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Webinar: Multidisciplinary approach in vaccine-prophylaxis

On 26 April was held the webinar “Multidisciplinary approach in vaccine-prophylaxis”. The event was part of a series “Vaccine school” – an Astra Forum Foundation initiative, in partnership with the Ministry of Health and UNICEF Bulgaria.

The participants at the event were Professor Colonel Andrey Galev – infectious diseases and epidemiology, Dr. Tsvetelina Velikova – immunologist and Momchil Baev, doctor of social medicine. The webinar was the sixth in the series “Vaccine school”. The subject of discussion was once again current recommendations for vaccine-prophylaxis, suggestions, data and advice from experts in the field of public healthcare.

During the event, we discussed important topics like indications and contraindication for immunization, related to disruptions in the immune system. We also spoke about which cases of immunizations can be postponed.


“Regardless of the advances in immunoprophylaxis, there are some fundamentals that have remained unchanged for more than decades. These are the values of collective immunity for individual infections”, said Professor Colonel Andrey Galev, MD from the Military Medical Academy. He also reminded that vaccination is performed by general practitioners and in some cases by military epidemiologists. Doctors from other specialties are rarely involved in vaccinations.

In his presentation, Galev said that recent advances in medical science require the introduction of new vaccines and the optimization of existing prophylaxis regimens. He pointed out the fact that vaccines are no longer applied exclusively in childhood, but throughout the entire life, with particular relevance after the age of 60. In his words, it is important that vaccine-prophylaxis is promoted by specialists like rheumatologists, cardiologists, pulmonologists and others, considering infectious diseases can cause diabetes, COPD (Chronic Obstructive Pulmonary Disease), heart failure and others.

In that sense, gynecologists also need to participate in prophylaxis of Papillomavirus infection.

“The purpose of the multidisciplinary approach towards vaccination is to reach an informed decision about vaccination, which should be safe and effective, meaning the vaccine should be inserted at the right moment, allowing enough antibodies to be built up. Excessive waiting increases the possibility of vaccine-preventable illnesses to develop, which means that the vaccine needs to be inserted at the first possible moment. After that, a revaccination can be performed.”

Professor Galev also suggested that it is necessary for the Public procurement law to include a replacement manufacturer.


“Vaccination approaches among patients with immunodeficiency, autoimmune and inflammatory diseases” was the subject of the following lecturer – Dr. Tsvetelina Velikova from Lozenets University Hospital.

According to her, it is important for the close relatives of people with reduced immune competence to receive all vaccines, suitable for their age and exposition, except for the smallpox vaccine.

Velikova also said that this will prevent the spread of the disease towards the person with compromised immune system. The virologist reminded that live vaccines can be applied to the rest of the family members. Velikova noted that contacts of people with reduced immune competence need to receive a seasonal vaccine against the influenza virus.

Patients with anatomical or functional asplenia need to have their pneumococcal, meningococcal and HIB vaccines inserted at least 14 days before elective splenectomy. If the vaccines are not inserted before the operation, they need to be used after the procedure, as soon as the patient is stabilized.

Dr. Velikova paid attention to the vaccination of patients who suffer from autoimmune diseases. Live-attenuated vaccines can be used cautiously with patients who suffer from autoimmune diseases. “The vaccines should be used before a planned immunosuppression, more specifically a therapy with depletion of B-cells. This will ensure an optimal response of the vaccines”, said the specialist.


During the last part of the webinar, Momchil Baev spoke on the subject of “Doctor-patient communication. Interpersonal communication about immunization. A handbook for health workers”

The primary responsibility lies with general practitioners and their motivation to help their patients overcome confusion, mistrust of vaccines and the misinformation that is surrounding us. They must address their patients’ fears using a timely communication strategy, adapted according to the different types of patients, Baev said. He presented the Astra Forum Foundation Handbook, which is also available in digital format on our website. The guidebook takes health workers through different strategies for overcoming the obstacles with routine immunization, despite the limited control that general practitioners and health workers have (or think they have) over the people they work with. 

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