As Israel prepares to launch its drive to vaccinate children age 5-11 against corona, parents should not forget how essential it is to make sure that they receive all the vaccinations recommended by the Health Ministry starting from the time they are babies, according to a specialist in pediatric infectious diseases.
From polio to hepatitis, these vaccines have helped virtually eliminate many dangerous diseases that were common among the young in the past decades, said Dr. Oded Scheuerman, of Schneider Children’s Medical Center.
He said that compared with the very heated public discourse around the inoculation against corona, the vast majority of parents across sectors appear to have their children receive the jabs they need.
“Israel is very advanced in terms of its vaccination policy for children,” said Scheuerman. “Vaccination is one of the essential elements that have changed medicine in the last century, because diseases that were very common have partially or absolutely vanished thanks to it.”
One example is smallpox, which has been completely eradicated. The virus is not found outside laboratories, and the vaccine is not even administered anymore.
Other diseases have become much rarer, but they are still circulating and therefore vaccination is crucial.
“There are diseases that were very common at the time of our parents and grandparents, such as polio and diphtheria,” Scheuerman said. “Even today we see older patients carrying disabilities because of them, but among young people, they have basically disappeared.”
The vaccine against diphtheria and polio is given to babies in the same inoculation with the one against pertussis and tetanus, in four doses at two, four, six and 12 months. A booster for this inoculation is given to children at seven and then again at 13 – without polio.
In Israel, the vaccination process for children starts at the hospital, when newborns receive their first shot against Hepatitis B. A second dose is given at one month, and a third at six months.
Inoculation against Haemophilus influenza B is also given in four doses at two, four, six and 12 months. According to data by the Health Ministry for children born in 2018, the vaccination coverage in Israel against all these diseases reached 94%-96%.
“I have been a pediatrician for 22 years and I have seen only two patients infected with the Haemophilus influenza B bacteria, which was a common cause of meningitis until the 1990s,” Scheuerman said. “They were either not vaccinated or presented a severe immune-deficiency.”
Another disease that has dramatically decreased thanks to inoculation is Hepatitis A. Israel began to vaccinate against this infection at the end of the 1990s.
“When I started my career, Hepatitis A was a very common disease,” Scheuerman recalled. “We saw many patients ill with it, some of them presenting fully hepatic failure and in need of a liver transplant. In the past few years, we do not see children and young adults with Hepatitis A.”
Among children born in 2018, exactly 83% have been vaccinated against this infection. The inoculation is given in two doses at 18 and 24 months.
The reason why the coverage is not higher, he says, might be that the second dose is given when children are between two and two-and-a-half, and parents stop taking them to the network of special clinics – Tipat Halav – that offer care for babies under two.
In the early 2000s, Israel also started to vaccinate against the varicella virus, or chicken pox. The same jab protects against varicella, mumps, measles and rubella, and it is given in two shots at 12 months and six years of age. Coverage among children born in 2018 is almost complete, at 98%.
“As a resident, I constantly saw many patients with complications caused by varicella in the ward, including encephalitis, bacterial secondary infections and pneumonia,” the doctor said. “Even though sometimes cases of varicella emerged in the community, especially among non-vaccinated children, since the vaccination we do not see patients with complications in hospitals.”
Vaccines can target diseases caused by both bacteria and by viruses.
“Some vaccines have also improved the quality of life, such as the one against the rotavirus, which is given to babies orally,” he said. “The rotavirus causes gastroenteritis. Compared with the past, we see very few patients admitted to the hospitals with such gastroenteritis, and most of them are not vaccinated.”
Scheuerman said he does not believe that vaccine hesitancy has grown over the past few years, but rather that the topic has been more under the spotlight because of social media and media in general.
“There have always been parents asking questions about vaccinations, and maybe there are more of those, but I think asking questions is a good thing,” he said. “I think that people who refuse vaccines might get more media coverage, but while Israel might have a small loud population that speaks out against vaccines, overall the vast majority get vaccinations and vaccinate their children.
“In the Arab population vaccination coverage is very high, and also in most of the haredi (ultra-Orthodox) sector. In the haredi community, there’s a minority who don’t vaccinate their children, but they are very small. We do not see the hesitancy that we have at times seen with the coronavirus vaccine.”
When vaccination rates are lower, there is usually an explanation. According to Health Ministry data, only 77% of children born in 2018 were vaccinated with the Bivalent Oral Polio vaccine, which is given in two doses at six and 18 months.
According to Scheuerman, since children also get inoculated against polio, many parents are not aware that there is also a need for the oral vaccine.
“The oral polio vaccine was added to the schedule more recently, because we know that the inactivated virus given via a shot does not help reach herd immunity,” he said. “The oral vaccine does, and helps eradicate the disease from the population.”
Another vaccine with vaccine rates under 90% is the one against the rotavirus, with coverage at 80%, according to the ministry.
“It could be that this disease causes severe morbidity, but it is unlikely to cause mortality,” said Scheuerman. “In addition, the window of time to give the vaccine is very limited, so sometimes it can happen that it is missed.”
The first dose of the vaccine for the rotavirus is supposed to be given at two months, followed by another two at four and six months.
At the moment, there is one vaccine that is recommended but not covered by public healthcare: the one against Meningitis B, a common cause of meningitis in Israel.
“I understand that in the past two years more and more parents are buying the vaccines and getting their children inoculated,” he said.