosis, polio, diphtheria, whooping cough, tetanus, measles, mumps, rubella and Haemophilus influenzae infections. B (Hib). The fact that the vaccination calendar in Ukraine differs from the Polish Preventive Immunization Program for 2022 is the lack of compulsory pneumococcal and rotavirus vaccinations5.

The European Center for Disease Prevention and Control (ECDC) recalls that refugees from Ukraine may be more susceptible to certain infections because of the living conditions and situations they are exposed to while on the move.

Ukrainian children may be more susceptible to various diseases that can be prevented by vaccination, such as polio and measles. Children under the age of 6, in particular, may be at risk of polio due to insufficient immunization. In 2021, the overall percentage of Ukrainian children vaccinated against polio was 80%. It fluctuated depending on the age group and region of the country from 60%. up to 99 percent

Measles is an equally serious concern for ECDC experts, as coverage for two doses of a measles-containing vaccine in Ukraine in 2020 was less than 82 percent. and it was too small to prevent outbreaks.

Also, the level of vaccination against COVID-19 (the first series of doses) in Ukraine is significantly below the average of the European Union (EU) / European Economic Area (EEA) countries. Data from February 23, 2022 indicate that this percentage in Ukraine was 35 percent, while on March 1, 2022 the average in the EU / EEA countries was 71,7 percent. The data as of April 19, 2022 show that in Poland over 22 million 404 thousand are fully vaccinated. people (58,7% of the population). The proportion of vaccinated people in Ukraine is low among adults, including those over 60, who have the highest risk of complications from COVID-19.

Therefore, EDCD experts point out that refugees from Ukraine should have the same access to protection against infectious diseases in the form of vaccinations as residents of the country they are in.

The Polish Ministry of Health very quickly (as early as February 25, 2022) decided that people coming to Poland from Ukraine due to hostilities can get vaccinated against COVID-19 free of charge under the National Immunization Program. The Minister of Health points out that vaccination against coronavirus should be performed as widely as possible and should cover children aged five and older and adults.

The Ministry of Health also informed at the beginning of March this year that children staying in Poland in connection with the war in Ukraine should be vaccinated free of charge under the current Vaccination Calendar (Protective Vaccination Program – PSO for 2022). These vaccinations should be carried out in entities that perform therapeutic activities in the field of primary health care.

Priority was given to: measles vaccination with MMR vaccine (against measles, mumps and rubella) in children in the second year of life, vaccinations against diphtheria, tetanus, pertussis and poliomyelitis according to age, anti-viral hepatitis

type B according to age, vaccination against COVID-19 according to the National Program of Immunization against COVID-19.

Refugees staying in Poland for up to three months may get vaccinated voluntarily. However, everyone under the age of 19, staying in our country for more than three months, will be subject to mandatory vaccination.

VACCINATIONS AGAINST PNEUMOCOCKS – AN EXAMPLE OF SUCCESS

One of the two vaccines that distinguishes the Ukrainian vaccination schedule from the Polish one is the pneumococcal vaccine. It was introduced in our country from January 2017.

Pneumococci (Streptococcus pneumoniae), also referred to as pneumonia, are the bacteria that most often cause diseases of the upper respiratory tract: pharyngitis, sinusitis and bronchitis. These bacteria are the most common cause of otitis media, leading to permanent deafness in some children, and community-acquired pneumonia. Bacteria can enter the bloodstream and cause invasive pneumococcal disease (IPD) – pneumonia with bacteremia, meningitis, and sepsis (sepsis). The mortality rate due to IPD is high – it may exceed 50% in septic shock, and 25% in pneumonia with bacteremia.

The disease can also lead to permanent organ damage, especially the brain. There are many complications, such as hearing loss and deafness, neurological symptoms (e.g. epilepsy), difficulties in concentrating and learning. Pneumococcal infections are one of the leading causes of childhood morbidity and mortality in the world – more than 1,5 million people die from them each year, including about 1 million from pneumonia.

Pneumococcal infections occur in all age groups, however, small children up to 2 years of age and the elderly over 65 are exposed to the most severe course.

The introduction of pneumococcal vaccination has contributed to a decline in the number of IPD cases and deaths due to it worldwide. Since the introduction of the first conjugate vaccine in 2000, there has been a global reduction in the incidence of pneumococcal disease in children younger than 5 years of age. It is estimated that almost 2000 vaccines have been avoided since 200 thanks to universal pneumococcal vaccination programs. deaths.

In 2022, the 10-valent vaccine (PCV-10) is available for free as part of universal compulsory vaccination against pneumococci. It consists of the capsular polysaccharides of the following serotypes: 1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F. It is given in the so-called a 2 + 1 regimen, i.e. two doses of the primary vaccination in the first year of life and a booster dose in the second year of life.

Vaccinating children against pneumococci protects against meningitis, sepsis, bacteremia, pneumonia and otitis caused by the pneumococcal serotypes in the vaccine.

As indicated by the authors of the HTA Consulting report entitled Vaccinations against pneumococci in children in Poland – facts for 2020, already in the third year after the introduction of pneumococcal vaccination into PSO, high vaccination coverage was recorded – in the case of children born in 2017, it reached the level of 96%, and the available data indicate an equally high percentage among the 2018 class. Meanwhile, the average vaccination coverage in Europe oscillates around 92 percent. A high level of pneumococcal vaccination among young children is very important, because it also indirectly protects the elderly, who most often get infected from the youngest.

VACCINATION AGAINST ROTAVIRUS – AVOID HOSPITALIZATION

Rotaviruses are the most common cause of acute infectious diarrhea in infants and children up to 5 years of age. The most common diseases are children from 4 to 24 months of age, and the most severe course of rotavirus diarrhea is noted in children under 6 months of age, because their body is quickly dehydrated as a result of diarrhea and vomiting, and the child may die quickly.

Virtually every child gets rotavirus infection at least once, and some – multiple times. In Poland, 20 thousand. up to 50 thousand illnesses. However, over 90 percent. the reports concern hospitalized cases. The frequency of rotavirus infections, estimated by Polish epidemiologists, taking into account the data of the National Health Fund and the Chief Sanitary Inspectorate, is estimated at around 200. illnesses annually. From January 2021, rotavirus vaccination is free of charge for children born after December 31, 2020.

Vaccination is oral and protects 96 percent. before severe diarrhea requiring hospitalization and in a high percentage before gastroenteritis. Vaccine protection lasts for at least three years.

Under the Preventive Immunization Program, the first dose of vaccine is given to a child from the age of six weeks, and subsequent doses should be given before the age of 22 weeks (with an interval of at least four weeks between each dose) 29. Although the state budget proposes a three-dose vaccine, parents can finance their child’s immunization with a preparation used in the easier two-dose schedule.

VACCINATIONS AGAINST MENINGOCOCCOM – STILL OPTIONAL

In Poland, meningococcal vaccination is still recommended and therefore not financed from the budget of the Minister of Health. Everyone, regardless of gender and age, is at risk of developing meningococcal infection (Neisseria meningitidis). Most often, however, children under one year of age are sick. Many cases of the disease also occur in children up to 5 years of age, and adolescents and young adults aged 16–21 years.

Transmission of the meningococcus occurs by droplets (when coughing or sneezing) or by direct contact (e.g. during an intimate, deep kiss). Infections with these bacteria are generally sporadic, but occasionally they can cause outbreaks or epidemics.

Meningococci are the most common causes of meningitis or sepsis (sepsis), which are collectively known as invasive meningococcal disease (IChM). It is one of the most dangerous human infectious diseases. IChM develops very quickly, can also lead to death or cause permanent complications (varying degrees of hearing loss or brain damage, epilepsy, amputations of fingers or parts of the limbs, skin and subcutaneous tissue defects requiring transplantation, and emotional disorders). Therefore, a patient with suspicion should immediately be hospitalized. In meningococcal sepsis, as much as 50 percent. deaths occur within the first XNUMX hours from the onset of disease symptoms. Meningococci can also cause, although much less frequently, pneumonia, middle ear, pericarditis, endocarditis, arthritis, and others.

Among the 12 serological groups of meningococci, serogroups A, B, C, W, Y are dangerous. In Poland, about 150-200 cases of IChM are reported annually. It is mainly caused by meningococci of serogroup B (in 2019 as much as 66% of reported and confirmed cases), C (20%), and recently the share of meningococci of serogroup W.

Because in the age group up to 11 months of age, as many as 70 percent. meningococcal serogroup B infections occur, children under the age of one should be vaccinated against meningococci of this serogroup. One of the vaccines can be used from the age of two months before the baby.

Subsequently, children should be vaccinated against meningococcal serogroups C or A, C, W135 and Y. However, for wider protection, instead of vaccination against meningococcal serogroup C, it is best to have a vaccine that protects against the four meningococcal serotypes – A, C, W135 and Y.

VACCINATION AGAINST HPV – PROTECT AGAINST CANCER OF THE UTERINE

Currently, all cases of cervical cancer are believed to be preceded by chronic HPV (human papillomavirus) infection 41. There are 150 types of HPV that are pathogenic for humans, but the most oncogenic are types 16 and 18. They are responsible for precancerous lesions of the cervix and cervical cancer, but can also lead to cancer of the anus, oropharynx, vagina, vulva, penis.

HPV infection occurs sexually, often early after sexual initiation. During life, as much as 50-80 percent. sexually active men and women have been or will be infected with HPV.

After 10 years of HPV immunization programs, immunizing countries reported that as much as 85% the number of high-grade pathologies of the cervix has decreased. In Poland, vaccinations against the human papillomavirus (HPV) are currently recommended, i.e. not financed from the budget of the Ministry of Health. They are especially recommended for people before sexual initiation. Some councils offer free HPV immunization programs.

Since November 2021, the HPV type 16 and 18 vaccine Cervarix has been included in the list of reimbursed drugs. This means that patients can buy the preparation with 50 percent. against payment in all registered indications – in patients from 9 years of age for the prophylaxis of precancerous lesions of the genital organs and anus (cervix, vulva, vagina and anus) and cancer of the cervix and rectal cancer caused by certain oncogenic types of HPV.

ADULT VACCINATIONS – CONTINUED TO BE Neglected

On its website, the National Institute of Public Health – National Institute of Hygiene emphasizes that vaccinating adults is as important as vaccinating children. Adults are 100 times more likely to die from a vaccine-preventable disease than children. An example is the epidemiological data from the United States, where 500 children and 500 adults die each year from infectious diseases that can be prevented by vaccination.

An aging population is a significant problem, because with age, the immune system weakens and the body is more and more susceptible to diseases such as pneumococcal infections or the flu. In addition, for diseases such as diphtheria, tetanus and whooping cough, immunity acquired through past vaccinations decreases over time after the last dose of vaccine is given. Therefore, booster doses are indicated.

In Poland, compulsory, i.e. free, vaccinations are carried out until the age of 19. Adult vaccinations are recommended, and therefore paid vaccinations. However, adults in Poland still neglect vaccinations. For example, we are one of the last places in Europe in terms of flu vaccination status.

Adults are recommended the following vaccinations against:

Hepatitis B for all unvaccinated (three doses),

Flu (one dose every year at the start of flu season)

Diphtheria, tetanus and pertussis (dTap vaccine with reduced content of diphtheria and pertussis antigens) – booster dose every 10 years,

Chicken pox – for people who have not been ill and have not been vaccinated,

Tick-borne encephalitis,

Group B meningococci and group A, C, W, Y meningococci,

Hepatitis A for all unvaccinated,

Pneumococcus (conjugate vaccine),

MMR vaccination against measles, mumps and rubella for all unvaccinated.

INFLUENZA VACCINATION

Every year, several million people in Poland suffer from influenza and flu-like diseases. In the flu season, there are several thousand hospitalizations due to this disease and cases of deaths due to influenza and its complications.

Flu is particularly hard for: people over 65, children under 5, pregnant women, overweight or obese people, people with chronic diseases – heart and lungs, immunodeficiency (e.g. HIV infection), diabetes, congestive heart failure. These people account for nearly 90 percent. all deaths from influenza.

The effectiveness of the flu vaccine in people aged 18-59 is estimated at 70-90%. The efficacy may be less effective in the elderly and the chronically ill. However, even if the vaccine does not prevent influenza, it increases the chance of relieving symptoms and reducing the number of complications (especially respiratory and central nervous system, cardiological, nephrological, neurological, and cerebrovascular diseases) and the risk of death.

Because the flu virus changes rapidly, the composition of the vaccine is slightly different each year, depending on what strains of the virus cause flu in a given season. That’s why you need to get vaccinated against flu every year.

In 2021, the Ministry of Health expanded the list of people eligible for influenza vaccination reimbursement: free vaccines are available to seniors over 75 years of age and pregnant women. 50% reimbursement covers people aged 65–74, children aged 6 months to 18 and people aged 18–64 who suffer from comorbidities. In addition, many councils offer free vaccinations for seniors, and more and more employers are providing such vaccinations to their employees.

VACCINATION AGAINST POTHEROSIS

According to NIPH-PZH, whooping cough has ceased to be only a childhood disease in recent years. More and more often, adolescents and adults are affected. An increase in the number of cases has been observed in many countries, including Poland. In our country, there are 5000–7000 cases of whooping cough every year. The results of epidemiological studies indicate that there may actually be more of them.

Whooping cough (or whooping cough) is a highly contagious respiratory disease caused by bacteria called Pertussis (Bordetella pertussis) or Paracetate (Bordetella parapertussis). The infection occurs through airborne droplets. A characteristic symptom is the tiring paroxysmal cough that can last for many months (the common name of whooping cough is “well cough”). Giving an antibiotic kills the bacteria but does not heal the consequences of the disease. There are known cases of patients who cough lasted up to two years.

In adults, whooping cough can lead to complications such as emphysema, rib fractures, and vomiting. Persistent cough may be a threat to people who have undergone abdominal or thoracic surgery and hernias, and may lead to exacerbations of chronic obstructive pulmonary disease (COPD), aneurysm rupture or urinary incontinence.

The risk of a serious infection, like for other respiratory infections, increases with age. Men, obese people, diabetics, and patients with chronic obstructive pulmonary disease (COPD) suffer more severely.

When pertussis vaccine is given, immunity to the disease decreases over time (most often within 5–12 years after primary immunization). Therefore, in many countries, including Poland, a booster dose of pertussis vaccine for adolescents and adults has been introduced into vaccination programs. The Tdap vaccine is recommended (against diphtheria, tetanus and pertussis with reduced content of diphtheria and pertussis antigens).

The groups that need a booster dose of whooping cough vaccine are: adolescents 19 years of age (instead of a booster for diphtheria and tetanus only) and adults – single booster doses every 10 years. As whooping cough is one of the few diseases that spreads from adults to children, it is very important that booster doses are taken by healthcare professionals who come into contact with newborns and infants, as well as older people at risk of infection, women planning to become pregnant, or pregnant (after 28 week), people from the environment of newborns and infants.

Unfortunately, the awareness of adults about the need to vaccinate whooping cough in Poland is very low. The nationwide study on whooping cough conducted by KANTAR in March 2021 shows that only 3 percent. adult Poles took a booster dose of whooping cough vaccine.

VACCINATIONS AS AN OPPORTUNITY FOR A LONG LIFE

Vaccinations prevent millions of deaths worldwide every year. We currently have vaccinations that can prevent more than 20 life-threatening infectious diseases. They help people of all ages to live healthier and longer lives. Vaccinations help prevent 2-3 million deaths from causes such as diphtheria, tetanus, whooping cough, influenza and measles alone. It is also one of the most profitable health investments. And yet a lot of people in the world, including nearly 20 million children, still have insufficient access to vaccines.

A growing problem is the refusal of caregivers to vaccinate their children. In 2019, the World Health Organization (WHO) ranked the anti-vaccine movement and denial of vaccinations among the 10 most serious threats to human health in the world.

The data of the NIPH-NIH shows that in recent years the number of cases of avoiding compulsory vaccinations has increased significantly in Poland. In the last five years, it was a twofold increase, from 2 thousand. abrogations in 23 up to 2016 thousand in 50,5

Therefore, according to experts, constant education is very important, which will help build pro-vaccine attitudes in society. An important role can be played by, among others, introducing education on immunization into curricula, public debate on vaccination of adults, and preventing the spread of false information (fake news) on vaccination.

Press material prepared by the Journalists for Health Association in connection with the XXX edition of the Quo Vadis Medicina? Fri Vaccination practice in Poland and new challenges, organized on the occasion of the European Vaccination Week, April 2022.