Subject: preventve vaccinatons in the prophylaxis of infectous diseases in children of clinical risk group

Ewa Beata Kowacka

Abstract


Despite the past years and intensifying attacks of so-called anti-vaccinationists against the idea and practice of preventive vaccinations, especially in children, the opinion that they are “one of the greatest benefits and health achievements of humanity” remains valid1. The vaccine is a biological immune care product containing specific antigen or antigens that provide immunity to infection with one or more pathogenic microorganisms.
The importance of implementing the concept of preventive vaccinations on the general scale consists primarily in the fact that they have eliminated from the life of societies, or at least from significant areas of the world known to us, traumatic experiences of epidemics decimating human communities, both on a local and regional, and sometimes even, as infamous Spanish influenza, which a hundred years ago consumed, as estimated even 100 million victims, on a global scale. As specialists point out, “even the invention of antibiotics has not had such a significant impact on reducing mortality and increasing human health. Vaccinations have significantly reduced the incidence of infectious diseases [...]. They practically eliminated diseases such as smallpox, diphtheria, tetanus, measles or poliomyelitis. Therefore, there is no doubt that the impact of vaccination on the health and development of each of us, regardless of age and gender, is unquestionable”2. In many modern countries, including Poland, the issue of preventive vaccinations, especially in children, is an inherent component of the state health policy. The scope, principles and procedures for the implementation of the Preventive Vaccination Schedule are regulated in the generally applicable provisions of law.
However, it should not be forgotten that the introduction of any biologically active substance into the human body is not indifferent to its functioning. This consideration also applies to vaccines, and the risks associated with their administration are emphasized in particular in connection with preventive vaccinations in children. In view of the generally recognized achievements of medicine of infectious diseases and vaccinology, current vaccines are completely safe. The data of the World Health Organization (WHO) demonstrate that the probability of death because of their administration, as well as of the disease that they are supposed to protect against, is statistically so small that it is not really possible1. It does not change the fact that in certain cases preventive vaccinations should be preceded by a medical qualification test, and where appropriate, an assessment of the risk associated with the administration of the vaccine2. Therefore, before proceeding with the implementation of the POS, not only the legal aspect of this issue, but also clinical contraindications to the administration of the vaccine should be considered.
Particular care and compliance with the legal procedures is recommended for the implementation of PSO in children and adolescents. This applies in particular to people of the group of clinical risk. It includes premature infants, children with immunodeficiency, cancer, rheumatic disease, after spleen removal, suffering from sickle cell disease, with allergy, cystic fibrosis, nervous system diseases, autoimmune diseases (e.g. diabetes), etc.3 Presentation of this issue in the context of legal conditions of preventive vaccinations in children and adolescents, as well as published research, is the primary purpose of this study.

Keywords


vaccinatons

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References


O. Branicka, J. Glück Bezpieczeństwo szczepień profilaktycznych u chorych na choroby alergiczne, “Alergologia Polska” 2016, no. 3, p.90.

Szczepienia ochronne. Obowiązkowe i zalecane od A do Z, ed. E. Bernatowicz and P. Grzesiowski, Warsaw 2017, p. 9.

The statutory premise for undergoing preventive vaccinations is article 5 section 1 point 1 letter b in connection with article 17 section 1 of the Act on preventing and combating infections and infectious diseases among people (hereinafter: UZ), Journal of Laws from 2008 No. 234, item 1570 as amended), obliging all people staying on the territory of Poland to undergo specific preventive vaccinations. Detailed conditions for submission to such an obligation are specified in the Regulation of the Minister of Health of 18 August 2011 on mandatory preventive vaccinations (hereinafter: ROSO), Journal of Laws from 2011 No. 182 item1086, issued on the basis of article 10 section 10 of the UZ. The list of vaccinations is defined in the Preventive Vaccination Schedule (PSO), announced on the basis of the delegation contained in article 15 section 5 by the Chief Sanitary Inspector (GIS) in the form of an annual announcement. In 2019, the announcement of the Chief Sanitary Inspector of 25 October 2018 regarding the Preventive Vaccination Schedule for 2019, Official Journal of Laws of the Minister of Health section 104 (hereinafter: POS’19) is applicable. The POS includes the following lists of vaccinations: 1) mandatory for children and adolescents, according to the vaccination schedule; 2) mandatory for people exposed in a special way to infection due to clinical or epidemiological reasons; 3) post-exposure vaccinations; 4) recommended vaccinations; 5) vaccinations against selected infectious diseases. PSO’19; A. Bednarek, M. Bartkowiak-Emeryk, J. Wysocki (hereinafter: A. Bednarek et al.), Szczepienia ochronne w profilaktyce chorób zakaźnych u dzieci, Warsaw 2018; J. Wysocki, H. Czajka, Szczepienia w pytaniach i odpowiedziach, Warsaw 2018. This study is focused on the issue of vaccinations of children and adolescents. The physician who provides patients with preventive care shall notify them about the obligation to undergo certain protective vaccinations. In the case of children, such information is provided in writing by the physician to their legal or de facto guardian, about which a territorially competent health inspector is informed. See also: A. Bednarek et al., Szczepienia ochronne…, pp. 47-61; N. Szczęch, Problematyka przymusowych szczepień ochronnych u dzieci na tle orzecznictwa sądów administracyjnych, “Roczniki Administracji i Prawa” 2016, no. 1, pp. 187-211; A. Augustynowicz, I. Wrześniewska-Wal, Aspekty prawne obowiązkowych szczepień ochronnych u dzieci, “Pediatria Polska” 2013, no. 88, pp. 120-126.

Six common misconceptions about immunization, material available in its electronic version at the Internet address: https://www.who.int/vaccine_safety/initiative/detection/immunization_misconceptions/en/

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For a detailed list of childhood diseases that constitute the premise to include children in the clinical risk group, see, among others:: A. Bednarek et al., Szczepienia ochronne…, A. Bednarek et al., Szczepienia ochronne…, J. Wysocki, H. Czajka, Szczepienia w pytaniach…

POS’19, p. 19.

M. Bartkowiak-Emeryk, A. Emeryk, I. Małecka, J. Stryczyńska-Kazubska, J. Wysocki (hereinafter: M. Bartkowiak-Emeryk et al., “Szczepienia ochronne u dzieci z grup ryzyka klinicznego, [in:] Szczepienia ochronne w profilaktyce…, p. 151.

Annex to the GIS Communication of October 25, 2018: POS’19. p. 9.

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M. M. McNeil, E. S. Weintraub, J. Duffy, L. Sukumaran, S. J. Jacobsen, N. P. Klein, S. J. Hambidge, G. M. Lee, L. A. Jackson, S. A. Irving, J. P. King, E. O. Kharbanda R. A. Bednarczyk, F. De Stefano (hereinafter: M.M. McNeil et al.), Ryzyko anafilaksji po szczepieniach ochronnych u dzieci i dorosłych, “Alergologia Polska” 2015, Vol. 50.

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E. Bernatowska, B. Mikołuć, M. Pac, Czy program obowiązkowych szczepień…, p. 17.

E. Bernatowska, B. Mikołuć, M. Pac, Czy program obowiązkowych szczepień…, p. 18.

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DOI: http://dx.doi.org/10.5281/zenodo.2547092

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