Most parents are confronted with the issue of additional (recommended) vaccinations as early as the first year of their child's life. Is it worth extending the vaccination calendar and additionally immunising the child against various infectious diseases? The first part of the text on boosters discusses four serious bacterial infections against which there are effective vaccines, but which are not included in the mandatory vaccination calendar.
Table of contents:
- Protective vaccinations
- Protective vaccination - additional vaccination
- Haemophilus influenzae infections
- Streptococcus pneumoniae infections
- Neisseria meningitidis infections
- Pertussis (whooping cough) - acellular vaccine
Protective vaccination
Protective vaccinations are an essential tool in the control of infectious diseases. The most important vaccinations are considered to be those included in the obligatory vaccination calendar, which in our country include vaccination against:
- tuberculosis
- hepatitis B
- diphtheria
- tetanus
- pertussis (whooping cough)
- polio
- measles
- mumps
- rubella
In addition to the above vaccinations, there is a large group of diseases that can be prevented by additional vaccinations. The Chief Sanitary Inspector, who defines the rules for vaccination against infectious diseases in Poland, recommends to all or selected groups of patients additional vaccination against the following diseases:
- viral hepatitis A
- infections caused by Haemophilus influenzae group B
- infections caused by Streptococcus pneumoniae
- infections caused by Neisseria meningitidis group C
- tick-borne encephalitis
- influenza
- chickenpox
Additional recommendations also include suggestions to purchase newer types of vaccine on one's own instead of the older preparations routinely used (e.g. acellular pertussis vaccine instead of whole-cell vaccine).
Preventive vaccination - additional vaccination
The issue of additional (recommended) vaccinations raises many controversies and questions from parents. Many are afraid of over-stimulating their child with numerous vaccines. On the other hand, there are also parents pushing for all possible additional vaccinations to be carried out. Many parents think (wrongly!) that the recommended vaccinations should be given to every child and that the reason for their inclusion in the additional list is only financial, i.e. the lack of funds to buy vaccines for the entire population. To support this thesis, the vaccination calendars recommended in the richest countries of the world (e.g. USA) are cited, where, for example, vaccination of every child against chickenpox and against Streptococcus pneumoniae infection is recommended.
Extension of the vaccination calendar, photo: panthermedia
This paper will discuss in detail additional vaccinations that are not part of the compulsory vaccination calendar. We will try to indicate which of these should be performed in every child and which should be restricted to children in specific risk groups. In addition, the potential risks of contracting an infectious disease not covered by mass mandatory vaccination will be presented.
In the first part of the paper, we will discuss additional vaccination against selected bacterial diseases, which include:
- infections caused by Haemophilus influenzae group B
- infections caused by Streptococcus pneumoniae
- infections caused by Neisseria meningitidis
- infections caused by whooping c ough (acellular vaccine).
The second part will focus on viral diseases: smallpox, influenza, tick-borne encephalitis and hepatitis A.
Haemophilus influenzae infections
Haemophilus influenzae is a bacterium commonly found in the upper respiratory tract. Six serological types of this bacterium are known, designated by the letters A to F. Most strains of Haemophilus influenzae are a component of the normal bacterial flora of the human nasopharyngeal cavity. However, there are highly pathogenic so-called envelope strains among them - categorised as type B (Haemophilus influenzae type B - HiB).
HiB infection is particularly dangerous in children under the age of three, and can cause very serious, life-threatening infections: meningitis, septicaemia, pneumonia or epiglottitis, which can cause severe respiratory failure. HiB is one of the three most common causes of meningitis and septicaemia in children. In countries that have introduced mass vaccination against HiB, a dramatic decrease in the incidence of severe infections caused by this bacterium has been observed.
Poland is one of the few European countries that does not include this vaccination in its mandatory vaccination calendar. It is likely that in the coming years, this vaccination will be introduced into the calendar of mandatory vaccinations, as the benefits of its introduction appear to be far greater than the associated costs.
Vaccines available in Poland
- ACT-HiB (Aventis Pasteur),
- Hiberix (Glaxo SmithKline),
- PedvaxHiB (MSD)
In combination vaccines, HiB is found in the formulations: Infanrix hexa (Glaxo SmithKline), Infanrix IPV + HiB (Glaxo SmithKline), Procomvax (MSD), TETRActHib (Aventis Pasteur).
Vaccination schedule
3 doses in the first year of life. Best given together with 3 doses of DTP (from 2 months of age, every 6 weeks). 1 booster dose is necessary at 16-18 months of age (together with a booster dose of DTP + polio). If we want to immunise a child aged 2-5 years who has not been vaccinated as an infant, 1 dose of vaccine is sufficient.
Recommended vaccinations
We strongly recommend this additional vaccination for every healthy infant.
Streptococcus pneumoniae infections
The pneumonia bug (Streptococcus pneumoniae, common name: 'pneumococcus') is a common cause of infection in children. Streptococcus pneumoniae mainly causes pneumonia and otitis media. In addition, it can cause sinusitis, septicaemia, meningitis, endocarditis and arthritis. Streptococcus pneumoniae is estimated to cause 60-80% of all bacterial pneumonias, in both adults and children. Pneumococcal pneumonia and meningitis are usually quite severe.
Extension of the vaccination calendar, photo: panthermedia
In our country, pneumococcal vaccination is recommended for children over two years of age, those suffering from chronic diseases that can reduce immunity (nephrotic syndrome, chronic heart and lung disease, diabetes, Hodgkin's disease, use of immunosuppressive drugs) and children after surgery to remove the spleen. The most common polysaccharide vaccines (containing 23 of the most common antigens) are quite poorly immunogenic, for which reason vaccination with these preparations is only effective above the age of 2 years.
Since 2000, there have also been so-called conjugate vaccines containing the 7 mainpneumococcal antigens (pneumococcalconjugate vaccine - PCV), which are effective in children as young as 2 months of age. The recommended US immunization calendar recommends routine pneumococcal vaccination (with PCV vaccine) for all healthy children from 2 months of age. The recommended vaccination schedule in the USA is 3 doses every 6 weeks (together with DTP + HiB) + 1 booster dose at 12-15 months of age. According to US epidemiologists, a significant decrease in pneumonia, meningitis and otitis media has been observed in populations of children vaccinated against pneumococci.
In Poland, the prevailing opinion is that this vaccination should be restricted to the so-called risk groups described above. This is mainly due to the fact that only polysaccharide vaccines, which are not very effective in infants, are still available in our country. Conjugated vaccines(Prevnar®) can be imported on an individual basis. With the increasing availability of vaccines for infants, a broadening of recommendations for their use is to be expected.
Vaccines available in Poland - polysaccharide vaccines only
- Pneumo 23 (Aventis Pasteur)
- Pneumovax 23 (MSD)
Vaccination schedule:
Polysaccharide: once. Conjugated (Prevnar®): 3 primary doses at 2, 4 and 6 months + booster dose at 12-15 months
Our recommendation:
At present, vaccination with polysaccharide vaccines available in Poland is indicated only in the risk groups listed above. In healthy children there are no indications for routine revaccination.
Neisseria meningitidis infections
Neisseria meningitidis (so-called meningococcus) is, along with Haemophilus influenzae and Streptococcus pneumoniae, one of the three most common causes of bacterial meningitis in children. The mortality rate in meningococcal meningitis is approximately 15%. This bacterium can also cause septicaemia, which is fatal in 30-60% of cases and progresses with adrenal damage and massive haemorrhagic diathesis.
Most cases of meningococcal infections in our country are type B. Types A and C, on the other hand, cause less frequent epidemic infections (large numbers of patients in a short period of time - in a specific, small area). In Poland, epidemic cases have recently occurred in Western and Central Pomerania.
Unfortunately, due to the specific structure of Neisseria bacterial antigens, it has not yet been possible to produce an effective (appropriately immunogenic) vaccine against type B of this bacterium. Infections with types A and C, on the other hand, are so rare that the routine use of these vaccines is not recommended in most countries.
Vaccines available in Poland
- NeisVac-C (Baxter): only against type C - from 2 months of age
- Meningococcal polysaccharide A+C vaccine (Aventis Pasteur): against groups A and C - from 18 months of age
Vaccination schedule
Infants: 3 doses at intervals of at least 1 month. Over 1 year of age: a single dose (sufficient for 3 years).
Recommended vaccinations
Due to the fact that most infections in Poland are type B infections, against which there is no vaccine yet, there are no indications for routine vaccination of healthy children with the Neisseria meningitidis vaccines available in Poland. Exceptions are children living in areas where there are numerous cases of infection due to types A, or C. Children who have had their spleen removed should also be vaccinated.
Extension of the vaccination calendar, photo: panthermedia
Pertussis (whooping cough) - acellular vaccine
Pertussis(whooping cough) is a disease caused by infection with the Bordetella pertussis bacillus. If contracted, a number of complications are possible, the incidence of which is estimated at up to 20%. These mainly include pneumonia and neurological disorders (pertussis encephalopathy). Complications are particularly common and dangerous in infants. Pertussis is a disease whose incidence in Poland has increased in recent years. This is due to too frequent exemptions from vaccination and the incomplete effectiveness of the vaccine used in our country.
Vaccine exemptions are often due to the increased adverse reactions observed after the first doses of the vaccine (fever, screaming and even convulsions). The full-cell component of the vaccine is mainly responsible for the adverse reactions. For this reason, only acellular (cell-free - DTaP) vaccines are already routinely used in most European countries. Acellular vaccines have been shown to be at least as effective in inducing immunity against pertussis with significantly fewer vaccine reactions.
DTaP vaccines available in Poland
- Infanrix-DTPa (Glaxo SmithKline)
- Tripacel (Aventis Pasteur)
- DTaP vaccine SIS (Statens Serum Institut)
Acellular pertussis antigen is also contained in a number of combination vaccines, such as Infanrix-IPV + HiB, Infanrix hexa, Infanrix penta, Pentaxim, DTaP-IPV SIS vaccine.
Vaccination schedule
Same as routine DTP vaccination with whole-cell vaccine
Recommended vaccination
If parents' budgets allow, we strongly recommend replacing the traditional DTP vaccine with one of the acellular vaccines (DTaP).
