The risks of letting our guard down in the vaccine schedule that protects against diseases such as cancer

Fifteen million people have died in the world directly or indirectly due to the pandemic. Covid-19, according to the latest data provided by the World Health Organization. But how many deaths would this disease have caused if there had not been quick access to vaccines against the SARS-CoV-2 virus?

It is difficult to answer this question, although the Aragonese Public Health nurse and midwife Inmaculada Cuesta refers to the stark images of the first months of the outbreak of the pandemic, with enormous morgues saturated because they could not cope with the high mortality rate that He left the disease in his wake. In these two years of pandemic, citizens have learned that vaccines against covid They avoid becoming seriously ill, reduce hospital admissions and, consequently, the number of deaths. 

Inmaculada Cuesta, secretary of the National Association of Nursing and Vaccines (Anenvac), is a reference in this field who is consulted by the Ministry of Health to the communities to make the best decisions regarding vaccines. She considers that in our country we are privileged by the great vaccine coverage and by its free nature to protect those who need it, something that does not happen in all corners of the planet. She highlights the good coverage achieved against covid-19, but between weak points detects that there are still unvaccinated people, who calls on them to get immunized because they run the risk of contracting the disease seriously, which can put them in the hospital and even in the grave. "Although those vaccinated with the complete schedule have lowered their guard by being protected, The unvaccinated are virgins and may have a false sense of security, because the virus is still there, the pandemic has not passed”, points out the nurse.

Another of the great challenges is the vaccination in children and adolescents. In this sense, there has been a reluctance that is difficult to understand due to the contradiction it implies, Cuesta emphasizes: "there are fathers, mothers and guardians who have been vaccinated but have refused to protect their children or wards. That is incomprehensible." Therefore, ddefends vaccination for all children over 5 years of age with the complete schedule (all three doses), even if they have passed the disease. According to the latest known figures, in Aragon the ratio of vaccinated children has improved, and we must continue along those lines.

He also sees it necessary to complete the three-dose schedule because having passed the disease does not allow him to achieve the desired dose. "hybrid protection" which is achieved with the vaccine. According to the fourth dose, is still not contemplated today for the general population, so it is limited to those who live in nursing homes, or who have important risk factors.

In general terms, Inmaculada Cuesta points out that as long as the entire population is not vaccinated, the pandemic is not over. "We still have to be cautious because the virus is still there"We must maintain protective measures, hand hygiene, safety distance in closed places... Especially the most vulnerable people have to protect themselves and wear a mask."   

The side effects of the pandemic on the vaccination schedule

One of the side effects of the pandemic it has been that has lowered its guard in widespread vaccination. At first, when health centers had to be closed, priority was given to the calendar vaccination of children under two years of age, because they were the most vulnerable, and of pregnant women. But some time later it was found that There are children who were not administered the corresponding doses either before or after, with which the coverage of the systematic vaccination schedule up to 14 years of age is decreasing. "This can have an impact on the appearance of diseases that we thought would not reappear", points out Inma Cuesta. Added to this is the arrival of children and adults from Ukraine who are not fully vaccinated because this is a population reluctant to be immunized. 

"This is very worrying. It is important that the health system makes the effort to recruit children who are missing a vaccine and parents or guardians must also worry about going to the health system to update the vaccination schedule." He gives the example of measles: to be well protected against this infectious disease, It is necessary to have received both doses of the vaccine. And furthermore, there are people who have neither had measles nor are they vaccinated because when they were children it was not included in the vaccination schedule nor did this disease circulate. They are people who are between 30 and 50 years old who may be at serious risk because, In adults, both measles and rubella can be fatal. According to the nurse, people who are not vaccinated can go to the doctor and ask to get it. If you do not know if the disease has passed or not, there is nothing wrong with receiving it.

Another disease about which we must be on alert due to what it is representing during the pandemic is pneumonia. Thus, vaccination against pneumococcus is included in the childhood vaccination schedule. But the WHO has called on all countries to make a special effort to vaccinate against pneumococcus in people who have suffered from severe Covid. In Aragon, Since 2019, the polysaccharide pneumococcus vaccine has been given to people who turn 65 years of age free of charge. They are sent a letter to go to the health center, but due to the pandemic it was stopped being sent, and the older a person is, the more likely they are to contract the disease. "It is important to resume vaccination against pneumococcus in adults"Cuesta insists. In Aragon, for a few months now, the conjugate pneumococcus vaccine recommended by the WHO has been administered in nursing homes.

In recent years, the vaccination schedule has been extended, explains Inmaculada Cuesta: "Now it is much more complete, and vaccines are no longer something for children and the elderly. They have to be worn throughout all stages of life"In fact, before birth, pregnant women are already recommended to be vaccinated against the flu if the gestation period coincides with the season of this disease and against whooping cough. It is the so-called "altruistic vaccination" because the woman is protected and transmits the antibodies to the baby, who cannot be vaccinated against the flu, for example, before 6 months and, therefore, would be unprotected at a very vulnerable time in his or her life.

The childhood vaccination schedule extends up to 14 years of age and includes vaccines that even prevent cancer, such as the one caused by human papilloma virus in the girls. This vaccine, which is injected at age 12, prevents cervical cancer. Scientific societies are recommending that children also be protected, because although they will not suffer from this type of cancer, they can infect and transmit it. In fact, in Catalonia, vaccination against the human papillomavirus for men is being launched. Furthermore, Cuesta points out, there are studies where it is observed that vaccination prevents oral cancer, due to sexual habits.

Another vaccine that is included in the childhood vaccination schedule and prevents cancer, in this case liver, is hepatitis B. All those born after 1980 are protected, and now it is given along with preventive vaccines for five other diseases in a single injection. 

The formula that prevents a fulminant disease, although it is not included in Aragon in the systematic vaccination schedule, is that of meningitis B: Pediatricians recommend it and parents purchase it. There are autonomous communities that do have it for free.  

Likewise, there are new vaccines not included in the vaccination schedule, such as Herpes zoster, which in Aragon has begun to be administered to people with serious pathologies, such as those undergoing oncological or immunosuppressive treatments, in which suffering from this disease can worsen their pathology. The coronavirus vaccine has also been developed and will soon be administered. respiratory syncytial virus, a very serious disease that mainly affects children and used to appear in winter, but due to the pandemic there was an outbreak in August and September 2021. 

Smallpox vaccine, available if necessary

According to the monkey poxInmaculada Cuesta remembers that this is an outbreak, it is not a pandemic, and the transmission is, for the moment, very moderate. While in the United Kingdom it has been considered necessary to administer two doses of the smallpox vaccine to people who are not vaccinated and one dose to people who are, in Spain this measure is not foreseen for now. In 1978, newborns were stopped being vaccinated against smallpox in our country, so those over 44 years of age are protected against monkeypox. Although in 1980 the WHO declared it eradicated, in 2013, the European Medicines Agency approved a non-replicative attenuated vaccine, that is, it has been treated so that it can prevent smallpox but not reproduce the disease.