Baltic region hitting childhood immunisation targets

Gary Finnegan

Gary Finnegan

November 1st, 2012

Gary Finnegan

‘When it comes to reaching childhood immunisation targets, Estonia, Latvia and Lithuania, are model students. The measles epidemics that Europe has been battling have barely touched the Baltic states due to their exemplary vaccination rates.’

Dr-Kuulo-KutsarDr Kuulo Kutsar, State Epidemiologist of Estonia, told Vaccines Today that coverage for measles, mumps, rubella, polio, tuberculosis and other vaccine-preventable diseases is high, although influenza vaccination is very low.

In Estonia, just 1.4% of the adult population received a flu vaccine last year. In Lithuania it’s around 6% – still a far below the 75% target for the at risk population.

“Immunisation is still mainly a childhood health issue in Estonia, but step-by-step understanding of the importance of adult vaccination is improving,” he said.

Still, Baltic childhood immunisation rates are a good news story that often gets overlooked in light of serious problems elsewhere in Europe.

Of the 30,567 measles cases reported by the European Centre for Disease Prevention and Control (ECDC) last year, almost all were in Western Europe.

While France, Spain, Italy and Romania each recorded thousands of measles in 2011, the figures for Estonia, Lativa and Lithuania were in single digits (7, 1 and 7 respectively).

Dr Kutsar, who recently addressed colleagues at the 11th Baltic Vaccination Day, said public confidence in vaccination has been good for decades but “it has been seriously damaged during the last ten or fifteen years by the growing anti-vaccination movement”.

He said that while the vast majority of parents in Estonia trust their family doctors’ advice on immunisation, the media is not always well informed on the issue and GPs rarely venture into public debates.

For his part, Dr Kutsar regularly accepts invitations to speak on radio and television, he has just published a handbook for parents on vaccination, and he now has a blog (in Estonian – use Google Translate!).

Read a transcript of our interview with Estonia’s State Epidemiologist,Dr Kuulo Kutsar

Vaccines Today: You recently chaired the 11th Baltic Vaccination Day. Can you give us some insights into vaccination rates in the Baltic states? For which diseases are immunisation rates particularly low?

Dr Kuulo Kutsar: There are no particularly low children immunisation rates in the Baltic states. For example, Table 1 gives the immunisation coverage (%) of 1-year-old children at the national levels for 2010 according to WHO statistics.

Diphtheria, tetanus, pertussis948995
Measles, mumps, rubella,959396
Haemophilus influenza b948895
B hepatitis948994


So, Estonia should reach WHO recommended immunisation coverage rates for diphtheria, tetanus (95%), Haemophilus influenza b, hepatitis B and poliomyelitis (95%), Latvia – for diphtheria, tetanus, pertussis, measles, rubella, mumps (95%), Haemophilus influenza b, hepatitis B, tuberculosis (95%) and poliomyelitis, and Lithuania – only for hepatitis B (95%).

Vaccines Today: Flu season is upon us. What proportion of the population in your country was vaccinated last year?

Dr Kutsar: Influenza vaccination coverage of the Estonian population was only 1.4% in 2011.

Vaccines Today: One of the topics addressed at the meeting in Tartu was adult immunisation. Do you think immunisation is still seen as a childhood health issue?

Dr Kutsar: Immunisation is still mainly a childhood health issue in Estonia, but step-by-step the understanding of the importance of adult vaccination is improving.

Vaccines Today:  How would you describe public confidence in vaccination in the Baltic region?

Dr Kutsar: I only know the situation in Estonia. Public confidence in vaccination has been good for decades in Estonia. It has been seriously damaged during the last ten-fifteen years by growing anti-vaccination movement.

Vaccines Today: What role has the media played in this?

Dr Kutsar: Estonian media has kept a moderate position on the issue. Usually it awakens due to parents’ complaints or misunderstandings, or during outbreaks. Our journalists are not well educated on the complicated world of immunisation and media coverage can be aggressive.

Vaccines Today: How important are doctors’ voices in the public discussion about vaccination?

Dr Kutsar: Vaccination is a responsibility of family doctors in Estonia. They very seldom participate in the public discussion. Nevertheless according to responses from the most recent parents’ questionnaire on children vaccination, 76% of them trust GPs, with a further 5% trusting family nurses on vaccination issues.

Vaccines Today: In addition to your contribution to the Baltic Vaccination Day, what do you do to improve attitudes to immunisation?

Dr Kutsar: To improve attitudes to immunisation in Estonia I am writing articles for family doctors’ journals, talking on radio and TV – when asked to do so – giving consultations to parents and this year I successfully published a handbook for parents on children and adult immunisation. The title translates as: “To parents, about vaccination”.