01.01.2014 Vaccinations? Let's talk about them!
Forum Dr. med. Nicole Pellaud. As paediatricians who look after growing children, we concern ourselves particularly with the recommendations for and administration of the vaccines. We already broach the topic of vaccination at the first visit when infants are one month old. At the age of two months, now no longer protected by their mother's antibodies, infants receive their first doses of vaccine, particularly in order to build up immunity to whooping cough and Haemophilus infections, two diseases that can cause serious complications in young children.
Between the ages of two and 48 months, children are vaccinated against ten infections in accordance with the Swiss Vaccination Schedule. Adolescents are immunised against hepatitis B, and girls additionally against the human papilloma virus (HPV).
And it works! We no longer see children with meningitis due to meningococcus C or Haemophilus, or respiratory decompensation due to Haemophilus epiglottitis.
But what happens? We immunise infants and young children, yet still see serious cases of whooping cough and measles...
Children are now better protected against meningitis, a disease that scares us, than against whooping cough or measles because these are still regarded as "harmless" illnesses. But they too can be life-threatening. Young adults are no longer protected against whooping cough by being vaccinated in childhood, and not all of them have received two doses of MMR (measles, mumps, rubella) vaccine.
We know what the solution is: it is not just babies that have to be properly vaccinated – immunisation has to be guaranteed in later years as well. We have to identify children and young people whose immunisation status has gaps in it and make good any past omissions – in our paediatric practices, maternity care centres, playgroups and kindergarten, schools, vocational training facilities – and, for healthcare and education professionals, on starting work.
As paediatricians, we are in a position to catch up on the whooping cough vaccination recommended for young people and for the parents of infants under six months and administer the required doses of MMR vaccine. But still requiring attention are a number of healthcare and education professionals who are inadequately immunised against whooping cough, measles and seasonal influenza. They are no longer of an age to consult a paediatrician and – because they are in good health – do not see any other doctor either. But they can infect as yet incompletely immunised infants with whooping cough or measles.
It is no longer sufficient to inform, recommend and advise – everyone involved must accept their own share of responsibility. Politicians must include protection of the Swiss population through vaccinations in their agendas. The health authorities must issue clear guidelines for the health and education sectors on how to check for and catch up on missed vaccinations in both children and adults.
A reference person must be appointed to supervise and coordinate implementation of the guidelines in the communities: it can be a public health nurse or school medical officer in the case of children attending kindergarten and school, and an occupational health nurse or medical officer in the case of healthcare and education professionals. The responsible childcare authority must guarantee the implementation of these guidelines. Childcare facilities should refer to the guidelines when engaging new staff or accepting children into their facility.
Non-vaccinated healthcare and childcare professionals should be aware of the risks to which they expose the people they look after. Even if they do not want to have themselves vaccinated for their own protection, they should do so for their clients' sake.
And we paediatricians? Our role is to share our knowledge and recommendations as widely as possible with all concerned and continue checking vaccination cards, providing information and administering vaccines in our practices and in hospitals or schools.
Nicole Pellaud, MD
FMH (Swiss Medical Association) Specialist in Paediatrics, President of the Swiss Society of Paediatrics