Information on immunoprophylaxis of infectious diseases
Rights of Citizens of the Republic of Belarus in the Field of Healthcare for the Prevention of Infectious Diseases.
The right to healthcare is regulated by the Constitution of the Republic of Belarus: "Citizens of the Republic of Belarus are guaranteed the right to healthcare, including free medical care at the expense of state funds in the manner prescribed by law. Citizens take care of preserving their own health" (Article 45).
The state provides everyone with the opportunity to protect themselves from infection with infectious diseases.
Vaccines are classified as medicinal products in our country (Law of the Republic of Belarus of July 20, 2006 No. 161-Z "On the Circulation of Medicinal Products"), intended for the prevention of infectious diseases and belong to the group of immunobiological medicinal products (hereinafter referred to as IBMPs). The procedure for registration, import, and use of medicinal products is determined by the legislative acts of the Republic of Belarus on state regulation in the field of circulation of medicinal products.
Vaccines are IBMPs intended for the prevention of infectious diseases in humans, therefore, the requirements for their quality are stringent, corresponding to international safety standards.
The country has a system for monitoring the registration of serious adverse reactions after the use of vaccines, which includes the recording and investigation of serious adverse reactions (Sanitary Norms and Rules "Sanitary and Epidemiological Requirements for the Transportation, Storage and Use of Immunobiological Medicinal Products, Conducting Preventive Vaccinations, Identification, Registration and Investigation of Adverse Reactions after
2. Procedure for the appointment of ILPs, carrying out preventive vaccinations and patient observation after their administration.
Preventive vaccinations – the introduction of ILPs into the human body to create specific immunity to infectious diseases.
Preventive vaccinations are carried out taking into account indications and contraindications for their administration, in strict accordance with the instructions for medical use attached to the ILP. In childhood, vaccinations are carried out against: hepatitis B, tuberculosis, diphtheria, tetanus, pertussis, poliomyelitis, pneumococcal and Haemophilus influenzae infections, measles, rubella, mumps. Adults require periodic re-administration of vaccines against diphtheria and tetanus. In addition, some categories of citizens are entitled to free vaccination against viral hepatitis B and influenza.
Information about preventive vaccinations is entered into medical documentation. You can clarify information about your vaccination status at the territorial healthcare organization at your place of residence.
When seeking medical care at a territorial healthcare organization, the patient has the right to clarify their vaccination status and the need for preventive vaccinations in accordance with their age.
In the Republic of Belarus, a National Calendar of Preventive Vaccinations and a List of Preventive Vaccinations by Epidemiological Indications have been developed, established by the Resolution of the Ministry of Health of
May 17, 2018 No. 42 "On Preventive Vaccinations".
Vaccination of the population of the Republic of Belarus is carried out within the framework of providing medical care to citizens. The minimum social standard for outpatient polyclinic care for the population provides for free preventive vaccinations based on the National Calendar of Preventive Vaccinations and the List of Preventive Vaccinations by Epidemiological Indications.
3. Preventive Vaccination Schedule. In 1974, the World Health Organization (hereinafter referred to as WHO) launched an international initiative known as the Expanded Programme on Immunization (EPI). The EPI was initially aimed at protecting children from six childhood diseases; today, its scope has expanded to include 13 universal vaccines recommended throughout the life cycle, and 17 additional vaccines administered based on specific conditions. With the program's vaccination coverage extended to the entire life cycle, it is now referred to as the Core Immunization Program.
The preventive vaccination schedule of the Republic of Belarus includes a list of vaccinations against 12 infections: hepatitis B, tuberculosis, diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, measles, rubella, mumps, as well as influenza and pneumococcal infection for specific risk groups. In our country, preventive vaccinations against 19 infections are mandated based on epidemiological indications.
4. Funding. In the Republic of Belarus, immunization within the framework of the National Preventive Vaccination Schedule is fully funded by the state. At the discretion of citizens, vaccination against infections not included in the National Preventive Vaccination Schedule can be carried out at their own expense in healthcare organizations.
5. Consent and Refusal of Preventive Vaccinations.
Preventive vaccinations are a simple medical intervention that requires obtaining verbal informed consent. The decision to vaccinate a child under 14 years of age is made by their parent or legal representative (parent, guardian). Minors aged fourteen to eighteen have the right to independently give consent for simple medical intervention (Article 44 of the Law of the Republic of Belarus of June 18, 1993, No. 2435-XII "On Healthcare". A note of consent is made by the healthcare professional in the medical documentation.
In accordance with Article 45 of the aforementioned Law, refusal of immunization is documented in the medical records and signed by the patient and the attending physician. The attending physician must explain the potential consequences of refusal.
Key Facts About Immunization.
- Immunization saves lives.
Routine immunization against diseases such as polio, tetanus, diphtheria, pertussis, and measles saves the lives of 2 to 3 million people worldwide every year. In addition, it protects millions of people from severe suffering associated with debilitating diseases and lifelong disability.
The benefits of immunization are increasingly extending to adolescents and adults by providing protection against life-threatening diseases such as influenza, meningitis, and cervical cancer, which can develop in adulthood.
Vaccines can not only save lives but also transform them by providing children with opportunities for healthy development, school attendance, and improved life prospects.
In recent years, which coincided with the pandemic period, progress in immunization has slowed down. Although 4 million more children were vaccinated worldwide in 2022 than in 2021, 20 million children did not receive one or more doses of vaccine. Factors hindering the vaccination coverage of these children include escalating conflicts, economic downturns, and growing vaccine hesitancy. As a result, the world is experiencing sudden outbreaks of diphtheria and measles – diseases that we had previously almost completely controlled.
In the Republic of Belarus, the number of cases of infections controlled and prevented by specific prophylaxis continues to decrease or remain stably low for most indicators. In 2023, no cases of diphtheria, carriage of toxigenic strains of the diphtheria pathogen, tetanus, rubella, or congenital rubella were registered. The country has maintained its status as polio-free, rubella-eliminated, and measles-eliminated.
2. Outbreaks of infectious diseases pose a constant serious threat.
Vaccination prevents suffering, disability, and death from vaccine-preventable diseases. Paradoxically, the fact that many infectious diseases have become rare or have virtually disappeared due to effective vaccination programs may contribute to the perception among parents that immunization is no longer necessary, or that it is more dangerous than the disease itself. Disease outbreaks affect everyone.
Measles
In 2022, following years of declining measles vaccination coverage, the number of measles cases increased by 18%, and the number of deaths from the infection rose by 43% (compared to 2021). The number of cases is estimated at 9 million people, and deaths at 136,000 people, the majority of whom are children.
The threat of measles for children continues to grow steadily. In 2022, large-scale and severe outbreaks of the disease occurred in 37 countries (compared to 22 countries in 2021). Twenty-eight countries affected by outbreaks are in the WHO African Region, six in the Eastern Mediterranean, two in South-East Asia, and one in Europe.
Measles infection can be prevented with two doses of the measles vaccine. In 2022, compared to 2021, vaccination coverage worldwide increased slightly, however, the number of children who missed a dose of the measles vaccine was 33 million, of whom almost 22 million children did not receive the first dose, and another 11 million missed the second dose. The global coverage rate for the first dose of the vaccine was 83%, which is much lower than the 95-97% required to protect the population from outbreaks.
The lowest vaccination rates (only 66%) continue to be observed in low-income countries. More than half of the
22 million children who missed the first dose of the measles vaccine in
2022 live in just 10 countries: Angola, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Madagascar, Nigeria, Pakistan, and the Philippines.
According to the conclusion of the European Regional Commission for the Certification of Measles Elimination, the Republic of Belarus has been classified as a country where this infection has been eliminated since 2012.
In 2023, 192 laboratory-confirmed cases of measles were registered (no measles cases were registered in 2022).
Polio
The global polio situation remained relatively stable in 2023. In recent years, the number of registered cases of paralytic polio worldwide has decreased: from 359 cases in 2014 to 30 cases in 2022. In 2023, 12 cases of paralytic polio were registered in two endemic countries: Afghanistan (6 cases) and Pakistan (6 cases).
Since 2002, the Republic of Belarus has been on the list of polio-free countries.
In 2022-2023, epidemiological surveillance for diseases with acute flaccid paralysis syndrome in children under 15 years of age was carried out in the Republic of Belarus. The registration rate fully meets the WHO-recommended criterion.
Influenza, ARVI
To ensure epidemiological well-being during the period of increased influenza incidence in September-February 2023-2024, an influenza vaccination campaign was conducted. As a result, 23.1% of the population of the Republic of Belarus (over 2 million people) received specific protection.
The coverage of preventive vaccinations for the population at high risk of adverse consequences from influenza was 43.8% of this contingent.
The coverage of preventive vaccinations for the population at high risk of influenza infection was 28.7% of the number of this contingent, of which 78.1% were healthcare and pharmaceutical workers, and 85.6% were individuals from long-term care facilities.
Tuberculosis
According to the European Centre for Disease Prevention and Control (ECDC) and WHO data on tuberculosis monitoring and surveillance in Europe, the sharp decrease (by 10%) in the number of registered tuberculosis cases from 2019 to 2022 is likely due to the COVID-19 pandemic, which created obstacles to case detection and registration. Tuberculosis remains one of the deadliest infectious diseases worldwide, and drug-resistant strains of tuberculosis continue to be a serious concern.
Tuberculosis in the Republic of Belarus continues to be a widespread disease of high socio-economic significance. Over the past seven years, the incidence of active tuberculosis has decreased by 1.7 times (from 23.5 cases per 100,000 population in 2017 to 13.8 cases per 100,000 population in 2023, p<0.001), and the mortality rate has decreased by 3.8 times (from 3.4 cases per 100,000 population in 2016 to 0.9 cases per 100,000 population in 2023).
3. Vaccine-preventable diseases can be overcome and eradicated.
With a stable and high vaccination coverage, incidence rates decrease, and diseases can even be completely eradicated. Smallpox, which killed 5 million people worldwide annually. The last case of smallpox was recorded on October 25, 1977, in Somalia, and in 1980, at the XXXIII session of the WHO Assembly, the global eradication of smallpox was officially announced. Today, this disease is almost forgotten.
In the 19th and first half of the 20th centuries, polio epidemics raged in Europe and the USA. In 1916 alone, 27,000 people in the USA contracted polio. Following the widespread use of the polio vaccine in many industrialized countries, the incidence has sharply declined. In 2002, the WHO declared the European Region polio-free, and the task of complete global polio eradication is currently close to achievement.
4. Immunization is a cost-effective measure.
Immunization is undoubtedly one of the most effective and economically viable medical interventions available today. It is one of the few measures that require minimal investment but yield tangible positive results for the health and well-being of the entire population. Annually, immunization saves millions of lives by preventing deaths and disabilities associated with infectious diseases.
In recent years, the financial burden associated with morbidity has significantly decreased in most Member States. Every US dollar spent on the measles-mumps-rubella vaccine saves more than US$21 in direct healthcare costs. According to estimates from a cost analysis of the 2002-2003 measles outbreak in Western Europe, direct costs amounted to €9.9-12.4 million, equivalent to the amount needed to vaccinate 1,358,100 children with two doses of the vaccine at 95% coverage.
According to economists, for every dollar spent on rubella vaccination, there are $7.7 that would have to be spent on combating the disease itself. The lifetime costs for a child with congenital rubella syndrome average over $200,000 USD. This amount includes the costs of caring for children with severe pathologies (congenital deafness, cataracts, intellectual disability, physical deformities), as well as the costs of education for visually and hearing impaired children and adolescents.
Since immunization helps prevent diseases, it provides significant, albeit unquantifiable, savings in terms of labor productivity, work capacity, and access to education, as well as reduced treatment costs for preventable diseases.
5. Successes and achievements of immunoprophylaxis in the 20th-21st centuries.
Thanks to successfully implemented immunization programs, a stable situation is maintained in our country regarding a number of infections that are controlled and preventable through specific prophylaxis measures:
|
Infection |
Year of mass immunization commencement |
Number of cases in the pre-vaccination period |
Number of cases in 2023 in the Republic of Belarus |
|
Smallpox |
1798/1918 |
102,000 |
eradicated |
|
Polio |
1959 |
1,000 |
eliminated |
|
Measles |
1967 |
58,620 (1966) |
192 |
|
Diphtheria |
1957 |
11,367 (1956) |
0 |
|
Tetanus |
1957 |
67 (1955) |
0 |
|
Rubella |
1967/1995 |
65,562 (1994) |
0 |
|
Tuberculosis |
1963 |
11,187 |
1253 |
|
Pertussis |
1957 |
17,880 |
881 |
|
Mumps |
1963/1974 |
32,526 (1973) |
3 |
|
Hepatitis B (acute form) |
1996 |
1 687 |
24 |
Information for the public that can be used in the preparation of informational and educational materials (brochures, memos, booklets) for European Immunization Week
Measles
Measles is a highly contagious disease caused by a virus that spreads through coughing and sneezing in close or direct contact with infected nasal or throat secretions from a sick person. A sick person can spread the virus from the fourth day before the rash appears until four days after it appears.
Signs and symptoms:
Early signs include:
high fever, runny nose, cough, red eyes, watery eyes, and small white spots that develop early on the inside of the cheeks.
A rash appears a few days later, usually on the face and upper neck. The rash spreads to the arms and legs, lasts for five to six days, and then dries up.
Serious complications of this infection include:
- blindness,
- encephalitis,
- severe diarrhea and subsequent dehydration,
- pneumonia.
In most severe cases of measles, complications can be fatal.
Rubella
Rubella is a viral disease that is transmitted through contact with a sick person via coughing and sneezing. The disease is particularly contagious during the period when the rash is present, but can also be transmitted up to 7 days before the rash appears. Individuals without symptoms can still spread rubella.
Signs and symptoms:
Rubella may begin with a mild fever for 1-2 days, pain and swelling of the lymph nodes, usually at the back of the neck and behind the ears. A rash then appears on the face and spreads downwards. However, some people with rubella have no symptoms.
In children, rubella is usually mild, although serious problems can occur in rare cases. These include meningitis and bleeding. Rubella is particularly dangerous for the fetus: congenital rubella syndrome can cause miscarriage or congenital developmental defects (deafness, intellectual disability, and developmental problems in organs such as the heart).
Mumps
Mumps is transmitted through airborne droplets (when an infected person coughs or sneezes). The virus can also be transmitted through saliva. Mumps can spread before clinical symptoms appear and for up to five days after.
Signs and Symptoms:
Common symptoms of mumps include: fever, loss of appetite, fatigue, muscle aches, headache, followed by swelling of the parotid or submandibular glands. Some people are asymptomatic.
Most children have a mild case of mumps, but the disease can cause serious problems such as meningitis and deafness. In rare cases, mumps can be fatal.
Poliomyelitis
Poliomyelitis is caused by a virus that affects the nervous system. The virus enters the body through the mouth and multiplies in the intestines. It is transmitted through the fecal-oral route. The source of infection is most often food or drinking water. Contributing factors include poor personal hygiene and inadequate sanitation. The poliovirus also spreads through coughing and sneezing.
Signs and Symptoms:
Initial symptoms include:
- fever,
- fatigue,
- headache,
- vomiting,
- stiff neck and limb pain.
Poliomyelitis primarily affects children but can also lead to paralysis in unvaccinated adolescents and adults.
Poliomyelitis can cause complete paralysis within hours as the disease affects the spinal cord and/or brain. This paralysis can be irreversible. In cases of paralysis, respiratory muscles may become immobile, leading to death. There is no specific treatment for poliomyelitis.
Diphtheria
Diphtheria is an acute infectious disease caused by the bacterium Corynebacterium diphtheriae and the production of diphtheria toxin, characterized by acute inflammation of the upper respiratory tract, primarily the oropharynx (approximately 90% of cases) and nose. Skin lesions may occur at sites of injury, as well as in the eyes or genitals.
A characteristic feature of the disease is the possibility of developing so-called carrier state of the diphtheria pathogen, where symptoms are absent or minimal and cause virtually no problems for the person.
The infectious agent is transmitted from person to person through airborne droplets during sneezing, coughing, and talking. Transmission of the infectious agent through household contact via everyday objects is possible, leading to cutaneous diphtheria, which is more common in hot climates. The incubation period for diphtheria lasts from 2 to 10 days.
Signs and Symptoms:
High temperature, weakness, sore throat when swallowing.
Diphtheria toxin causes the formation of painful, dense membranes (a buildup of necrotic tissue) on the back of the throat and tonsils, making swallowing and breathing difficult, leading to the development of so-called diphtheritic croup. It also affects the nervous, cardiovascular, and excretory systems, thereby posing a threat to health and life.
The only treatment for diphtheria that allows for recovery and avoids irreversible consequences, including death, is the prompt administration of antitoxin serum. Vaccination against diphtheria and even having had the disease does not lead to the formation of lasting lifelong immunity; it wanes over time. Therefore, vaccination against diphtheria is carried out throughout a person's life.
Tetanus
An infectious disease caused by toxigenic bacteria Clostridium tetani, not transmitted from person to person.
An important characteristic of the pathogen is its ability to form spores, which can remain viable for years. Bacterial spores are found in the environment – in soil, on the surface of rusty instruments, in the feces of animals and humans.
Tetanus spores can enter the human body through skin damage: abrasions, scratches, wounds, or animal bites, burns, frostbite, or through the umbilical stump in newborns.
The incubation period for tetanus lasts from 3 to 21 days after infection (average 14 days).
Signs and Symptoms:
The disease begins with general weakness, irritability, headache, pulling pain around the wound, and stiffness of the neck muscles.
The first and most common symptom is tonic tension (trismus) of the masticatory muscles with difficulty opening the mouth. Trismus is followed by other signs of tetanus, forming the classic triad: a "sardonic smile" due to facial muscle spasms and dysphagia (difficulty swallowing) resulting from pharyngeal muscle contractions.
Muscle involvement progresses in a descending pattern. Subsequently, convulsions affect all the muscles of the trunk, causing the patient to arch backward.
Tetanus requires immediate medical attention in healthcare facilities.
From 1 to 8 out of 10 people who contract tetanus die from respiratory arrest, and in case of recovery, speech and memory impairments persist for a long time.
After recovering from the disease, immunity against tetanus is unstable and short-lived, with the possibility of reinfection.
There is only one method of specific tetanus prevention – vaccination with tetanus toxoid.
Diseases caused by Haemophilus influenzae type b (Hib)
Haemophilus influenzae type b is caused by the bacterium Haemophilus influenzae. When the bacterium enters the lungs or bloodstream, a person becomes ill. The disease spreads through coughing and sneezing of an infected person.
Signs and symptoms:
Fever is characteristic of all forms of the disease.
The following forms of the disease are distinguished:
- meningitis (inflammation of the membranes of the brain and spinal cord),
- epiglottitis (swelling of the epiglottis at the back of the throat),
- pneumonia (lung inflammation),
- osteomyelitis (inflammation of bones and joints),
- cellulitis (inflammation of subcutaneous tissue, usually on the face).
The disease can develop rapidly, and meningitis and epiglottitis can be fatal. Most children with this disease require hospitalization. There is a high risk of death or disability.
Pneumococcal Infection
The bacterium Streptococcus pneumoniae causes pneumococcal disease. The disease spreads through airborne droplets when an infected person or a carrier of the bacterium coughs or sneezes.
Signs and symptoms:
There are many types of pneumococcal infection, and the symptoms depend on which body system is affected. Pneumonia is the most common and severe form of the disease. It is characterized by the following signs: fever, chills, cough, rapid or difficult breathing, and chest pain.
Another serious form of the disease is pneumococcal meningitis, which is an inflammation of the membranes surrounding the brain and spinal cord. Symptoms of meningitis include: stiff neck, fever, headache, and sensitivity to light. Pneumococcal meningitis can lead to long-term disability or death. Pneumococcal infections are sometimes difficult to treat, especially because some bacteria are resistant to antibiotics.
European Immunization Week 2024
Diphtheria: What You Need to Know
Hepatitis B and Vaccination: What You Need to Know
HPV Vaccination and Cervical Cancer: What You Need to Know
Measles: What You Need to Know
Vaccination Before and During Pregnancy: What You Need to Know
Rotavirus Infection: What You Need to Know