Children who haven’t been vaccinated should not go to kindergartens if we want to avoid epidemics that threaten the health and life of both children and seniors. This is the position of the epidemiologists who insist on vaccinating the population, in compliance with the proposal of the Commission for Infectious Diseases to declare a whooping cough epidemic in Skopje, the capital of North Macedonia. Meta talked to Professor Nikola Panovski and Dr. Aleksandar Stojanov, who believe that people can be protected only with the DTaP vaccine, which is given five times in childhood.
The vaccine is mandatory
Children who are not vaccinated should not go to kindergartens. There are also some children in schools who are not vaccinated, but it is deemed that they would overcome the disease easier and therefore they are not as risky. But the babies must be protected, appeals Professor Dr. Nikola Panovski.
Secondly, quick diagnostics is also a must. If the doctor suspects whooping cough, an antibiotic should be prescribed. It cures slowly, but prevents the spread of the disease, says Panovski.
According to him, the opposition to the vaccines and the COVID-19 pandemic brought about the fear of vaccines and increased the number of anti-vaxxers.
Skopje has the lowest percentage of vaccinations, specifically in the urban municipalities Centar and Karpos. The anti-vaxxers caused a great deal of trouble, he adds.
His colleague Dr. Aleksandar Stojanov, says that the whooping cough is the reality, just as we had the epidemics of measles and mumps.
There were no whooping cough epidemics in the past. But then the process was good – DTaP was given five times in a lifetime and people were protected. We allowed the anti-vaxxers to shrink the vaccination percentage. It should be 98 percent if we want the population to be protected. If it is below this percentage, it could always return, says Stojanov.
In the past we were going to the villages to vaccinate
Stojanov recalls the 2018 measles epidemic when the first case appeared in a school in Radishani.
Once everyone got vaccinated, the situation calmed down. Mumps epidemic broke out in Bair in Bitola and was quickly spreading. Vaccination has always been a problem. In the past, however, we used to have a good system that worked. We were going to the villages and vaccinated people, we did not wait for them to come to the clinics. Every 45 days we went to the villages, there were regular rounds with set schedules. Now we are waiting for them to come to us, but they are not coming. And the vaccination centers were also downsized, and the number of vaccination teams also decreased. More needs to be done in the field. In the past everyone was vaccinated with DTaP. The problem is in Skopje where the anti-vaxxers are concentrated. In the villages people trust the doctors, says Stojanov.
No vaccine has 95 percent coverage
Concerning the primary vaccination, the recommended coverage above 95 percent has not been reached for any vaccine at the national level. The registered primary vaccination coverage is below 90 percent for all vaccines, including those against Hepatitis B, Haemophilus influenzae type B, DTaP/IPV and MRP vaccine, as well as vaccination against HPV, which has the lowest coverage of all vaccines.
The primary vaccination coverage with three doses of the vaccine against HiB, DTaP and IPV for the entire country was 83.9 percent for 2022. Lower than 90 percent coverage was registered in the territories of Veles, Gevgelija, Shtip, Ohrid, Tetovo, Prilep, Skopje, Bitola and Strumica, while the lowest coverage of 53.7% was registered in Kumanovo. From the total number of children who should have been vaccinated, 3,322 children were not vaccinated, out of which 41 percent (1,368) are from Skopje and 27.4 percent (910) are from Kumanovo, according to the latest report of the Institute for Public Health.
Since 2015, the first DTaP revaccination has been constantly declining, reaching the lowest coverage of 66 percent in 2020. In 2022, a decrease in coverage was also registered (69.3 percent) compared to 2021 (72.8 percent). The average coverage for 2017-2021 is 78.1 percent and is higher than the registered coverage in 2022.
The revaccination coverage with DTaP/IPV among 7-year-old school children is 88.5 percent, which is an increase compared to 2020 (87.3 percent) and 2021 (74.7 percent). The revaccination coverage with DTaP/IPV among 14-year-old school children (89.3 percent) shows an increase compared to 2020 (80.3 percent) and 2021 (85.9 percent), but still the percentage is below 90.
Parents should vaccinate their children immediately if a dose is missed
Recently Dr. Kristina Stavridis from the Public Health Institute for Meta.mk said that the parents should check their children’s vaccination cards and if a dose of vaccine is missed or they have not been vaccinated at all, they should immediately call the vaccination center to vaccinate their child according to the vaccination calendar.
The emergence of pertussis cases is not unusual, especially now when the region and Europe have registered epidemics and an increasing number of cases. This is especially true in a situation when we are facing reduced vaccination coverage, she said.
Brain damage, one of the complications of the disease
The Public Health Institute published information related to the whooping cough disease. In the part dealing with whooping cough complications the following are listed: pneumonia, inflammation of the middle ear, loss of appetite, dehydration, convulsions, brain damage, hernias, fractures in the chest area, prolapse of the colon, and episodes of respiratory arrest.
Whooping cough causes serious complications and sometimes even death in children under one year of age. One-third of the children under one year of age who get sick with whooping cough need hospital treatment. The most common complications are apnoea (life-threatening cessation of breathing), pneumonia (inflammation of the lungs), convulsions, encephalopathy (brain damage), and every 100th patient may die. The complications are less severe in older children and adults, especially those who have previously been vaccinated against whooping cough, PHI states.
The best way to prevent whooping cough is the accination. Vaccination against the disease is performed with combined vaccines: Hexaxim (DTaP-IPV-HiB-HepB), Pentaxim (DTaP-IPV)
The primary series of vaccinations is carried out with three doses of combined vaccines (Hexaxim or Pentaxim). According to the Immunization Calendar, the first dose of vaccine is given to two-month-old children, the second dose at the age of 4 months and the third dose at the age of 6 months. The first revaccination is done one year after the completion of primary vaccination, by giving one dose of Pentaxim at 18 months of age. The second re-vaccination is given in the second grade, i.e. at the age of 7, with application of one dose of the Tetraxim combined vaccine.
