The Vaccination Schedule as of 1 August 2007

Transcription

1 THE CHILDREN S VACCINATION SCHEDULE IN DENMARK 2007 The Vaccination Schedule as of 1 August 2007

2 Age Vaccination Health care examination for children 5 weeks 3 months 5 months 12 months DiTeKiPolHib1 + Pn2 (DPT/Polio/Hib + Pn) 2 DiTeKiPolHib + Pn (DPT/Polio/Hib + Pn) DiTeKiPolHib + Pn (DPT/Polio/Hib + Pn) 15 months MFR(MMR)2 2 years 3 years 4 years MFR(MMR)3 (April 1 st 2008) 5 years DiTeKiPol (DPT/Polio) revaccination 12 years MFR(MMR)4 over 17 years Rubella/ German measles (women)5 Footnotes 1 DiTeKiPolHib (DPT/Polio/Hib): diphtheria, tetanus, whooping cough, polio, Haemophilus influenza type b. 2 pneumokok (pneumococcal infection). 3 MFR (MMR) measles, mumps, rubella. 4 If not received 2 MMR previously. 5 May be given as a form of MFR (MMR) The National Board of Health (Sundhedsstyrelsen) recommends that children in Denmark be vaccinated against the following diseases: Diphtheria Tetanus (lockjaw / stivkrampe) Pertussis (whooping cough / kighoste) Polio Meningitis and inflammation of the epiglottis caused by haemophilus influenza bacteria type B (Hib) Meningitis and other serious diseases caused by pneumococcal bacteria Measles Mumps (fåresyge) Rubella/German measles (røde hunde) In addition, women who have not received MFR (MMR) vaccination, can receive vaccination against rubella (German measles) free of charge, possibly in the form of an MFR vaccine.

3 Vaccinations are free of charge and voluntary and can be given by your private physician. In the table you can see which vaccines are recommended and when they are to be given. Contents Introduction 6 Diseases 8 Diphtheria 8 Tetanus (lockjaw / stivkrampe) 9 Pertussis (whooping cough / kighoste) 10 Polio 11 Meningitis and inflammation of the epiglottis caused by Haemophilius influenza bacteria type B (Hib) 12

4 Meningitis and other diseases caused by pneumococcal bacteria. 13 Measles 14 Mumps (fåresyge) 15 Rubella/German measles (røde hunde) 16 Vaccines 17 General information about vaccination 18 Side effects 20 Diphtheria, Tetanus, Pertussis, Polio and Hib vaccine (DiTeKiPolHib) 22 Pneumococcal vaccine (Pn)

5 24 Diphtheria, Tetanus, Pertussis and Polio vaccine for re-vaccination 28 Monitoring the vaccination schedule 29 Measles Mumps and Rubella/German measles (røde hunde) vaccine (MFR) 26 Introduction Health authorities in all countries recommend that children be vaccinated. The Danish vaccination program includes vaccination against nine diseases. A child who adheres to the vaccination program is well protected against the nine diseases. Why vaccinate? Vaccination protects the child from contracting diseases that can be serious and cause permanent damage, or in the worst case, death.. Some vaccines protect very small children against diseases that can be potentially fatal for infants. Such diseases are, for example, whooping cough, Hib-meningitis, and pneumacoccal disease. The child may be infected with the bacteria at a later point in time, even if vaccinated, but the course of the disease will be milder, or the child may not become ill. Certain vaccines protect children against infections that are so contagious that all children would normally become ill during the epidemics that - without a vaccination program - would occur every few years. These are contagious illnesses that children normally recover from within a few weeks, but during every epidemic, some children become seriously ill. This applies to measles, mumps and polio.. Some vaccines protect against serious but rare diseases such as tetanus and diphtheria.. An unvaccinated child will be unprotected and may contract infections at a later time in life, when the course of the disease is often more serious than in childhood.

6 Child with Rubella Diseases Diphtheria Diphtheria is a contagious disease caused by the bacteria, Corynebacterium diphteriae. The disease often begins with fever and a serious tonsillitis/strep-throat with coatings on the throat and swelling of mucous membranes that may cause choking. The bacteria can produce a poison (toxin) that spreads to other parts of the body. Inflammation can thus develop in the heart and in the nervous system. The disease is potentially fatal even under favorable hospital conditions. There have been only a few instances of diphtheria in Denmark during the past 50 years, but there is still a risk of becoming infected while abroad. Tetanus (lockjaw / stivkrampe): Tetanus (lockjaw) is caused by the bacteria Clostridium tetani. The bacteria produces a poison (toxin) that enters the nervous system and causes muscular stiffness and attacks of cramps. In the worst cases, breathing stops. The disease is not transmitted from person to person. The bacteria are commonly found in soil and enter the body e.g. via contaminated wounds. Formerly, infants contracted the disease due to contamination of the navel. At present, older unvaccinated persons predominantly contract the disease. There are only few occurrences each year, but some are fatal. Pertussis (whooping cough / kighoste): Whooping cough is caused by a bacteria, Bordetella pertussis, which is spread via droplets of

7 fluid from the breathing passages, often by coughing or sneezing. The bacteria are very contagious. At the start, the disease resembles a common cold, but it evolves during 1-2 weeks into very violent and long lasting coughing spells. Coughing spells follow each other rapidly and interfere with the child s breathing. This is followed by a characteristic whooping sound. The child will cough up mucous and will often vomit following a coughing spell. The attacks are very exhausting, and very small children often do not have the strength to cough up the viscous mucous. Whooping cough can be fatal for infants. Children younger than 1 year, who have not had two pertussis vaccinations, may not attend a nursery or kindergarten when whooping cough occurs. This is due to risk of contagion. Mild instances of whooping cough in older children or adults can resemble a cold or tonsillitis/strep-throat. There are indications that older siblings often infect infants at home. Persons with colds or who cough should be kept away from unvaccinated infants. If an infant has been exposed to contagion, preventive antibiotics may be given following the advice of a physician. Polio Polio is caused by poliovirus which is very contagious. Symptoms of polio can vary greatly. Most persons get no symptoms, while others get a slight fever and headache for some days. A small percentage get symptoms related to the nervous system and suffer serious paralysis. Paralysis can be limited to individual muscle groups or can be so extensive that the muscles used in breathing become paralyzed. Some patients suffer paralysis for the rest of their lives while others recover. The disease can be fatal. There has been no polio contagion in Denmark since 1976, but the disease still occurs in India and Africa. It is expected that the disease can be totally eliminated by WHO s widespread campaigns for polio vaccination. Meningitis and inflammation of the epiglottis caused by Hib bacteria: Hib, Haemophilus influenzae type b, is a bacteria that can cause serious diseases such as meningitis (inflammation of the membranes that cover the brain) and inflammation of the epiglottis, particularly in small children. With meningitis the child gets a high fever and is severely affected. It can be difficult to contact the child and breathing may be affected. Meningitis and inflammation of the epiglottis can be fatal diseases. Hib infections can cause permanent injury such as hearing loss and brain damage. Prior to introduction of the vaccine in Denmark in 1993, this disease caused a couple of fatalities among small children each year. The disease is now largely eliminated but can recur if vaccination is discontinued. It is important to know that the Hib vaccine does not protect against the forms of meningitis

8 that are caused by other bacteria or viruses. Meningitis and other diseases caused by pneumococcal bacteria: Pneumococcus is the English name and pneumokokker is the Danish name for the bacteria Streptococcus pneumoniae. There are many types of pneumococcal bacteria. The disease often appears as acute middle-ear infection, sinus infection and pneumonia. The most serious forms of pneumococcal disease occur when the bacteria enters the blood stream and causes blood poisoning (sepsis) and/or meningitis (inflammation of the membranes that cover the brain). Serious pneumococcal disease can result in permanent injury such as hearing loss and brain damage and in rare cases, death. Small children and elderly people, whose general powers of resistance are lower, are especially prone to contracting diseases caused by pneumococcal bacteria. The risk of contracting serious pneumococcal disease falls markedly at approximately 2 years of age, and children over 4 years old have a very small risk of getting serious pneumococcal disease. Prior to the introduction of the vaccine, among children under 2 years of age in Denmark there were annually approximately 20 cases of meningitis and approximately 50 other serious cases of pneumococcal disease. Measles: Measles is caused by the very contagious virus morbilli virus. The disease usually begins with high fever and a cold. A reddish, blotchy rash is also visible. It is often accompanied by middle-ear infections and pneumonia. In rare cases complications such as encephalitis may occur which can cause deafness and in the worst case, death. In Denmark, prior to our 1987 introduction of MFR (MMR) vaccination, almost all children got measles. The disease is now rare in Denmark, but in the past few years there have been epidemics in numerous areas in Europe with fatalities among children. Child with Measles Mumps (fåresyge): Mumps is caused by the parotitis virus, a virus which is less contagious than measles. The

9 virus causes inflammation and swelling in the salivary glands and also fever and queasiness. Approximately 1-10% can get a mild case of meningitis (inflammation of the membrane that covers the brain) in connection with mumps. In rare cases, children suffer hearing loss in one ear following mumps. Mumps can cause an inflammation of the testicles in boys at or after puberty. This can result in temporary or permanently lowered semen production. Child with Mumps Rubella/German measles (røde hunde): In children, rubella is a mild disease, caused by the rubella virus, which often begins with symptoms resembling a cold and a slight fever. After approximately 24 hours the lymph glands at the base of the neck can become sore and swollen accompanied by a rash. The rash is blotchy and reddish and will disappear after a few days. Rubella can occur without a rash and without any symptoms. Vaccination against rubella is done primarily to avoid contagion of pregnant women by small children. A pregnant woman who contracts rubella during the first half of her pregnancy runs the risk of giving birth to a child with deformities such as disfigured eyes, hearing disabilities, brain damage or heart problems. An adult woman cannot know whether she has suffered from the disease because many other virus diseases resemble rubella. MFR (MMR) vaccination includes the vaccine against rubella and is therefore made available to all children. Women who are older than 17 years and have not been MFR vaccinated can be vaccinated against rubella free of charge. The vaccine may only be available in the form of an MFR vaccine. The vaccines

10 The table shows when vaccination against the various diseases was introduced in Denmark. Tetanus (stivkrampe) 1949 Polio 1955 Pertussis (whooping cough / kighoste) 1961 Measles, Mumps, Rubella (MFR) 1987 Haemophilus influenzae type b (Hib) 1993 Pneumococcal disease (Pn) 2007 The year when the vaccine was introduced Diphtheria 1943 The vaccinations that have been used for many years have resulted in nearly eliminating the diseases or in their occurring in only a very few children or adults. A vaccination program can be successful only if almost everyone is vaccinated. Otherwise the disease will continue to be able to spread. When a recommendation regarding vaccination is contemplated, an evaluation is made to determine whether the disease is so serious that all children should be vaccinated, whether the vaccine is safe, and whether it can be fitted into the present vaccination schedule. How does a vaccine work? Vaccines can be either dead vaccines which contain parts of killed viruses or bacteria or else living vaccines which are comprised of living, but weakened forms of viruses or bacteria. When a child is vaccinated, so-called antibodies are formed which protect against the disease in the same manner as if the child had had the disease. When later on the child,encounters the virus or bacteria in question, its body can remember it and the antibodies combat the microorganism. We say that the child has become immune. Can more than one vaccine be given simultaneously? It is our aim to subject children to as few injections as possible. Tests of vaccines have shown that it is possible to vaccinate against more than one disease at a time, thereby reducing the number of injections. Where on the body do children receive injections? This differs from vaccine to vaccine, but small children normally receive injections in the thigh and bigger children in the shoulder. Can a sick child be vaccinated? Children who are sick, e.g. a child with fever, are not normally vaccinated. But a slight cold is not a reason to prevent vaccination. It is not necessary to begin a new series of vaccinations if one vaccination is postponed.

11 Side effects Vaccines generally give few side effects. Side effects of vaccines are times more rare and less serious than the consequential damage from the disease itself. Most children will, at one time or another, during the course of a vaccination schedule get a mild reaction, e.g. swelling at the injection site, a slight fever or a rash. This is an anticipated side effect. Over 360,000 vaccinations are given annually to children and approx. 200 instances of side effects are registered each year. Most of these involve local swelling at the vaccination site, a rash or a fever. Serious or unanticipated side effects must be reported to the physician or to the Danish Medicines Agency (Lægemiddelstyrelsen). On July 1 st 2003 a law was passed enabling patients and their relatives to report side effects of medicine and vaccines directly to the Danish Medicines Agency. To post a report, a form is used which is available at pharmacies or which can be downloaded from the website of the Danish Medicines Agency Hwww.laegemiddelstyrelsen.dk. Instructions for filling out the form can be obtained at a pharmacy or directly from the website. In case of permanent damage a report must also be made to the Patient Insurance Association (Patientforsikringen), and compensation may be awarded. It is important to be aware that small children will occasionally get infections or other illnesses

12 during the period in which they are being vaccinated. Consequently, if a child appears to be suffering for example. from a high fever shortly after a vaccination, it may be a good idea to have a doctor determine whether this is due to illness or to the vaccine. Where is more information available about vaccines? The vaccinating physician will be able to inform the parents about the effects and possible side effects of the vaccines. Often, the parents will also have discussed the vaccinations with their home visitor Diphtheria, Tetanus, Pertussis, Polio and Hib vaccine (DiTeKiPolHib) DiTeKiPolHib, the vaccine used to protect against diphtheria, tetanus, whooping cough, polio and haemophilus influenza b, is administered three times: when children are three, five and twelve months old. The present version of the vaccine was introduced in The vaccine is made up of completely detoxified parts of the poisons (toxoids) of diphtheria, tetanus and whooping cough plus killed polio virus and parts of killed haemophilus influenza b bacteria. The form of whooping cough vaccine that was introduced in 1997 contains only purified parts of whooping cough bacteria and therefore causes far fewer side effects than the old vaccine, which contained whole whooping cough bacteria. How long does the vaccine keep working? After the three vaccinations the person is well protected against diphtheria, tetanus, whopping cough and polio until the age of 56. At five years of age children are re-vaccinated against diphtheria, tetanus, whooping cough and polio. This prolongs the period of protection against diphtheria and tetanus by 10 years. Protection against whooping cough is presumably extended correspondingly. Protection against polio is considered to be permanent. Following three vaccinations against haemophilus influenza b, children are considered fully protected and will not be re-vaccinated. Does the DiTeKiPolHib vaccine have any side effects? The most frequent side effects are redness and tenderness at the injection site. Some children also get fever and feel unwell during the first couple of days following the vaccination. Febrile seizures can occasionally occur in conjunction with a fever, particularly if the child is so disposed. Every year a few cases of prolonged crying are reported. These were mostly noted in connection with the previous whooping cough vaccine that contained whole killed whooping cough bacteria. The cause of this reaction is not known, but after the prolonged crying the children are normal again. 180,000 vaccinations are performed annually with the DiTeKiPolHib vaccine and nearly all children are vaccinated with these vaccines.

13 Pneumococcal vaccine (Pn) The vaccine contains parts of the 7 sub-types of pneumococcal bacteria that are responsible for approximately 75% of serious pneumococcal disease in children from the ages of 6 months to 2 years in Denmark. The vaccine furthermore protects against a lesser number of lung and middle ear inflammations experienced by children. Pneumococcal vaccine, which is administered to children under 2 years old, is given a total of three times: when the children are 3, 5 and 12 months old, i.e. at the same time as the DiTeKiPolHib vaccine. The two vaccines are injected at two different sites. it is important to know that pneumococcal vaccine does not protect against all types of pneumococcal bacteria, but against the majority of the sub-types that cause serious illnesses in small children. Therefore there is still a small risk that vaccinated children can contract meningitis of pneumococcal bacteria origin. How long does the vaccine keep working? The vaccine is effective until the child is older than 4 years, after which the risk of serious pneumococcal disease is very small. Re-vaccination is only recommended for children with special illnesses. Are there any side effects? Following vaccination, up to one half of all children can get a fever of over 38ºC and some few percent over 39.5ºC; febrile seizures can, therefore, occur. There are seldom any reports of hypersensitivity reactions. Measles, Mumps and Rubella vaccine (MFR) The vaccine is administered when children are 15 months and 4 years old (as of April 1 st, 2008). Older children receive a second vaccination with MFR when they are 12 years old. The

14 vaccine is comprised of living, weakened virus that can cause a very mild infection. The vaccine has been used in Denmark since 1987 and over 100,000 MFR vaccinations are given annually. Over the course of some years, more than 10-15% of children have not been vaccinated. Therefore it is possible that minor epidemics of the three diseases can occur. How long does the vaccine keep working? After receiving two vaccinations, the child is regarded as permanently protected. The body remembers meeting these viruses and has created antibodies that protect against the microorganisms. Are there any side effects? Because the vaccine is comprised of living weakened virus, the child may get symptoms mildly resembling the disease 12 weeks following the vaccination. Most of the side effects are fever, a cold or a rash, which are not contagious. Children with a previous history of febrile seizures may need to have medicine prescribed by a physician if there is fever following the vaccination. Very rarely, meningitis occurs following vaccination. During a year in which children are vaccinated, deaths and instances of meningitis could be expected if the same children had contracted measles. Re-vaccination with Diphtheria, Tetanus, Whooping cough and Polio vaccine (DiTeKiPol revaccination) The vaccine contains the same components of DiTeKiPol as DiTeKiPolHib vaccine with weakened versions of the components for diphtheria and whooping cough. Re-vaccination against diphtheria and tetanus at age 5 is given to ensure long lasting protection against both diseases. Thereafter the child will be protected for another 10 years. The duration of protection against whooping cough is presumably the same. Protection against polio is regarded as permanent. Re-vaccination against whooping cough was introduced on September 1 st, In addition to protecting the child itself against whooping cough, the whooping cough re-vaccination reduces contagion to infants who are not yet vaccinated against the disease. Re-vaccination against polio for 5 year olds was introduced on July 1 st, Are there any side effects? There is occasional local swelling at the vaccination site. Monitoring of the vaccination program The vaccination program is monitored constantly to ensure that it is working as intended.

15 Registration is made of the number of occurrences reported of the diseases being vaccinated against. In addition, the number of vaccinations performed by physicians is recorded, as well as the number and type of side effects reported. If the need arises, changes in the schedule can be made. The Danish vaccination schedule functions well, and therefore the diseases children are protected against occur now only rarely in this country. However, this is not a reason to stop vaccinating. In addition to continued risk for contagion in Denmark there is also the risk that Danish children can be infected and bring with them contagion contracted through travel abroad. Notes This leaflet and other information about the children s vaccination program is available on the website of the National Board of Health (Sundhedstyrelsen) This booklet is available at no charge by contacting: