Vestnik Kavkaza opens a new interactive project "Ask Doctor Kozlova’’. Lyudmila Kozlova, Professor, Doctor of Medical Sciences, Honored Doctor of Russia and Honored Scientist of Russia answers questions of readers and listeners. The theme of the first program is vaccination. Ludmila Kozlova advises at what age children should be vaccinated, as well as when it is best to refrain from vaccination.
- Ludmila Vyacheslavovna, is it necessary to vaccinate children?
- This matter still causes debate. Vaccinations are necessary, and their role is the prevention of diseases, and severe complications are so great that this issue isn’t discussed anywhere in the world. We always used to put the blame on other countries, but both we and they have national immunization schedules. And they have even broader ones. I am aware that there may be some adverse reactions to vaccinations, but they can be prevented. Therefore, if you put on the scales all "for" and "against", of course, "for" prevails. And due to preventive vaccination we have almost got rid of such terrible diseases as smallpox and plague, which took the lives of entire cities. Starting from the mid-1970’s they have disappeared from the world due to preventive vaccination.
- What’s your attitude towards the existing vaccination schedule? Do you think that it should be extended, or vice versa, should it be shortened?
- Our immunization schedule needs to be optimized. This includes vaccinations against 12 diseases. In developed countries the number of diseases reaches 16-18. So the answer is obvious. We need to extend the calendar, but this requires costs. Despite the difficult situation, the merit of the presidential administration and the government is that they have found an opportunity to extend the national immunization schedule.
- The last extension was tied to the implementation of a national calendar of vaccination against pneumococcal disease. Children, especially in the first two years, and even in the first five years have an increased prevalence of these diseases caused by pneumococci: otitis, otitis media, sinusitis, inflammation of the sinuses, pneumonia, inflammation of the meninges, meningitis. The last two can sometimes lead to death or disability, especially meningitis.
We expected the introduction of this vaccine. When this vaccine hadn’t been introduced to the national calendar, almost all of my friends tried to inoculate their children and grandchildren. Now it is almost free of charge for people. This is a great achievement, because the prevalence of otitis and the other diseases that I have already named is very high. They are often accompanied by complications, and a group of children with recurrent respiratory infections is formed. Mainly due to these diseases.
- Can parents refuse vaccinations because of their beliefs?
Parents have a right to refuse vaccination. Refusals are often made due to ignorance of the complications. Parents often get information from friends, acquaintances, neighbors, or the Internet. And it is necessary to refuse when they have an obvious reason. It is necessary to consult with competent specialists: local doctors, infectious disease doctors, immunologists.
There is an opinion that "the doctor just needs to give a vaccination." But this is absolutely not true. There are contraindications for vaccinations: permanent or temporary. It is necessary to follow the timing of the introduction of the vaccination. Vaccinations are not given to sick children, or immediately after an illness. A month and a half after an illness. It is necessary to wait longer after some diseases before vaccination.
If you look at the conditions of storage, transportation, expiry dates of vaccines, as well as giving a vaccination in respect of these parameters, so that adverse reactions are minimized. It is believed that immunizations are contraindicated for children who suffer from allergies. This is not true. Special training is required prior to vaccination. Doctors know this very well, we just need to follow their advice.
There are reasonable and unreasonable refusals of parents. I think that parents need to understand their responsibility to the child. They have the right to refuse, but the child also has a right to choose, but at ten he doesn’t understand whether he needs to refuse or not. Therefore, you are responsible for the health of your children together with your doctor. No local doctor would take the responsibility of inoculating a child if he had any reason not to do so. There are experts whom you can consult with: infectious disease doctors, epidemiologists and immunologists.
If the child is frequently ill it is necessary to understand whether the doctor is monitoring the child in the wrong way, or you are involved in this negative process, as well as how your unreasonable refusals affect the illness of your children. The awareness of parents is very important for reaching a reasonable solution.
- You have said that a vaccination should not be done if a child has any particular contraindications. Children receive the very first vaccinations in hospital in the first hours of life. It is clear that no studies are usually made. All children are vaccinated. Are there any contradictions?
- Not everybody is vaccinated. Not so many children are born absolutely healthy. There are children with abnormalities in the nervous system, children with a history of intrauterine hypoxia. The work of neonatologists is extremely difficult. For many years I was engaged in neonatology, and being in a group of physicians I received the national award 'Vocation' for a new scientific direction – perinatology. That is why I know that a good doctor-neonatologist is in doubt, he conducts research. These results can help resolve the issue. If the baby is premature, in this case BCG (Tuberculosis Immunization) should be done on the third day, for example. Doctors can wait a little before the maturation of the child – a certain number of days. Doctors have a very serious attitude to this in hospitals.
A good doctor has the ability to be compassionate, considerate, to be friendly, and to think. I usually tell students: before doing something, put yourself in the place of the parents of the child, if you would do this for your child, you have a right to do it for other children.
I have never met doctors who have a thoughtless attitude to this. Maybe I was lucky, because I am also aware that there are people in any profession who are not careful. But only a few of them, especially among pediatricians. If parents have any doubts they need to have a conversation with the head of department, head of the clinic, or chief of department in the hospital.
I believe that vaccination cannot be done without parents’ consent. But only a competent physician can inform them and persuade them, can put himself in the place of the parents.
