Dr José Garcia-Sicilia, a paediatrician at the Hospital Infantil Universitario La Pazin Madrid, says that while most Spanish people follow recommended immunisation schedules, there have been outbreaks of vaccine-preventable diseases.
In an interview with Vaccines Today, Dr Garcia-Sicilia said local outbreaks of measles mostly affect infants under 12 months of age who are too young to be vaccinated. There have also been several cases of mumps and pertussis recently, he added.
“Every year there are a few cases of whooping cough [pertussis] in infants under six months – born to unimmunised mothers and infected by young asymptomatic adults – incompletely primed due to their early age. In this group there is a considerable mortality rate,” he says.
The delivery of health services can also be a barrier to achieving optimal uptake of vaccines. Spain’s 17 autonomous communities and two autonomous cities have 19 official vaccination schedules, each subtly different to the next.
“All of them include the nine mandatory antigens (in different schedules), and only a couple of them add non-funded vaccines such as chicken pox or pneumococcus. This disparity certainly confuses parents when moving from one location to another,” says Dr Garcia-Silicia.
The Spanish population generally accepts vaccination, he adds, and coverage for many vaccines which are recommended and funded can reach 95%.
“The most concerning vaccines for paediatricians in Spain are those which are not financed by the authorities, such as rotavirus, chicken pox and conjugate pneumococcal vaccines.”
Other areas where improvement is needed includes uptake of HPV vaccines, immunisation during pregnancy, immunisation of health professionals, and flu vaccination for at-risk groups.
Full text of interview with Dr José Garcia-Sicilia
What vaccine-preventable childhood diseases are of most concern to paediatricians in Spain?
The most concerning vaccines for paediatricians in Spain are those which are not financed by the authorities, such as rotavirus, chicken pox and conjugate pneumococcal vaccines.
Have there been serious measles, pertussis or other outbreaks in Spain?
There have been some unexpected re-emerging disease outbreaks like measles, locally limited, due to the lack of vaccination among some groups that interrupt the heard immunity and affect mostly infants under 12 months of age (our official earliest age of immunization) and young adults who are unvaccinated or partially vaccinated; with only one dose.
Every year there are a few cases of whooping cough in infants under 6 months, born from unimmunised mothers and infected by young asymptomatic adults, incompletely primed due to their early age, with a considerable mortality rate. Most of these young adults haven’t received a pertussis vaccine after their second year of life and vaccine efficacy lowers to 84% four years after the last dose and to 46% 7 years later, so persistence of immunologic protection in immunized subjects doubtable lasts longer than 8-10 years.
Various studies in Spain have confirmed the intrafamilial origin of the infection in more than 50% of hospitalized infants in intensive care units. High coverage of dTap vaccination of adolescents and young adults would lessen this problem. Also outbreaks of mumps have become a frequent national disruption.
Are childhood vaccination rates good?
The Spanish population accepts vaccination as a very effective health promotion system. When a vaccine is included in the official schedules and funded by the health authorities, coverage easily rises to 95% or over in the first years of life.
These rates decrease when the vaccines are not funded by the public system such as with rotavirus, conjugated Pneumococcal and chicken pox. Although an acceptable coverage with these vaccines, higher than in most of the European countries, is still maintained.
A particular exception is the HPV vaccine, although publically funded, with extreme local variations, doesn’t reach optimal coverage levels. This seems to be an unexplainable paradox seen in many other Western countries.
Is childhood vaccination free? Where do they get vaccines for their children?
All Spanish children receive diphtheria, tetanus, pertussis, measles, mumps, rubella, Hib, Meningococcus C and HPV (young girls), granted by the government, up to 14 years of age.
Risk groups also get the flu, pneumococcal and chicken pox vaccines.
Most immunisations are dispensed, by nurses, in the numerous primary care health centers spread all over the country. In special campaigns vaccines are administered at school. There are some centres specialised in vaccination, including those for travellers. Some private paediatricians vaccinate their patients too.
Do many children receive the flu vaccine?
Coverage, even in risk group children is very low.
Is there a vocal anti-vaccine movement in Spain? If so, what can be done to address this?
Anti-vaccine movements, currently increasing after the H1N1 campaign, are still not very popular (apart from those classical worldwide religious or ethnic prejudices). Most of the followers of anti-vaccine groups, in our country, are young professionals – “Google- addicts”.
There are different vaccine schedules in different regions of Spain. Does this cause confusion for parents if they move their families from one region to another?
The political and administrative division of Spain in 17 Autonomous Communities and two Autonomous Cities since 1978 have established 19 different official regional vaccination schedules. All of them include the nine mandatory antigens (in different schedules), and only a couple of them add non-funded vaccines (such as chicken pox or pneumococcus. This disparity certainly confuses parents when moving from one location to another.
What do you see as the key vaccination issues in Spain?
First, vaccination during pregnancy and health care personnel seems to be an impossible mission.
Second, recently the attempt to control the unofficial non-funded vaccines has led to a very surreal situation. Vaccines like PCV13, hepatitis A or inactivated flu vaccines can be acquired in every pharmacist office.
However, new meningococcal B and tetravalent A,C,Y&W135 meningococcal conjugate vaccines can only be prescribed and administered in hospitals by hospital specialists. In Spain, children are attended in primary care stage mostly by paediatricians and not by GPs.
Chicken pox vaccine is currently in a very peculiar, probably illegal, situation as, after many years of free access to the vaccine, the authorities have blocked its distribution for private sale based on the high but incomplete coverage reached in the private market and its impact on the epidemiology of the disease and herpes zoster.