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First national conference on vaccine-preventable diseases

In 2019 if felt as if planet Earth stopped its rotation and everything we knew and were used to flew away into the Cosmos. People’s everyday life came to a standstill, to make space for the Coronavirus that swooped down much like the devil in the novel „The Master and Margarita“.  Each problem has its solution. In this case, these were the vaccines. The natural course of events suggested that after the decision, the regressive hypotheses that denied it came up. Because of the contradictory opinions of „experts“ on the efficiency and safety of vaccines, major part of the people lost confidence even in the time-tested vaccines, which have been used for decades.

Movements of the “anti-vaxxers”, of the „fighters for freedom of choice, the choice whether to be healthy. They inflict serious damage to the society, one that will reverberate in the generations to come. The most serious damage is the one inflicted onto their families, exposing them to danger daily. Anti-vaccination movement results in less vaccinated children and in increase of the cases of diseases, such as measles.

It namely was to help and disseminate accurate information, that the First National Conference on Vaccine-Preventable Diseases (programme) was held on 11, 12 and 13 November 2022. The event was organized by Astra Forum Foundation, in conjunction with the Ministry of Health and the representative offices of UNICEF and WHO in Bulgaria.

The goal of the Conference was to carry out scientific debates and lectures, focused on the need and the opportunities for vaccination prophylaxis. A prophylaxis that improves the quality and length of life and is designed for people of all ages.

The first national conference in vaccine-preventable diseases was orientated to the general practitioners, paediatricians, infectious disease specialists, epidemiologists, microbiologists, immunologists, post-graduate students, doctoral candidates, and students in medicine.

The topic covered were: Epidemiology and public health; Regulatory questions related to vaccination prophylaxis; Vaccines, administered in paediatric age; Aetiology, clinical manifestations, diagnostics, treatment and specific prophylaxis of influenza; meningococcal and pneumococcal infections; measles, parotitis, rubella (German measles), varicella (chickenpox) and smallpox; poliomyelitis; tuberculosis; COVID-19; human papilloma virus and others. Problems and risks, originating from the decrease of the total immunization scope were analysed. Of course, with the accent on the discussion of strategies and suggestions for its increase.

The first national conference in vaccine-preventable diseases started with the presentation of the regional adviser in immunoprophylaxis of the WHO for Europe and Central Asia – Dr. Siddharta Datta. He summarized that during the COVID pandemic, physicians were compelled to find new opportunities for immunoprophylaxis. The vaccine against COVID-19 was developed for only a year, thanks to the innovations in the medicine. WHO prepared immunization plan until 2030, which will provide a common framework that is to be followed in all countries members of the European Union.

After Dr. Datta, Christina De Bruin, representative of UNICEF for Bulgaria spoke. She reported that in 2021, UNICEF, being the greatest distributor of vaccines, delivered more than 2.3 billion vaccines around the world, excluding the vaccines against COVID-19. Based on data, collected by UNICEF and WHO, vaccination of the children decreased in 2021. UNICEF’s greatest centre in Copenhagen supplies vaccines for half of the children from all over the world, and the goal is to reach the most vulnerable locations. UNICEF’s mission is to provide vaccines for every child.

The definition in the National immunization calendar is that vaccines are used for prevention, restriction and elimination of diseases. Thanks to the preparations against poliomyelitis, the disease is now almost fully eliminated, and recurrences are registered in only two countries. Bulgaria is the first country, which through introduction of immunization, liquidated the smallpox. Today, the problems consist in the lack of competent opinion, in the lack of permanent informative campaign and in the clumsy access to information.

Assoc. Prof. Angel Kunchev, chairman of the Organizational committee, held a lecture on the way in which the consequences from COVID-19 affected the mandatory immunization. It has been emphasized that the main problems originate in the low public trust, combined with the various conspiracy theories, in the disinformation and in the dissemination of false data.  Due to the tangible drop of the mandatory vaccinations in the children, we can forecast the threat for the mankind to return to the epidemics that were characteristic of the Middle Ages.

Prof. Radka Argirova began her lecture with an appeal that vaccines are not only for the children. The idea is in the need to make immunizations and prophylaxis of a number of vaccine-preventable diseases over the entire life of the man. Upon introduction of such an immunisation practice, that the use of antibiotics will decrease, and hence we will be seeing a drop in the microbial resistance to pharmaceutical preparations. Professor Argirova and her colleagues made new Immunization calendar, which includes vaccinations even after the age of 17.

There are basic hypotheses on the emergence of viruses. The first one is that they emerged from genetic elements, and the second one – that they are remnants of different cellular organisms. It is supposed that there are around 1.7 million different viruses, and every year another 3 to 6 new human viruses are registered. It is asserted that interspecies barrier is very strong, and it is very rare that viruses can be transmitted from animal to human.

The earliest information about smallpox date back to around 10,000 years B.C. In 1796 the English physician Edward Jenner infected an eight-year-old boy with exudate from pustule, taken from the hands of a cow milkmaid. Until then it has been known that the people raising cows suffer much less from the disease or do not fall ill, at all. In fact, the term „vaccine“ originates from the Latin “vacca” – cow, which denotes the name of the first development of the smallpox pathogen in cows.

Subsequently, in 1840 law on vaccination was passed in England, and it was free-of-charge for the poor. The anti-vaccination movement appeared immediately after that. Suggestions spread that the vaccination is blasphemy, and it is dangerous, because it turns a man to a cow.

Infantile paralysis, also known as poliomyelitis, is a very serious infection, damaging the nervous system. Fortunately, it can be prevented.  Thanks to the vaccine, in 1957 was the beginning of the immunization policy, which Bulgaria undertook. Prophylaxis of poliomyelitis was done with three administrations of anti-poliomyelitis vaccine – in the second, third and fourth month after birth. Re-immunization is done at the age of 16 months and at 6 years.

The antibiotic microbial resistance is another global threat to the public health. That is why vaccines with key pathogens and underlying profile of resistance are being developed against diseases that kill 33 thousand patients a year in Europe. A strategy, which includes schematic route of response to the preparation is required for the efficient combat with the antibiotic microbial resistance.

Another topic in the Conference was the provision of immunization for communities with difficult access, which includes refugees from Ukraine. In May 97 % of the refugees are situated in Burgas and the region. The Ukrainian immunization calendar lacks the pneumococcal vaccine and one against poliomyelitis, as well as the re-immunizations for tetanus, pertussis and diphtheria are less in number. A centralized data system must be created, and every institution that is somehow involved in integration, should have access to it. Health mediators also play an important role for the improvement of the immunization scope, among the vulnerable groups.

Prevention against influenza has quite a long story. Bulgaria is one of the countries, which took prompt measures. Perfect epidemiological supervision concerning the influenza has been exercised from 1979 to 2000. What is missing in Bulgaria is the information related to the serious cases.

Respiratory syncytial virus and the human metapneumovirus are most frequently identified in double infections in breast-fed infants hospitalized with bronchiolitis. Frequency and weight of the mixed acute respiratory infections are identified in one clinical sample, which includes the identification of Respiratory syncytial virus and of the human metapneumovirus.

There are four stages observed with the meningitis – colonisation, invasion into the bloodstream, survival in the blood, invasion in the subarachnoid space. Inflammations and neurological damage follow, caused by combination of factors of interaction between microorganisms and the host cells. Researches show that with Neisseria meningitidis, the serogroups predominating in Bulgaria are B and C. With Streptococcus pneumaniae, predominant is a high percentage of serotypes, which are not included in the ten-valent vaccine applied, along with serotypes of non-vaccine type strains. Problems with the pneumococcal infection are in the increasing antibiotic resistance of the streptococci and the increase in the frequency of invasive pneumococcal infections. Neisseria meningitidis is an agent capable of generating large epidemic outbreaks of meningitis. The highest is the percentage of the diseased of suckling age, and male children are more severely affected.

More and more frequent cases of tuberculosis are noticed among teenage people. To find the latent forms of the disease, the mandatory tuberculin skin test at the age of 11 years should be reintroduced. Prophylaxis aims at subsequent reduction of the severe forms. Tuberculosis continues to be a serious challenge for the system of the health care in Bulgaria. Thirteen per cent of the tuberculosis patients, are also HIV positive, which makes it the most significant risk factor on a world scale. The highest risk of infection is among the drug users; residents and employees at locations, where people vulnerable to infection gather; poor people, who have no access to adequate medical care; high-risk ethnic minorities; children in close contact with high-risk person and health workers, who provide services to these groups.

Varicella (chickenpox) is an acute viral disease, which complications are quite rare, but quite severe. Efficacy of the vaccine is between 80 and 100 per cent and it has its place in the mandatory Immunization calendar of Bulgaria.

The lecture about the measles drew the attention to the high professional risk, to which the medical employees are exposed. The need of adoption of a global recommendation about vaccination of the hospital personnel was emphasized. Secondary to the restriction of the infection, its spread in the healthcare facilities is more and more important.  341 patients have been hospitalized with measles for the period from February to August in 2019. To reduce the risk of development of antibiotic resistance, reviewing of the indications for antibiotic treatment is necessary when measles infection is suspected.

A novel threat that mankind confronts it the epidemics of monkey smallpox. Measures against the diseased are the ones we already know – isolation at home; frequent washing hands with water and soap; using disinfectants; wearing protective face mask; using individual cutlery and clothes; disinfection of surfaces, subjects, and frequent ventilation. Incubation period is 12 days, on the average. Symptoms include fever, profuse sweating, strong headache, back pains, muscle pains, weakness, pharyngitis, shortness of breath, cough, and others.

Priorities regarding the human papilloma virus must include cheaper diagnostic and treatment activities with pre-cancer changes and early cancer, apart from the primary and secondary prophylaxis with the highly-specific hrHPV-test. Increase of the percentage of recovered patients and decrease of the advanced cases and public expenses for surgical treatment. Anal and perianal acute condylomas are the most frequently spread sexually transmitted disease. Incubation period is from 3 weeks to 8 months. There are several predisposing and risk factors – previous radiation therapy, smoking, Crohn’s disease, multiple sexual partners, and others.

As concerns COVID-19, researches show that with the vaccinated against Delta variant the risk of infecting is 17 times lower, and the one of death – 25 times lower. The third mRNA dose of the vaccine, which was introduced because of the variant Omicron, protects from hospitalization by up to 90%. The risk of hospitalization is highest with the unvaccinated people. Mortality rate in Bulgaria is just above 30 thousand, and the most affected by COVID-19 were the smaller regions in the country.

Prof. Dr. Radka Argirova, renowned as one of the people most actively fighting for the development of vaccine against HIV, said that it is namely that product is the main challenge of the XXI century. The published statistics showed clearly that the newly HIV infected are 1.5 people. The efficient vaccine against HIV should contain all components of the immune system – humoral, cellular and mucous, it must mobilize the full protection against all viral types, which the vaccinated persons could encounter.

Prof. Georgi Momekov, Doctor of Pharmacy, chairman of the Bulgarian scientific association of pharmacy and head of department „Pharmacology, pharmacotherapy and toxicology”, presented a technology for development of vaccines against Lyme disease, oncological diseases, influenza, malaria and others. He explained that the future of vaccines, gene therapy and editing of the genome would most probably depend on the evolution of mRNA technologies.

Towards the end of the First conference on vaccine-preventable diseases, there was a wonderful proposition for positive campaign in the social networks. This campaign aims at clarifying the benefits and safety of the mandatory and recommended immunizations. Nowadays, vaccines can prevent 28 diseases. The need of such a campaign is conditioned by the low level of health literacy in the country.

Speaking of the future, of the survival of the mankind and about innovations, which permit this, I will finish off my article with a quote from prof. Radostina Aleksandrova: “We need such conferences!”

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