Tuesday , June 22 2021

The incidence of pneumococcal infections in Slovenia is among the highest in the EU



In the winter, not only flu, but also other infectious diseases are circulating. One of these is a pneumococcal infection that causes severe health problems – including pneumonia, blood infection and inflammation of the brain's lining. In Slovenia the incidence of these infections is three times higher than in other European countries and is five times higher in children. The reason for this is mainly in poor grip.

Pneumococci settle in the lining – especially in the nose and throat.PHOTO: Thinkstock

First, let's clarify what pneumococci are and what is the infection with them. Streptococcus pneumoniae are bacteria that can be present in the mucous membranes, especially in the nose and throat. Under favorable conditions (reduced immunity, mucosal damage), various (even severe) infections can be caused: pneumococcal meningitis (inflammation of the brain), sepsis, bacteremia (blood infection), battery pneumonia and, , causing inflammation in the middle ear. In elderly patients suffering from pneumonia, one of the most common causes of pneumonia is pneumococcal infections.

There are more than 90 serotypes of this bacterium – of course they do not cause illness, they also differ in how serious the infections are. Generally, these infections are divided into so-called invasive and non-invasive experts.

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In Slovenia, in 2017, 17 people died of invasive pneumococcal infections. Among the risk factors for the infection are aged up to 2 years and over 65 years, lack of resistance, chronic diseases, respiratory infections and inflammatory conditions such as influenza and asthma, poor socio-economic conditions and cohabitation.

Increasing the resistance of pneumococcus to antibiotics

In the first year of life, nearly 60% of children have at least one middle ear defect, and in more than half of the cases they are caused by pneumococci. Children are the most common carriers of this bacterium that is "formed" in the nasal-intestinal canal. Even 70% of children in Bulgaria have this bacterium, whereas bacterial carriers are only about 10% among adults. Children can also transmit the infection to adults, but they are dropped. "By coughing, sneezing, talking, sharing toys, toys … Transmitting drops to a meter," explains the epidemiologist Alenka Tropp WroteFor the spread of pneumococci, healthy bacterial carriers are more important than patients.

Here is a colony of pneumococcus.PHOTO: NIJZ

Infections occur mainly in winter, when immunity from permanent viral infections is already reduced. "Children going to kindergarten can be permanently ill because they are experiencing ever-increasing viruses, and each viral infection weakens the mucous membrane, and mucous membranes are our primary barrier to bacteria penetration." If it does, of course, accessibility is wide open. The other reason is that children are wintering in enclosed enclosures, and there is significantly more open space in the summer, and this transfer is smaller. "explained the pediatrician Andrea Borink Beden,

The pediatrician also explained the possible course of the infection: "Children are usually ill with a viral infection of the upper respiratory tract with symptoms of cold, fever, coughing and sneezing, and then a pneumococcal infection is possible in such a way that the child is infected with the lining and when the actual viral infection can be slightly calming the situation suddenly gets worse, the child becomes disabled, refuses to eat, does not drink, fever, starts to breathe heavily, sucks out.

Laboratory tests then confirm whether it is a bacterial infection. "If a child suffers from pneumococcal meningitis, which is a much more serious infection, severe, unbearable headache, vomiting, child harm, absence of a child, the child has a hard neck, she described the symptoms.

It is not at the top of the EU

Compared to other European countries, pneumonia in Slovenia is a very serious problem. According to the National Institute of Public Health (NIJZ), we have three times the incidence of these infections than the EU average. In children this difference is even more obvious. "In 2017 there was five times more pneumonia than the average for the European Union among children aged one to four years," "warned the pediatrician Dennis Bash,

And what is the reason why Slovenia should be ranked at the top of Europe after the outbreak of pneumococcal infections? Experts are convinced that the cause is in bad clutter. Four years ago, vaccination against pneumococcal infections was not included in the routine vaccination of children. Bacteria can expand freely and even become more resistant to antibiotics. The acute inflammation of the middle ear in children is the most common reason for prescribing antibiotics in our country, warns Tropp Sparta.

If not required, parents do not divorce

Vaccination is one of the most effective "weapons" in the fight against pneumococcus. Only in 2015 Slovenia introduced vaccination against pneumococcal infections as part of the routine vaccination of preschool children for children born after October 2014. Vaccination is optional and therefore the incidence of the disease is still low, %. "If we compare to the Scandinavian countries, the Netherlands, Belgium, where this vaccination was introduced earlier than in Slovenia, they reach between 70 and 90% of the population. We, as we have said, have a good 55%. , " – says Tropp Cast.

Interestingly, vaccination is not mandatory in the rest of the world, but the parent-vaccination relationship there is different. "Parents accept it as a benefit to their child" pediatrician Borink Beden. It is different with us: "The only argument that parents refuse to vaccinate is that this is not mandatory, and if not ordered, parents will not vaccinate it, we are still a company that needs some kind of coercion" is critical of Borink Bedenova, who says her clinic has a high degree of intolerance. Thus, he notes that the so-called "collective spirit" is strongly influenced by parents – seeing other children get vaccinated makes it easier for them to decide to vaccinate their own.

"Perhaps parenting or even awareness of the possibility of vaccination against invasive pneumococcal infections is a little worse, and they may wonder why it is not necessary." We are afraid that if the choice of decision-making is free, we will agree with the percentages we see in pneumococcal vaccination and vaccination against HPV. stressed the epidemologist Tropp Spat.

"Vaccination against pneumococcus offers individual protection for the vaccine, and if many people are vaccinated, the incidence of bacteria in the area of ​​burning the nose is reduced. she continued. As pneumococcal carriers are mostly young children, they vaccinate this infection with "disfigurement" and thus protect adults.

A pneumococcal vaccine for children under 2 years of age is placed with a piercing in the muscle in the front of the thigh.PHOTO: Thinkstock

Side effects and vaccination costs?

If the parents agree with the optional vaccination against pneumococcal infections, this is covered by compulsory health insurance, which is why free of charge for children of the first year. It is also free for older children and adults with certain medical conditions.

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NIJZ vaccinations are also recommended for other adults, especially those over the age of 65 years. However, in this case, in the absence of the abovementioned health claims, the vaccination is self-adhesive. "Adult vaccination is important because it significantly reduces the risk of pneumococcal pneumonia, which leads to serious complications," they highlighted the NEI. Patients suffering from pneumococcal pneumonia are on average hospitalized for ten days, and recovery may take several weeks or even months. In up to 20% of people pneumococcal pneumonia is fatal.

Perhaps this is one of the main issues of people who think about vaccination: what are the side effects or side effects? They are recorded in a central register that is also publicly available. In 2017, when we spread about 30,000 doses of vaccines, only 15 children and one adult experienced a side effect – a local reaction at the injection site (redness, pain). Among the side effects that are rare, the impact highlights a little higher temperature and irritability.

One of the factors that can (adults) discourage people from being vaccinated is the price. "When we talk about what persuades people to divide, the price is somehow another reason in the third or fourth place. First of all, trust is trust, then trust or believe the information, or do you think the vaccine is effective, then comes the price, " – says Tropp Cast.

We are able to vaccinate with three different vaccines. According to the NIJZ list, vaccination with a 10-valent conjugate vaccine costs 42 euros, a 13-valent vaccine of 64.50 euros and a 23-valent polysaccharide vaccine of 35 euros. However, the rates of self-adhesive vaccination may vary depending on the operator. Adult vaccination is usually done with a single dose, and protection is expected to last for the rest of your life.

But the trend of vaccination with us is upwards?

The World Health Organization, among the top ten health threats this year, also opposed vaccination. Despite the increasing resistance to vaccination in the world and in our country over the past decade, Slovenia has seen a slight upward trend over the past two years. "In 2017, for the first time in 10 years, in the mandatory vaccination segment of pre-school children, the cumulative rate rose slightly upwards, probably due to the unfavorable epidemic situation – measles. In 2016 and 2017 large measles outbreaks in Italy, Austria, Romania Many children have died from measles in Serbia, so we started talking about the benefits of vaccination, about the importance of vaccination, why we even vaccinated them, although we have not seen diseases in us so many years that collective immunity is important " says Trop Skaza, who hopes that this trend will not be just "annual."

"It is not right for the opponents of vaccination to calm the false facts, but the profession is silent" stressed Borin Bedenova. In her words, unfortunately in Slovenia, the culture of vaccination is still low, "therefore, in the event of the abolition of compulsory vaccination, adherence would certainly be dangerous"She expressed her fear that in this case only half of the parents would decide to vaccinate the children.


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