Vaccination – for or against? For!

Oleg Ternovenko, Weekly "Pharmacy"

One of the issues of concern to both doctors and ordinary citizens of Ukraine is the immunization campaign against measles and rubella, which is associated with the death of a schoolboy from Kramatorsk. The great resonance of this event and the one-sided nature of the information provided in the media has led to the fact that the anti-vaccination movement has unfolded in full force in Ukraine, many cases of parents refusing routine vaccination of children are registered. Many doctors began to sound the alarm – after all, a sharp decrease in the coverage of routine immunization can result in outbreaks or even epidemics of infectious diseases, harm caused to the health of the population, and economic losses can be very serious. In order to inform the population about the importance and necessity of immunization, a round table on the topic "The value of vaccination" was held on June 26, 2008, initiated and conducted by the public relations agency "GCI Kyiv". The sponsor of the event is GlaxoSmithKline Pharmaceuticals Ukraine LLC. The issues discussed by the participants of the round table are related to the relevance of vaccination as an effective method of combating serious diseases.

In order to dot the "I" before the journalists asked their questions, there was a report on the value of vaccination prepared by Lyudmila Chernyshova (L.Ch.), Doctor of Medical Sciences, Professor, Chief Pediatric Immunologist of the Ministry of Health of Ukraine, Head of the Department of Pediatric Infectious Diseases and Pediatric Immunology of the National Medical Academy of Postgraduate Education named after P.L. Shupik.

A vaccine is a biological preparation designed to create immunity in humans to pathogens of infectious diseases. The composition of vaccines may include live weakened, killed microorganisms or products of their vital activity. Vaccines may contain a whole microorganism or some of its antigens.

Immunization goals:

1) immediate – prevention of disease in individuals;
2) remote – elimination of the disease in the population.

It is well known that disease prevention is easier and more affordable than treatment.

Vaccination is one of the greatest achievements in the field of social health in the world.

After providing clean drinking water, immunization has the greatest impact on reducing and preventing the occurrence of infectious diseases. Today, 26 diseases can be prevented with the help of vaccination.

Some facts about the achievements of vaccination in the world:

• smallpox has been eradicated;
• Polio (North and South America, Europe, East Asia and the Pacific) – eliminated;
• measles (North and South America, most of Europe) – controlled infection;
• effective reduction of morbidity (tetanus, diphtheria, whooping cough, rubella, meningitis (caused by Haemophilus influenzae type b and Neisseria meningitidis serogroup C), liver cancer: hepatocellular carcinoma (caused by hepatitis B virus);
• through vaccination, at least 3 million child deaths are prevented every year in the world and, very importantly, 750 thousand babies avoid a wheelchair.

But there are people who oppose vaccination, which, in their opinion, is harmful or inappropriate.

The paradox of the situation lies in the fact that it is the effectiveness of immunization that leads to the emergence of the anti-vaccination movement. This is due to the fact that with effective vaccination, cases of diseases for the prevention of which it is carried out become increasingly rare, the circulation of pathogens decreases. At the same time, cases of post-vaccination reactions and complications that are inevitable with any medical manipulations come out in the first place, which gives rise to the anti-vaccination movement.

The results of such counteraction are dangerous: vaccination coverage is decreasing, immunization is beginning to be seen as a cost rather than an investment, the government is reducing funding for vaccination programs, the population is wary of it, cases of refusal to carry it out are becoming more frequent, even if vaccines are provided free of charge.

A good example is the situation in Japan in the 70s of the twentieth century, when, as a result of the high effectiveness of vaccination, the number of reported cases of whooping cough decreased.

This led to the decision to cancel the immunization of DPT (whole-cell pertussis-diphtheria-tetanus vaccine). A few years later, this caused an outbreak of morbidity associated with a high percentage of people in the population who are not immune to pertussis, and vaccination was resumed with AaCDS (acellular pertussis-diphtheria-tetanus vaccine).

The effectiveness of immunization cannot be proved by the example of one child, it is analyzed on a population scale. However, a vaccinated child may have post-vaccination reactions that need to be registered, but it is impossible to register the fact that the vaccine has saved him from diseases that can lead to serious complications. Post-vaccination reactions are much less dangerous than the consequences of diseases that the vaccine protects against. The greatest success that cannot be seen is all the people who do not suffer or die from vaccine–controlled diseases.

Insufficient awareness of the population leads to the fact that parents do not understand the meaning of routine vaccination of healthy children.

Another important point is that the media often earn a rating on this topic. Moreover, reports of post-vaccination reactions or complications attract maximum attention, such information spreads very quickly, becomes overgrown with rumors and myths. The preparation of messages and materials explaining the value of vaccination is not a pursuit of a rating, but a civic duty.

Positive vaccination results:

• prevention of diseases;
• easier their flow;
• parents' peace of mind for the child's health;
• doctor's confidence;
• reducing the burden on medical personnel.

Vaccination also brings significant economic benefits, which are difficult to calculate (the difficulty of assessing events that did not happen because they were prevented). There is a decrease in the number of hospitalizations, the cost of expensive treatment, as well as those related to temporary disability, prevention of epidemics, reduction of disability, reduction of labor productivity losses.

The problem of restoring confidence in vaccination is important today.

This requires a clear understanding of its value and the collective work of doctors. Each of them should provide parents with the most objective, complete information about the importance of immunoprophylaxis.

Doctors of all specialties should not advise against vaccination, even if their attitude to it is cautious or negative. Unfortunately, doctors also fall under the influence of myths and speculation about vaccination. In medical universities of Ukraine, few hours are devoted to the topic of immunoprophylaxis.

The decision to cancel vaccination should be made by the vaccination commission.

Fedor Lapiy (F.L.), Candidate of Medical Sciences, WHO certified trainer on vaccine prevention, assistant of the Department of Pediatric Infectious Diseases and Pediatric Immunology of the P.L. Shupik National Medical Academy of Postgraduate Education expressed full agreement that in Ukraine it is impossible to allow a decrease in vaccination coverage, it is very dangerous. It is also important to inform parents that there is a large selection of vaccines in Ukraine today.

A huge number of questions asked by journalists showed that the topic of vaccination is really very relevant now.

Here are just some of the issues that were discussed during the round table:

– How much has vaccination coverage decreased as a result of the anti-vaccination movement in Ukraine recently?

F.L.: There are no exact data for today. Immunologists face daily refusals from routine immunization of children. We can talk about a loss of confidence in immunoprophylaxis.

– How perfect is the modern vaccination calendar in Ukraine, is there any possibility to improve it?

L.Ch.: When developing a modern vaccination calendar, all available world data and developments were taken into account. There are disadvantages, however, I note that in comparison with most countries of the post-Soviet space, the vaccination calendar in Ukraine is closest to those adopted in European countries. It is regularly reviewed, this is done to improve the effectiveness of immunization.

F.L.: There is no limit to perfection. Many experts take part in writing the calendar, while they must take into account world standards and experience. Often, experts' opinions on the same issue differ radically, because the result of such work is always consensus, all arguments must be taken into account.

Mass immunization in accordance with the modern vaccination calendar is the only way to prevent the disease and reduce the circulation of the pathogen.

Collective immunity is most effective in preventing general morbidity.

An example of a controversial issue may be vaccination against hepatitis B, which causes a lot of discussion.

Vaccination is prescribed to persons belonging to such risk groups: medical workers; patients in need of taking blood products; drug addicts; homosexuals; healthy people whose families have carriers of HBs-antigen; children raised in orphanages.

The vaccination calendar in Ukraine provides for vaccination of children of the first months of life against hepatitis B. There is an opinion that only adults belonging to such risk groups should be vaccinated against hepatitis B.

However, it is necessary to take into account that there is a risk for children to become infected with hepatitis B in such situations: medical manipulations, injuries and serious diseases, contact with children and adults with hepatitis B, etc.

When hepatitis B occurs in the first year of life, a child is 90% likely to become its chronic carrier. Treatment of hepatitis B and its complications (cirrhosis and liver cancer) is very expensive, and often inaccessible to ordinary citizens in full.

Are parents sure that all relatives and acquaintances from the child's environment are not carriers of the hepatitis B virus, which is why vaccination against hepatitis B should be carried out in the first months of life. Then you can be sure that children will be protected from hepatitis B.

– Is there a system in Ukraine for assessing the condition of a child in a maternity hospital before vaccination, will the vaccine harm him?

L.Ch.: The BCG vaccine, which is usually administered to children in the maternity hospital, contains weakened microorganisms. Such vaccination is dangerous for children with congenital immunodeficiency. This is a fairly rare condition, but there are a number of criteria that can indicate the likelihood of such a congenital pathology and the need to refuse to vaccinate a child.

– Do parents have the opportunity to choose a vaccine manufacturer for their child during routine immunization, or should they be vaccinated only with a vaccine provided by the state?

F.L.: Yes, there is such a possibility. According to the legislation of Ukraine, a child can be vaccinated with a vaccine purchased by parents at their own expense. Each of the vaccines registered in Ukraine (purchased by the state or sold through a retail network) is evaluated according to a number of parameters: immunogenicity, safety, epidemiological effectiveness.

– Are your children vaccinated according to the National Vaccination Calendar?

F.L.: Yes, completely, in the maternity hospital and in the district polyclinic.

– How is the quality of transportation and storage of vaccines ensured, is it possible to be sure that they reach the consumer in proper quality?

F.L.: Each batch of vaccines is accompanied by a thermal indicator, and at each link of their transportation there is a responsible person who monitors compliance with the cold chain. In case of non-compliance with the conditions of storage and transportation, the vaccine is not allowed for use.

L.Ch.: Improper transportation has a certain effect on the immunogenicity of vaccines, without significantly affecting their reactogenicity.

Additional information on this issue was also provided by Tatiana Miroshnichenko, a representative of GlaxoSmithKline Pharmaceuticals Ukraine LLC. The company is one of the most famous vaccine developers and manufacturers in the world.

– The procedure for storing and transporting vaccines differs from that of other drugs.

Most vaccines are stored and transported at temperatures from +2 to +8 °C. When the vaccine is exposed to a temperature that is above or below the recommended range, its activity may decrease. Once lost, the activity of the vaccine is not restored when it returns to the correct temperature regime. The system that provides the necessary conditions for the storage and transportation of immunobiological drugs is called a cold chain.

It is also important to understand that even if vaccines are stored and transported at the right temperature, they do not retain their activity indefinitely. Therefore, you should pay attention to the expiration date indicated on the package.

The state dictates a number of rules and regulations regarding the transportation and storage of vaccines, compliance with which guarantees the effectiveness of vaccination.

GlaxoSmithKline Pharmaceuticals Ukraine LLC conducts constant audits of distributors, monitoring compliance with the cold chain during transportation and storage of vaccines.

At the end of the round table, experts urged media representatives not to chase sensations and conduct educational work with the population?– to convey objective information about vaccination.

The media often show examples of adverse reactions, but it should be borne in mind that parents of children who have suffered an infectious disease with severe consequences due to refusal of immunization often lock themselves in their grief, do not make contact and do not show a civil position, reporting through the media about their mistake in order to avoid its repetition by others. At the same time, parents of children affected by immunization are looking for the culprits, complain and are willing to contact the media.

Only complete, objective information from experts competent in vaccination issues will help to understand the situation and make a decision based on evidence-based medicine.

Portal "Eternal youth" www.vechnayamolodost.ru
09.07.2008