“Morning Call” – Guest: Gindrovel Dumitra, vice president of the National Society of Family Medicine.
RADIO ROMANIA NEWS – Producers: Daniela Petrican and Cătălin Cîrnu
Producer – Daniela Petrican: Children can wait between one and three months on the lists of family doctors, because the MMR vaccine doses against measles, mumps and rubella, included in the national immunization program, are missing. The doses are given at one year and then at five years and are essential to prevent complications from so-called childhood diseases.
Producer – Cătălin Cîrnu: Romania has had moments in the past, including at the end of 2022, with a high risk of a measles epidemic, for example, when there was a shortage of vaccine doses in most of the country’s counties. But what is the situation now, on February 17, 2023, we learn from the guest of the “Morning Call”, Dr. Gindrovel Dumitra, vice-president of the National Society of Family Medicine and coordinator of the vaccinology group. Good morning!
Producer – Daniela Petrican: Good morning!
Gindrovel Dumitra: Good morning, good to see you again!
Producer – Cătălin Cîrnu: Is there, at this moment, a sufficient stock of doses at the offices for possible emergencies?
Gindrovel Dumitra: There is an uneven distribution at the national level at the moment, in the sense that there are still medical offices where ROR doses are found. Basically, we are talking about those cabinets where they were distributed by the Directorate of Public Health, but it was not used, either because of the children’s refusal or for other reasons, but overall, in the vast majority of counties it does not exist, not even in stocks at the level of the DSP and especially at the level of my fellow family doctors. The good news I want to give you this morning – and I’m glad to be able to do so – is that, following the fact that I contacted the Ministry of Health, it appears that from Monday this vaccine will begin to be distributed to The Directorate of Public Health, so it is very possible that by the end of this month, this vaccine will reach all family doctors’ offices in Romania.
Producer – Daniela Petrican: But is there a risk of a measles epidemic, for example?
Gindrovel Dumitra: Yes, let’s not say that this risk exists at the moment. He, of course, exists, without question, but any delay in vaccinating children, especially one-year-old children against these three diseases, creates the conditions for this epidemic to reappear. Basically, the mechanism of the recurrence of this measles epidemic consists in the accumulation of a large number of children who are not vaccinated, which, from one generation to another, this number increases. And thus, a critical mass appears that allows the spread of the virus within this community. It is well known that in order to be able to limit, prevent the occurrence of an epidemic, for measles we need to have a vaccination coverage of 95% at the national level or above 95%. But in Romania, in recent years, the vaccination coverage or, please, has fluctuated for the first dose, the one given at one year, between figures of 80% or 89%. It never rose above 90%. Well, these children who remain unvaccinated, either because their parents refuse, or because there are these delays in supply, constitute, as I said, each of them, an element that leads to the appearance of a significant number of people who can develop this disease and, further, to transmit it to other, we say, susceptible persons. That is, people who have no defense and who can get the disease.
Director – Cătălin Cîrnu: Measles, let’s put it this way, native, non-Aoș, is measles. Yes, so everyone can understand.
Gindrovel Dumitra: It’s measles. “The little boy” is also called. There are several popular forms. It also depends a lot on the region in which we are.
Producer – Cătălin Cîrnu: The big problem is among young children, although the disease can also be contracted by adults, right?
Gindrovel Dumitra: Well, I have to tell you that in the epidemic that happened between 2016-2019-2020 there were deaths, especially among infants, small children, but also among adults. And that is a tragedy. I remember one of the deaths was of a nurse working in a pediatric ward who got sick from the children she was caring for. And who had no other comorbidities. So here it can take its toll, even among adults. But in general, the most exposed to this disease are young children, especially infants. Why? Because we have this vaccine, being a live attenuated virus vaccine, it becomes effective when you administer it at the age of over one year. As such, infants have no protection against this disease. There is another formula by which we can provide additional protection for them by vaccinating the mother. That is, before becoming pregnant, she has the full vaccination schedule, which consists of two doses administered. At that time, the existing antibodies in the mother can be transferred transplacentally, and those antibodies provide protection to the child against an illness, against measles, for about 6-7 months. From here on, until the age of 12 months, the child is not protected in any situation, which is why if there is a particular … or a single case in a collective, well, this small group of under one years old represents the way through which this virus is transmitted, and the number of victims is the highest, precisely in this age group.
Producer – Daniela Petrican: You said that there are cases in which the child’s vaccination was refused, especially the parents refused this vaccination, but what did they tell you when they refused?
Gindrovel Dumitra: There have been a lot of, let’s say, myths or, please, false information related to this vaccine. And we remember that article that was once published by a British researcher in The Lancet, which made possible or raised the suspicion of the existence of a link between this vaccine and autism. Well, from then until now, we’re talking about the year 1998, there have been thousands of articles that have all disproved this. Basically, at this point there is no link between their vaccination and autism, but parents have a certain level of hesitation, even though, again, this link has been categorically disproved.
Director – Cătălin Cîrnu: Yes, it is very strange. However, given that the parents were largely vaccinated with this vaccine and obviously, things went well, there were no problems. Not?
Gindrovel Dumitra: That’s right. The parents, in turn, are vaccinated with this vaccine, because the vaccine has been administered in Romania since the last century, we like to say now, already, and the vast majority of parents who come with their children for vaccination are well and vaccinated.
Producer – Daniela Petrican: What is the situation with the administration of the other categories of anti-polio, anti-TB, flu, HPV, even the anti-Covid vaccine?
Gindrovel Dumitra: Let’s take it one by one, if we mean the BCG vaccine, which is given at birth, well, here we still have satisfactory vaccination coverage, and we administer this vaccine to prevent serious forms of tuberculosis, such as milia , respectively tuberculous meningitis. And what is important to know is the fact that Romania is still a country with an increased incidence of tuberculosis cases. The differences are very big compared to Western Europe, which is why we keep this vaccination. Again, vaccination coverage is still very good at this point. Regarding the polio vaccine found in the hexavalent vaccine, we had a supply hiatus here as well, but that has been resolved since December and at the moment vaccines are available in our clinics and we are in the process of recovering the children who could not be vaccinated at the time. In the hexavalent vaccine we are talking about the protection of diseases such as diphtheria, whooping cough, poliomyelitis, hepatitis B, infections caused by hemovirus influenza type B and very important for us is that this vaccine is administered in a national program to infants, every two months, four months and 11 months along with 13-valent pneumococcal conjugate vaccine. You also raised the issue of the HPV vaccine. Regarding the HPV vaccination, I am very happy that, it seems, the quantities of vaccines consumed, according to INSP reports, are doubling from year to year. For example, if in 2020, when we resumed vaccination, after about 11, 12 years of interruption, we had a number of about 25,000 doses administered, well, in 2021 there were 50,000, and in 2022 this number is approaching of double values. So we’re basically in an area of regaining or gaining confidence in this vaccine, in terms of safety, but mostly effectiveness, and we’re, of course, in what’s being talked about right now, in the implementation of the European plan to fight cancer, through which we aim to eliminate cervical cancer by 2030. Well, in Romania this will not be possible, precisely because we lost very precious time in these 10, 11 years, but we must do everything possible, such as through HPV vaccination, respectively through screening, the Babeș-Papanicolau cytological examination or the identification of viral HPV at the level of the cervix, so that we too can reach civilized Europe, and I say this with great responsibility, there are women who are young, who can leave behind a family. Regarding the flu vaccine, here things are more delicate, because we administered only one million 500,000 doses of vaccine, i.e. the vaccines that were bought by the Ministry of Health, given that the recommendations of international bodies are that every season we vaccinate the a little 75% of the groups at risk, or that would mean four million, five million people. But precisely because of a mistaken perception on the part of the adult population, as if vaccines are necessary for children and not necessary for adults, we are in this situation and let’s hope that in a few generations we will succeed, again, in reaching vaccine coverage of 75% to the share at risk, as it happens in the Netherlands, as it happens in Portugal or Great Britain.
Producer – Cătălin Cîrnu: Yes, we need information, every time, of quality, verified and to go to the hands of the doctors. Thank you for the discussion on “Morning Call” today.
Gindrovel Dumitra: Good morning!
Producer – Cătălin Cîrnu: Doctor Gindrovel Dumitra, vice-president of the National Society of Family Medicine and coordinator of the Vaccinology Group, was today’s guest.
