Content:
- Editorial
- The results of the analysis of vaccination coverage data for selected preventable diseases in children in the Czech Republic – Hana Cabrnochová, Roman Chlíbek, Ladislav Dušek
- Vaccination of children against covid-19 – Daniel Dražan, Hana Cabrnochová
- Catch up schemes, recommendations for supplementing missing doses of vaccines as a part of mandatory vaccination in children – Hana Cabrnochová, Daniel Dražan
- Dengue vaccine poised for roll-out – Hana Cabrnochová, Daniel Dražan
Editorial
Zahájili jsme nový rok a ukazuje se, že vůbec nebude jednodušší než léta předcházející. Čelili jsme prudkému nárůstu respiračních onemocnění, kde klíčovou roli hrály tři základní patogeny – virus SARS-CoV-2, virus chřipky a RS virus. Tato vlna vedla k zvýšenému požadavku na analgetika, ale i antibiotika, na což náš systém nebyl očividně připraven. Důvodů je nepochybně celá řada a já si většinu z nich dovolím pojmenovat. Prvním je objektivní epidemiologická situace, která po mnoha měsících používání osobních ochranných prostředků vedla k vyšší kompenzační potřebě ve srovnání s předchozími roky. Dalším důvodem je naše významná závislost na producentech mimo Evropu, kdy suroviny například na výrobu paralenu jsou dominantně vyráběny mimo EU (60 % Čína a Indie). Selhal i evropský farmaceutický průmysl, který na základě předchozích let naplánoval nižší objemy produkce, aby nevyráběl na sklad. Roli hrají i migranti, kdy nárůst obyvatelstva o 500–600 tisíc s převahou vulnerabilních věkových kategorií má nemalý význam. Situaci zhoršuje chování obyvatelstva, které je schopno vykoupit v případě nedostatku vše, co se do lékáren doveze. V neposlední řadě nese svou roli SÚKL a MZČR, neboť intenzivní reakce nastala až deset minut po dvanácté, tedy v době, kdy už je opravdu krajně obtížné něco nakoupit v celé Evropě, neboť nedostatek je plošný. Zřízení jakékoliv komise mělo přijít o rok dříve. Věřme, že tuto dobu ve zdraví přečkáme a nebudeme muset léčit zábaly a česnekem.
Proto má vakcinace velký význam spojený s jejím preventivním charakterem. Ani zde však situace není příliš jednoduchá. Doba covidová výrazně zhoršila krizi důvěry v očkování, zejména mRNA vakcínami. Existuje významná část populace, která se přesunula na pozice tvrdých antivaxerů, a s tím rozhodně musíme bojovat.
S přáním pevných nervů v této nelehké době
prof. MUDr. Roman Prymula, CSc., Ph.D.
[články]
The results of the analysis of vaccination coverage data for selected preventable diseases in children in the Czech Republic
Summary:
Introduction: The analysis of vaccination data is a necessary prerequisite for the evaluation of vaccination programs and for the possible planning of vaccine consumption for the next period. At present, it is carried out according to the method of payment of vaccines and in relation to the legal obligation of vaccination, this obligation only applies to regular vaccinations. Data from health insurance companies on the number of vaccination doses reported, including the vaccines used in the case of regular vaccinations and for selected vaccinations covered by health insurance, have been available in the national register of paid health services since 2012 thanks to the change in the reimbursement of vaccines by amendment to Act No. 48 /1997 Coll. This national public administration information system enables analyzes to be carried out based on defined criteria within the framework of monitoring vaccination coverage for specific preventable diseases, the year of birth of the vaccinated and the time of administration of the vaccine. Based on the use of other registers, it is also possible to determine the number of administered doses of the vaccine in relation to the permanent residence of the vaccinated, i.e. data on the level of vaccination in individual regions of the Czech Republic.
For vaccinations not covered by public health insurance funds, we currently only have available analyzes and surveys carried out by various entities, usually commissioned by pharmaceutical companies with the aim of planning the consumption of vaccines for the next period. Vaccination can be affected by various factors. The increase is due to the introduction of vaccination reimbursement from public health insurance and sufficient capacity of vaccinating doctors to implement existing and new vaccination programs. An increase in the positive perception of preventive measures, i.e. vaccination, can also influence the improvement of vaccination coverage. On the contrary, a decrease in vaccination rates may occur due to the restrictive measures applied and the decrease in the availability of health care, which we experienced during the COVID-19 pandemic.
Vaccination of children: During the ongoing epidemic of COVID-19 in the Czech Republic, when a number of preventive antiepidemic measures were applied, there may have been a decrease in vaccination of children, similarly to some other countries. Vaccination data for 2020 and now also for 2021, including the prediction for 2022, show that there has been no decline in the smallest children, thanks also to the unlimited operation of pediatric clinics. According to a comparison of vaccination against measles, rubella and mumps in children born in 2015 (86.8%) and 2016 (88.3%), on the contrary, an increase in vaccination over 90% can be seen in those who were born in 2018 (90.3%) and continuing the trend is also among those born in 2019 (90.7%) vaccinated up to two years of age, i.e. in 2020 and 2021. The likely reason for the increase is both the maintenance of preventive care during the COVID-19 epidemic in the Czech Republic, as well as a more positive perception of the benefits of vaccination and a decrease in activities opponents of vaccination focusing on the vaccination of the youngest children and influencing public perception.
In the case of vaccination of children with the combined vaccine against diphtheria, tetanus, whooping cough, jaundice type B, communicable polio and invasive infections caused by Haemophilus influenzae type b (hexavaccine), high vaccination coverage continues while monitoring the parameter of administration of at least one dose of the vaccine until the child is one year old. For children born in 2020 and vaccinated in 2020 to 2021, the vaccination rate was 95.6%, for children born in 2019 and vaccinated in this and the following year 2020, the vaccination rate according to the defined criteria was 95.2%.
With regard to vaccination against pneumococcal infections in infants, we also managed to maintain the trend of a further slight increase in vaccination coverage from 73% in those born in 2019 to 74.6% in those born of 2020. Preliminary data for those born in 2021 predicts a further increase in vaccination coverage to 76 %. This trend is favorable not only with regard to the gradual increase in vaccination rates, but also with regard to the start of another immunization program for children in the first months of life, which means that vaccination against meningococcal infections is paid for with payment from the Ministry of Health from May 1, 2020. The implementation of this program took place during the period of the COVID-19 epidemic in the Czech Republic, i.e. in 2020 and 2021. The vaccination rate for children born in 2020 and vaccinated against meningococcal infections in this and the following year is 65.4% for meningococcus type B. In the case of serogroups A, C, W, Y and vaccination against these groups with a vaccine in the second year of life as of May 1, 2020, the vaccination rate is 50.2%.
Revaccination against diphtheria, tetanus and whooping cough (Tdap) in 2020 among five-year-old children vaccinated that year and the following year reached 89.7%, i.e. there was a slight decrease from 2017. A slight decrease can also be seen in the revaccination of older children with a combined vaccine against diphtheria, tetanus, whooping cough and against polio (Tdap- IPV) in children aged 10–11 years in 2020. Vaccination in these children vaccinated in the year they turned 10, but also in the following year (2021) reached 90.2%, while in the previous year it was 91.7%, even in 2018 it was a figure of 94.5% of vaccinated children that year and the following year.
For human papillomavirus (HPV) vaccination, there is a slight increase in the number of girls and boys vaccinated in 2020 and 2021. Among girls who reached 13 years of age in 2020 and were vaccinated this year and the following year, the coverage rate was 65.4%, preliminary the prediction for the following year assumes a figure of 62.5%. However, this number may be affected by the number of girls vaccinated only in the following year, i.e. in 2022. For 13-year-old boys vaccinated in 2020 and 2021, there is an increase to 40.1%. In the case of pre-vaccination for one year older boys vaccinated in 2021 and the following year, the figure of 41.4% of vaccinated boys can be predicted.
Conclusion: In 2020 and 2021, it was possible to maintain preventive care for children, and thus there was no decrease in vaccination coverage for both mandatory and optional (reimbursed) vaccinations for infants and toddlers. In older children at 5 and 10 years of age, there was a slight decrease in vaccination coverage in the case of booster doses against diphtheria, tetanus and pertussis, possibly together with revaccination against poliomyelitis at 10 years of age. We monitor vaccination coverage for a specific period, where various factors can affect the percentage of those vaccinated in this period. The regular vaccination reimbursement system does not strictly limit a specific age category. In contrast to vaccinations covered by health insurance, where payment is made when the terms of the administration date are met depending on the age of the vaccinated person, vaccinations can be supplemented later, especially for confirmed revaccinations at 5 and 10 years of age.
The limitation of the analysis is that it is carried out so far from national data obtained from health insurance companies and its time delay. In the future, we will not do without registers of vaccinations based on information obtained from the medical records of the vaccinated in the form of a system of electronic evidence of vaccination with the possibility of analyzing this data according to the legal authorization to collect and use the data.
Keywords:
vaccination coverage, mandatory vaccinations, hexavalent vaccine, vaccination against diphtheria, tetanus, pertussis and polio, measles, rubella and mumps vaccination, vaccination against pneumococcal infections, vaccination against human papilomavirus (HPV), vaccination against meningococcal infections, vaccination register
Hana Cabrnochová,1 Roman Chlíbek,2 Ladislav Dušek3
1Očkovací centrum pro děti, Pediatrická klinika 1. LF UK a FTN Praha
2Katedra epidemiologie, Fakulta vojenského zdravotnictví Univerzity obrany, Hradec Králové
3Ústav zdravotnických informací a statistiky ČR, Praha
Vaccination of children against covid-19
Summary:
Most cases of COVID-19 in children are asymptomatic or mild, and the risk of complications is much lower than in adults. Due to the number of reported cases in children, we also encounter complicated courses, the need for hospitalization and even stay in the intensive care unit (ICU). A rare complication for childhood is a multisystem inflammatory disease (in the literature referred to as MISC-C or PIMS-TS), which arises as a post-infectious complication of COVID-19. Although less often than adults, a significant percentage of children have long-term post-covid conditions referred to as long-covid.
Vaccination is recommended for all children, including those who have had the disease. Like vaccination, a natural infection does not provide complete or long-term immunity. Vaccination reduces the risk of reinfection and severe courses. Vaccination against COVID-19 is indicated for all children aged six months and over, infants younger than six months can be protected by vaccinating a pregnant woman.
The degree of effectiveness of vaccination against COVID-19 in children today depends on many factors. These factors include, but are not limited to, the vaccine used, the number of doses, the time since the last dose, the time since the previous infection, age, immune status and more.
In childhood, mRNA vaccines are predominantly used. Their safety has been unequivocally proven. Billions of adults were vaccinated before childhood vaccination began, and millions of children are now safely vaccinated.
Keywords:
COVID-19, children, clinical manifestations, complications, risk groups, vaccinations, vaccines, adverse effects of vaccination, safety, efficacy, contraindications
Daniel Dražan,1 Hana Cabrnochová2
1DD ordinace, Jindřichův Hradec
2Očkovací centrum pro děti, Pediatrická klinika 1. LF UK a FTN Praha
Catch up schemes, recommendations for supplementing missing doses of vaccines as a part of mandatory vaccination in children
Summary:
In the practice of vaccinating physicians, we encounter the need to make up missing doses of vaccination, non-compliance with the intervals between doses, late initiation of vaccination, the need to supplement vaccination in children vaccinated abroad and the use of other combined or monovalent doses of vaccines. While the vaccine manufacturer defines so-called minimum vaccine dose intervals, maximum intervals are not given because missing a dose always means insufficient protection against preventable diseases. Nevertheless, in these situations, we are obliged to make up the missing dose as soon as possible, followed by a reflection on the need and number of missing doses, the intervals for the next necessary vaccination, taking into account both the age of the child and possible risk factors. In very exceptional situations, the vaccinator may also check antibody response levels, usually after the missing dose of vaccine has been completed.
Keywords:
catch up schemes, mandatory vaccinations, hexavalent vaccine, vaccination against measles, rubella and mumps vaccination
Hana Cabrnochová,1 Daniel Dražan2
1Očkovací centrum pro děti, Pediatrická klinika 1. LF UK a FTN, Praha
2Ordinace praktického lékaře pro děti a dorost, Jindřichův Hradec
Dengue vaccine poised for roll-out
Summary:
Dengue fever is an infectious disease caused by the dengue virus, transmitted by mosquitoes. Dengue fever is also known as “bone-breaking fever”. It is capable of causing pain in the affected person that feels like the pain of breaking bones. Other symptoms include fever, headache, a skin rash – not unlike measles, as well as muscle and joint pain. The disease may progress to haemorrhagic fever, which causes haemorrhage associated with a significant reduction in the number of platelets, or dengue shock syndrome, which causes dangerously low blood pressure.
Keywords:
dengue, viral hemorrhagic fever, vaccine, vaccination, mosquitoes, clinical trials
Vanda Boštíková
Katedra epidemiologie, Fakulta vojenského zdravotnictví, Univerzita obrany, Hradec Králové