Vaccination of children

I greatly appreciate the fact that a top infectious disease specialist with twenty years of experience, preceded by a similarly long pediatric clinical practice, MUDr. Květa Batistová, has worked out a comprehensive and exhaustive expert article for Kameveda, on a topic that is extremely topical among parents - vaccination.

When my children were growing up, I was forced to take a stance on their vaccination, which was based on mere common sense, limited information, and the effort not to hurt the child. We vaccinated the children for all diseases which were in the "mandatory" box and refused all types of vaccinations that were beyond the scope of this mandatory vaccination. Still, I was struck by the feeling that I was not entirely sure I was doing the right thing. Information in this regard is unclear, often unfounded and frequently very contradictory. Just utter chaos.

We are now presenting you with one of the most valuable expert articles on the issue so far. After having studied it in detail, I finally feel that I can adopt a meaningful stance on the issue of the vaccination of children. In addition, I believe that it is possible to create a general idea of what is particularly important regarding this complex issue. I believe you will get a similar feeling after reading it too:

Today's time is overpsychologized. People are afraid about their health, information is pouring in on them from all sides, until they lose all reason, often on account of the fact that self-styled professional information is supported by research, whether known, invented or altered, which is published as unwavering truth. And this is the big problem of our time. Who can we trust and what can we believe? Experts or people who very emotionally portray the drama surrounding vaccination on the internet, offering their own insights, experiences, stories, and, on numerous occasions they lend credibility to their opinion with the title of MD. People in the position of laymen cannot verify what is true and what is fabrication. They are worried about their children who they do not want to hurt. They must choose. Choose from what is optimal for them and their child, because everything is not 100% positive in life. Everything has some pitfalls.

The truth, like any truth, always lies somewhere in the middle. Every extreme leads to an imbalance of truth. The truth, of course, is only true within the limits of its knowledge, and new findings can move it elsewhere. That is why it is necessary to maintain a healthy dose of "common sense". It is necessary to return to the roots from the beginning to the present and to ask ourselves what vaccination has brought us thus far. Has it been good or bad? The obverse and reverse of the same coin.

The history of vaccination

Throughout the millennium, microorganisms have accompanied people, living with them in symbiosis or as a deadly enemy. The stronger won, natural selection took place, or sometimes also luck and coincidence. One of the scourges of humanity, smallpox, devastated humanity from time immemorial, whatever the disease killed them or disfigured them with scars, and so people tried to defend themselves against it.

For example, it is noted that in India before the year 1000 BC, people used the small pox scabs of sick people, and they either avoided infection or the course was milder. People in the 10th century BC in China inhaled dried small pox scabs, mainly containing inactive virions of smallpox, thereby protecting themselves from infection. Those civilizations that did not use or did not know this method, such as the Indians in Latin America, were threatened by the extinction of the entire population through contact with the unknown infection.

Even Thukydides, in 431 BC, noticed that there was no Athenian who would become sick twice from the plague. The plague (Yersinia pestis) was a dreaded bacterial disease transmitted by rat fleas to humans. It successfully spread through medieval Europe, about which we know that the hygiene on the streets was at a very low level, where sewage was poured from houses directly onto sidewalks so that the whole street was like a large sewer, full of rodents, intensifying the spreading of the plague. People, however, did not want to die hopelessly or stand idly by just witnessing the devastation. So gradually research and advances meant that mankind began to defend itself against infection, whether through increased hygiene or the development of vaccinations, which in Europe began its journey from the 17th century.

Lady Mary Wortley Montagu (1689-1762), an English aristocrat and writer who herself had been afflicted with smallpox, met with this interesting way of preventing the disease in the then Ottoman Empire, present-day Turkey, where she lived with her ambassador husband. She watched the women who were designated for that there, inoculate the pus from the scabs of smallpox into children's skin, always in the month of September, when the hot days ended. She described this process in her letters, which she sent to England. We call this method variolation, and it is done by scratching the needle tip into the skin and then putting a small amount of pus stored on the tip of the needle into the wound. Lady Mary Montagu herself did this variolation in Britain in the aristocratic circles and vaccinated the children of English King George. Variolation slowly progressed to Europe, but its greater spreading was hindered by church dignitaries who considered it inappropriate. Still, the positive effect of variolation was well demonstrated.

This method was later perfected by the British physician Edward Jenner (1749-1823), who used cow pox instead of small pox for a vaccine against small pox, thus laying the foundation for vaccination (vacca - cow in Latin). He had noticed at the age of 21 that the milker cows that had been sick with cowpox, which, unlike smallpox had a milder course, also had a light course of small pox or had no illness at all. Thus he established the first vaccination in the modern sense, based on his professional research. And thanks to the worldwide vaccination of the world's population, this disease was completely eradicated by 1983, which is a tremendous success, because in most cases we still do not have effective antiviral drugs for viral diseases.

Similarly, the French scientist Louis Pasteur discovered that the to date fatal rabies disease can be prevented by vaccination with a substance he prepared from the weakened living virions. How did this happen? He had already had experience with fowl pest. As with any great discovery, there was an omission. Although here too, coincidence favors those who are prepared.

As Mr. Alexander Fleming invented penicillin, when he did not wash his petri dishes and penicillin mold, that came from the air, settled in the soil where he was cultivating his colony of bacteria and ate a colony of his streptococci. He understood what a historic thing it was, and from then on led the way to the mass production of antibiotics. It was the same with Pasteur. He knew that the dangerous virus had to be weakened, as he said, to tame it. The test tubes with the cultures of the fowl pest were differently matured and old. If they were fresh, the hens which were given it, died. When the culture had been in the air for several days, the birds survived. However, it didn't occur to him at that time what an important point this was. Only when he came back from his vacation and wanted to continue to inject the freshly prepared plague cultures into the hens' bodies did he discover that he did not have any hens. He only had one group that had been vaccinated before his vacation with a fowl plague culture which had been matured for two months. This group of hens was still alive. What to do? He had to settle for these surviving hens and injected these heroines with a completely fresh culture. And then, wonder of wonders. The hens did not show any signs of disease, nor did they die. And at that time, he understood that the weakened culture induced immunity in the hens, which was also resistant to the totally virulent strains of aggressive cultures of the plague. In the same way, he then also weakened the rabies virus and produced a vaccination procedure.

Tuberculosis and diphtheria are serious diseases that caused death both in childhood and in adulthood. Children died of diphtheria by choking, and also by the fact that the toxin - the poison that the bacteria produced, damaged and dissolved the heart muscle. In 1891, a child was successfully given a dipterous antitoxin from animal serum. Later, horses were deliberately immunized to provide a source of diphtheria antitoxin in their sera. And so in 1895, the worldwide child mortality from diphtheria dropped dramatically. New perspectives then opened up, because unlike the live vaccines of Luis Pasteur, only the immune serum of immunized animals were being used. Protection against animal poison was known before that time. Snake charmers in Burma still tattoo themselves in ink mixed with snake venom, to build up immunity against their bites.

We have to admit that because of the vaccination with anatoxin (which is an antibody against bacterial poison, not against the bacteria itself), both against diphtheria and tetanus, we do not encounter these diseases. Despite the fact that we now have diphtheria antibiotics, they may not save us because they can not destroy the toxins - the poisons that the bacteria secrete.

The positive experience with the use of an antitoxin in the treatment of diphtheria has led to attempts to take advantage of this seemingly safer treatment for other illnesses. In addition to tetanus, an anatoxin were produced for cholera and snake bites. It soon turned out that this treatment had its own pitfalls. On the one hand, the concentration of the serum differed from case to case and, on the other hand, there was a problem with serum purity. A common side effect which appeared was so-called serum sickness, manifested by rashes, fevers and joint pains, which occurred as a reaction to foreign, especially animal proteins. Exceptionally, the deaths of the treated patients were also observed.

While the treatment of diphtheria was accompanied by unprecedented success, the results of tuberculosis therapy were accompanied, despite the expectations, by constant disappointment. Consumption became the main cause of adult mortality. For a long time, it was not known whether this was a congenital or infectious disease. The preferred locus of seizure of these bacteria are the lungs and from there it spreads through the blood or lymphatic system to other organs before any problems appear. These will take effect later after a year or longer. The symptoms are minor, sufferers experience fatigue, night sweats, have an elevated temperature and a weight decrease. Pulmonary forms manifested in a cough. A very severe form is miliary tuberculosis of the lungs or meningeal tuberculosis - inflammation of the brain with an uncertain outcome of treatment, accompanied by neurological consequences.

In 1882, Robert Koch discovered the bacterium of tuberculosis, Mycobacterium tuberculosis, and after 8 years he announced that he had found a cure for tuberculosis, which he called tuberculin (a glycerin extract of tuberculosis bacilli). With this he gained instant popularity, but according to Arthur Conan Doyle, it was just as good as business like Lourdes. In actuality, the drug was ineffective. However, tuberculin could be used as a test to test the contact of a human or animal organism with tuberculosis. Later it was shown that the tuberculosis bacillus is able to attack both cattle and humans. The gentlemen Albert Calmette and Jean Marie Guéring made and for the first time inoculated experimental calves in 1925. They used the Calmette-Gerring bacil called the BCG vaccine. Then, first children in France were vaccinated, and gradually throughout the world.

In the former Czechoslovakia, the fight against tuberculosis took place in 1953. Thus, in the 1950s, newborns were vaccinated on the 4th day after birth (due to the large contamination of tuberculosis in families returning from the maternity hospital) as well as the older classes of the population due to the rapid inoculation of the entire population. From the early 1960s to 2009, vaccinations of newborns and older tuberculin negative children were performed at the age of 11 years. The exception was the transition period in 1986-1994, when newborns in Central Bohemia and East Bohemia and later in the South Bohemian Region were only vaccinated voluntarily. In these years, the number of cases of tuberculosis increased to 200 children and there was one death of a newborn from tuberculosis. Children were vaccinated retroactively and blanket vaccination continued until 1 November 2010, when Europe was globally declared an area with a low incidence of tuberculosis. Currently, the world's most tuberculosis cases are in Africa, Mongolia and Indonesia, with a median incidence in India, Pakistan and Afghanistan. Still less, namely up to 200 cases per 100,000 inhabitants, are across the Asian continent and in all the Trans-Soviet republics including Ukraine. The least number of cases are in our area, with only 100 cases per 100,000 inhabitants, all over Europe and North America. The African and Asian countries, where tuberculosis still prevails, are countries where the most resistant strains are currently resistant to antibiotic therapy and, unfortunately with the migratory waves these strains are spreading to Europe. This then begs the question of how do we protect our children? The Danish vaccine is no longer on the market, and even children at risk are not vaccinated with the Polish vaccine. Additionally, the BCG vaccine not only protected against tuberculosis but also against avian tuberculosis and today it is said that it also protects against skin cancer with melanoma by activating immunity. As pediatricians, we did not encounter scrofulosis, which is a throbbing ulcer in the throat of five-year-old children that causes avian tuberculosis and which are resistant to antituberculotics. The only solution is the surgical removal of the extirpated node.

BCG vaccines have strong and weak sub-strains in them. The stronger ones are more immunogenic, greater protection is expected from them, but they also have more skin reactions. Bone inflammation after vaccination has also been described. The truth is that during the whole 5 years that I spent as a pediatrician in the Znojmo region, we did not experience any case of tuberculous osteomyelitis (inflammation of the bones). On account of the pronounced hypersensitivity effects, they no longer revaccinated in the 11th year, not even children considered to be at risk. Children at risk are currently vaccinated at a later age (4-6 weeks after birth), because newborns are no longer in the same danger as they were in the 1950s.

Another significant, severely disabling disease was viral polio, or poliomyelitis. The virus did not cause illness in all those infected, but every 10th person, most often a child, was handicapped for life with a faint paralysis of the limbs. Polioviruses were excreted in the feces and again spread through food or more often infected water. Even here, the Czech Republic launched a comprehensive vaccination of children via a live attenuated oral vaccine, the so-called Sabin vaccine, in 1960, and a year later not a single incidence of this disease was reported in the Czech Republic. In 2007, there were still about 10,000 people in the Czech Republic who suffered the consequences from their illnesses. Since the only carrier of this virus is human, it is possible to eradicate this disease worldwide, just like smallpox. In the 1950s, after the introduction of vaccinations, the polio rate declined significantly worldwide and in 1988 the world was poised for eradication. In 2002, polio was eradicated in Europe. However, because of the fighting in the Middle East and partly in Ukraine, the national vaccination programs were disturbed, and the blanket vaccinations began to falter. That is why new cases of polio in refugees in Syria, Turkey, Iraq and neighboring countries emerged in 2013. The strain of poliomyelitis originated from Pakistan. In the course of 2013, WHO started sounding the alarm and within its campaign, within a few months, the whole population of the Middle East was fully vaccinated and the immunity of the population rose to 85% using the Sabin vaccine. However, there are also countries in Europe such as Bosnia and Herzegovina, Austria and Ukraine, which have very low vaccination, so they are not protected by collective immunity and are threatened with the introduction of these old, newly arriving infections.

It is therefore not true that dangerous diseases do not occur anymore, they are only held at bay through a high level of vaccination. This is called collective immunity.

Vaccination against polio with a live oral vaccine (received by teaspoon) stimulates the immune response in the digestive tract to a extent analogous to natural infection by a wild-type virus. Post-vaccination antibodies cross-react, thus reducing the risk of paralysis in poliomyelitis even in the case of a different serotype. Currently, a live vaccine is not used in the Czech Republic, but the inactivated (killed) injectable polio vaccine, which is part of the polio hexavacine. It is very effective, though somewhat less than a live vaccine.

Active immunization is the most effective means of significantly reducing the incidence of infectious and especially dangerous infections. Vaccination is especially important for children because they are most vulnerable to health and life-threatening infections. The aim of the regular vaccination of children is to achieve high collective immunity and to reduce morbidity and mortality rates for infectious diseases, as well as to protect children who can not be vaccinated due to immune disorders or corticoid treatment (when they cannot be vaccinated because they do not produce antibodies). Collective immunity only occurs when 95% of the population is vaccinated.

Although it does not currently appear so, the success of modern vaccination is a significant reduction in the number of serious and often fatal diseases we have heard of but not seen before, such as diphtheria, tetanus, paralytic forms of polio, whooping cough, measles , invasive forms of hemophilia and rubella. On the contrary, today we may encounter a new incidence of mumps (parotitis) in the vaccinated population of young people, presumably due to poorly stored vaccines, or the use of vaccine strains with low immunogenicity. In spite of meningeal complications (inflammation of the brain) and testicular inflammation with mumps, this disease is not as dangerous as for example measles (morbilli).

Morbilli (measles) did not reach the vaccination schedule until 1969 because, although it was a serious illness, it was mostly not a deadly disease in our conditions. Some complications particularly common in young children are feverish cramps, pneumonia, inflammation of the brain (encephalitis) and subacute sclerosing panencephalitis. The live attenuated (attenuated) vaccine, along with mumps and rubella, has been used and is still used. Morbilli was virtually eradicated in the Czech Republic except for a few misplaced cases. What is most important, however, is that the fatal complications of the persistence of the measles virus have been completely eradicated with vaccination, namely slow sclerotizing inflammation of the brain, manifested in gradual dementia several years after suffering from the measles. The illness led to the gradual destruction of the brain through the loss of all functions and the death of the child during the three year course of the disease. It is definitely not any triumph to get measles voluntarily.

Vaccination today

Later, vaccination against viral inflammation of the liver (hepatitis A and B), which is immunized against in many European countries, was added. Type A hepatitis (the disease of unwashed hands) can be completely cured without permanent liver damage, but unfortunately, cases of fatal disease are known to occur in pregnant women, just like with flu. In addition, vaccination is recommended especially when traveling abroad. It is worse with type B hepatitis. Asian and African countries are significantly contaminated with both types of hepatitis. The hepatitis B virus, even after the survival and disappearance of viraemia, remains in the human immune tissues and after possible weakening (such as biological treatment of rheumatic diseases or aggressive immunosuppression in cancer) the virus can be reactivated and cause fulminant (fatal) ongoing disease. Therefore, in order to avoid this cumbersome illness, the blanket vaccination of small children, which is part of the hexavacine, was initiated.

Here I would mention why polyvalent vaccines are preferred instead of monovalent ones. We know that the human organism reacts to hundreds of antigens without any problems, introduces them to its immune system and begins to form antibodies. However, each vaccine (except for live vaccines) must be bound to a chemical carrier for our immunity to register it at all, and since there is an attempt to eliminate these chemicals as much as possible, for example aluminum, only one application of a hexavacine to reduce the amount of chemicals to a minimum is injected into the body instead of six.

Currently, we do not have a vaccine against AIDS, malaria and Lyme disease. On the contrary, in less than a year, the Ebola vaccine was marketed to reverse the unfavorable state of expansion of this bleeding (hemorrhagic) disease, for which there is not a cure, and which plagued Africa and threatened the whole world. Currently, the vaccination is only given at the epicentre of infection.

I would like to mention something about the Lyme disease vaccine. More recently, they succeeded in producing a vaccine against borreliosis but it was withdrawn from the market for side effects and new options are being looked for. The original vaccine had surface antigens of bacteria that are similar in structure to the lining of the joint cells or myelin that are found in the brain. The human organism created antibodies that were targeted against both the borrelias and the joints, and there have been cases of arthritis after vaccination (inflammation of the joints). Now a completely different path is being searched for, which will take several years before we get new vaccines.

Another serious illness is meningococcal meningitis (purulent inflammation of the brain). Meningococci are found in the nasopharynx of 15% of the population who are carriers, but the disease breaks out only in a fraction of people, mostly young children or adolescents. Meningococcus type C is known from discos, clubs and bars. Meningococcus type C is the most insidious by inducing immunosuppression, a frantic confusion of our defenses, lasting just 24 hours from the outbreak of the disease to death. That is why medical assistance can not intervene in time. Here vaccination is entirely appropriate. For the Czech Republic, type B meningococcus is typical, which is slightly slower, usually a three-day illness ending with death or amputation of the limbs, but with early diagnosis it can be managed with antibiotics without permanent consequences. This vaccine is the third generation of vaccines produced by a specific method of so-called reverse vaccinology, where the same gene sequences for targeting proteins in the majority of meningococcal strains of serogroup B (with about 800 strains of serogroup B in Europe) were selected by computer. The carrier is aluminum hydroxide. Since it is a vaccine which has been on the market for 2 years, epidemiologically confirmed efficacy is still lacking. The vaccine also has certain side effects
In Asia, the Middle East and Africa, there are large meningococcal epidemics of the W135 type, in the US we encounter the serotype Y, and in Russia it is type A. All of these serotypes (A, C, W, Y) excluding the European type B are merged into one vaccine that is recommended for vaccinations both in our country and abroad. It also includes a dangerous, frantically fast meningococcus C, which this year again attacked in our country (January 2017). Tolerance of the vaccine is good.

Tick encephalitis. With this disease, it is a well-known fact that the most persistent impairments are experienced by those of older age. In childhood, antibodies against this disease are produced more quickly, so no disease will occur up until the age of 10 in the sense of brain inflammation, since the disease is destroyed after the first phase. On the other hand, in old age, because of the slow production of antibodies, the virus is more likely to grow and can damage the brain to a greater extent. Therefore, adult and elderly populations benefit from vaccination against tick inflammation of the brain. Generally, it is very well tolerated.

Why do we actually vaccinate?

We know that innate immunity can detect foreign antigens after the first encounter, but the bond is weak, slow, and the response is not initially large. Only during the second encounter with a foreign antigen will the antibody immunity respond in a prompt, effective and vigorous manner. This knowledge is based on acquired immunity. In the form of vaccination, we present our bodies with foreign antigens, so that immunity can slowly feel, memorize and create antibodies for them. We are counting on the fact that during a secondary encounter we will respond quickly and in a timely manner, so that the disease will virtually not arise.

"Diseases have disappeared because of better hygiene, not because of vaccination. Proof of this is the plague or typhus, which have disappeared, even though they are not vaccinated against."

This is how opponents of vaccination respond. The truth is that due to increased hygiene in the civilized part of the world, where we have chlorinated drinking water, diseases such as cholera, food-borne faecal infections such as typhus (Salmonella typhi) and dysentery have dissappeared. By reducing the number of rodents and their parasites such as fleas and lice, diseases such as the plague (Yersinia pestis, transmitted by rat fleas) or typhus (Ricketsia prowazeki, which are transmitted by lice) have disappeared. That is why they do not vaccinate against these diseases in the Czech Republic. But what kind of antiepidemic protection against infection transmitted directly from person to person either by droplet infection (cough, measles, rubella, mumps or flu) or by direct contact can we have? E.g. with measles, the risk of transmission to a non-immune individual while in a confined space with an infected person is a near certainty. The only effective hygienic measures against this mode of transmission would be strictly wearing face masks, or better masks with microbial filters, or consistently avoiding contact with humans.

Types of vaccines

Preventing the development of infection can be achieved in several ways.

According to the method used, the following types of vaccines are distinguished:

• 1st generation vaccines - live, weakened, attenuated vaccines.
• 2nd generation of vaccines - dead, inactivated vaccines.
• 3rd generation of vaccines - subunit and conjugate vaccines.
• 4th generation of vaccines - subunit recombinant vaccines obtained from genetic engineering.
• 5th generation of vaccines - vaccines for the near future - DNA Vaccines

Weakened vaccine (attenuated vaccine)

The attenuated vaccine is composed of live, attenuated pathogens that have lost the ability to cause disease. After such a vaccine, usually a mild infection occurs, which leaves the same immunity as after the disease, and it is practically lifelong after a single dose of the vaccine. The great advantage of attenuated vaccines is that such a vaccination, by its very nature, gives virtually the same immune response as a natural wild-type infection. The effectiveness of such a vaccination is very high.

On the other hand, the administration of a living strain can theoretically lead to the whole course of the disease occurring. This threatens immune-compromised individuals, i.e. those with a congenital immune system disorder. The same can be attributed to medically acquired immunosuppression, through immunosuppressive drugs in the case of cancer or in the treatment of rheumatological patients or corticosteroids that we administer after transplantation or when using drugs for autoimmune diseases. Another risk is the return of the weakened strain back into a pathogenic one. In practice, this has been only rarely seen in the oral polymyelitis vaccine (nowadays the unused Sabin's vaccine). Moreover, the technical disadvantage of attenuated vaccines is that vaccines tend to be sensitive to transport and storage conditions, so their effectiveness can be impaired, especially by frost. (This is being considered in the current failure of mumps vaccination).

Examples of attenuated vaccines:
Previously, it was oral polio vaccines (a spoon of oral Sabin's vaccine) and the rabies vaccine.
Today, it is the flu vaccine in the case of intranasal application (nose drip), against typhoid, if it is given orally.
Otherwise it is known vaccines such as thee measles vaccine, the vaccine against chickenpox (varicella), mumps (parotitis), rubella, rotavirus, tuberculosis (BCG), and yellow fever.

Inactivated vaccines

An inactivated vaccine is made up of killed pathogens. Inactivated vaccines contain dead viruses or bacteria, so they are sometimes referred to as whole-cell vaccines. Organisms are grown in appropriate cultures in the laboratory, then killed, usually by heat or chemicals. The killing of pathogens must be done in such a way that the structure of the antigens recognized by the immune system is not impaired. Virions are split or crushed, but if some virions are not well crushed then they can cause the disease they are vaccinating against, for example this is sometimes seen in flu vaccination. The main advantage of inactivated vaccines is that they can not cause infection even in immunocompromised individuals, so we can vaccinate everybody. On the other hand, the response is less prolific. Whilst attenuated vaccines usually require one dose to produce a good response, the second or third doses and possibly the so-called "booster" dose with a relatively long interval are usually required for the inactivated vaccine. The amount of surface antigens on the surface of bacterial bodies is reactive to the vaccine and thus local and general symptoms occur after vaccination (redness and pain at the injection site, fever and fatigue, sometimes joint pain or a high amount of crying). Inactivated vaccines are combined with an adjuvant such as aluminum hydroxide, aluminum phosphate, MF59 or ASO4, which increase otherwise weak immune responses. They do not usually induce permanent immunity and need to be revaccinated.

Examples of inactivated vaccines:
Contemporary polio (poliomyelitis) vaccination, cholera vaccine, fissile influenza vaccine, Japanese encephalitis, tick-borne encephalitis, hepatitis A, rabies, vaccine against whooping cough (pertussis), typhoid fever and plague.

Toxoid vaccine

The toxoid vaccine is made up of bacterial toxins that have a suppressed ability to induce a toxic reaction but stimulate an immune response. For example, tetanus toxoid vaccination does not limit the proliferation of tetanus, but prevents the arisal of tetanus.

Examples of the toxoid vaccines:
The vaccine against tetanus and diphtheria.

Subunit vaccine

The subunit vaccine is one of the inactivated vaccines and consists of only some fragments of the originator of the disease against which it is vaccinated. Production takes place by propagating, killing, and subsequently dividing the pathogen into individual fragments. Only the fragments that are relevant for the immune response to the relevant micro-organism, such as surface antigen, are present in the vaccine. They can never cause the disease against which the vaccine is given for.

Long-term to lifelong immunity is expected.

Subunit vaccines have tried to remove the disadvantage of inactivated vaccines by containing a single component of the micro-organism that elicits the immune response and by eliminating unnecessary components to reduce the number of undesirable effects. The components are adsorbed onto the mineral carrier with adjuvant effects. They are also applied in three doses.

Examples of subunit vaccines:
Hepatitis B vaccine, some influenza vaccines, acellular whooping cough vaccine (pertussis), HPV - vaccinations of girls in particular, anthrax is not vaccinated against in our country, and against Lyme disease. This vaccine is also not used in our country on account of the greater risk of post-vaccination inflammation of the joints for the similarity of the borrelia surface antigen and the lining of the joints in humans.

A particular type of subunit vaccines are polysaccharide vaccines, where fragments of the polysaccharide wall of bacteria are used. A major disadvantage is that the immune system of children under 2 years of age is not usually able to process these vaccines in the desirable way and vaccination does not result in immunization. Unlike subunit vaccines where immunity is long-term, polysaccharide vaccines last only 3 years and must be re-vaccinated.

Examples of polysaccharide vaccines:
Pneumococcal vaccines (Pneumo 23), meningococcal vaccines (Meningococcal), and typhoid fever (Typhim-Vi) infections caused by Haemophilus influenza type b (Hib).

Conjugate vaccine

The conjugate vaccine is constituted by its own usually polysaccharide antigen, to which an immune response is to be induced, and usually a protein carrier (diphtheria or tetanus toxoid) to which the antigen is conjugated and which facilitates the presentation of the antigen to the immune system. This results in long-term immunity. The conjugated vaccine is a solution to the problem.

Examples of Conjugate Vaccines:
Meningococcal infections (Menjugate, Neisvacc), hemophilitis infection of Haemophilus influenza Type b (Hiberix) and pneumococcal infection (Prevenar)

Recombinant vaccine

The recombinant vaccine is similar to a subunit vaccine, but the subunits are obtained using genetic engineering techniques using molecular biology methods as the products of bacterial and yeast activity. Genetic information encoding microbial antigen production is inserted into the genome of a carrier such as a bacterium or yeast, and they begin to produce the antigen (e.g., Australian hepatitis B antigen). After isolation and purification, this pure gene is used.

The vaccines are administered in three doses. Long-term immunity is assumed.

Recombinant vaccines are characterized, in particular, by the fact that the production phase of the pathogen does not appear in the production technology. The fragments, that would be separated from killed pathogens in the case of a subunit vaccine, are produced by genetic engineering methods. Once the structure of the fragment to be obtained and the gene for its production are identified, the gene is introduced into the genome of an organism usable in a bioreactor, usually yeast, but it may also be a bacterium or a tissue culture of mammalian cells. Fragments usable for vaccination are then produced in bioreactors.

Examples of recombinant vaccines:
Hepatitis B (Engerix) Human papillomavirus HPV (Cervarix, Silgard)

The future of vaccination

DNA Vaccine

This is still a research concept. The goal is to force several cells of the vaccinated person to temporarily produce fragments of the pathogen against which the subject is being vaccinated.

The removal of the virulence of the micro-organism

Another option is to remove the infectivity from the body of the microorganism through genetic engineering.
Genetic engineering offers one more option in the production of vaccines. By knowing the genome of the pathogenic organism, it is possible to eliminate genes responsible for virulence (infectivity) from the body of the microbe through targeted manipulation. The result will be a weakened strain, which is fully viable, only it is not able even theoretically to cause the underlying disease. Thus, for example, a weakened strain of Salmonella typhi, which is unable to induce abdominal typhus, is available.

In the case of a modified influenza virus, the strategy is different because the virus must grow in the host cells. Therefore, the virus is modified to be able to grow only in the nasopharynx mucosa, from which it is no longer able to attack the lungs.

The following information is important to know about vaccinations...

Excipients in vaccines-adjuvants

What processes are taking place at the site of administration is important for the effect of the vaccine. A number of substances added to the vaccine, what are known as adjuvants, serve to improve the response of the immune system to the vaccine, in order to better react to it.

An adjuvant is an added substance that has the task of activating the immune system into a state of emergency, and as with all substances of this kind, the adjuvant can have some side effects. As with all vaccines, adjuvants are also tested for safety, however, occasional reports of the possible toxicity of some adjuvants or the undesirable effects of adjuvants as a whole appear.

An overview of adjuvants and their possible harmful effects

Generally speaking, the better the adjuvant activates the immune system, the more side effects it has and vice versa:

Insoluble aluminum compounds are good and effective adjuvants, but they are less immunogenic (weaker immune system activation) than other adjuvants. Sometimes they can cause a local reaction - redness and pain at the injection site. The dose of aluminum injected into the body is very small. More aluminum can be obtained, for example, by eating frozen vegetables where aluminum hydroxide is added to make peas and other frozen vegetables nicely colored. Otherwise, this aluminum compound has already been used in the vaccine industry for 90 years (from the 1920s) in billions of vaccines, making them one of the longest and most intensively used substances in the history of modern medicine. Aluminum is an omnipresent substance which also gets into the organism from drinking water, food and air. In the body, it is partially excreted and partly stored in tissues, especially the bones. The amount of aluminum in one dose of the vaccine is limited to 0.85 mg, equivalent to 3 liters of drinking water or two tablets for nausea. Yet, for decades, the link between aluminum adjuvants and the occurrence of neurological diseases has not been established. Calcium phosphate appears to be a good adjuvant for which neither local nor systemic reactions have been observed.

Formaldehyde (CH2O) is used in small amounts to inactivate (kill) live microorganisms in vaccines. Finally, residual amounts of 0.1 mg per dose of vaccine remain in the end products, which is a negligible amount. Some people may not know that formaldehyde is also produced by living organisms, and therefore the human body has mechanisms for its degradation. Milk contains up to 3 mg/l, vegetables up to 20 mg/l.

Oily emulsions used in the past were heavily immunogenic, but more pronounced local reactions appeared somewhat more frequently (about 0.5% of those vaccinated), For this reason, modern oil emulsions (e.g. MF59, AF03, AS03) have been produced, which are characterized by higher biocompatibility (tolerance). For example, the influenza vaccine with MF59 (squalene) oil emulsion induced a higher antibody titre, but also had more frequent light local reactions, whereas systemic reactions were transient and minimal.

Squalene (MF59) occurs in all higher organisms as an intermediate of cholesterol synthesis. Previously, it was obtained from the liver of sharks and nowadays also from olive oil. It supports the immune system thanks to its antioxidant effect. Because it is easily emulsified, it has been used in the past by the cosmetics industry and later as an adjuvant for vaccines. In 2000, reports of the presence of anti-squalene antibodies were reported in patients with Gulf War syndrome who were vaccinated against anthrax, a vaccine containing a squalene adjuvant. It was found that antibodies in the IgM class appeared in only one fifth of the vaccinated, but the antibodies in the IgG class, i.e. specific and memory antibodies, did not appear in anybody. Further research has revealed that anti-squalous IgM antibodies appear naturally in some people, and the proportion of humans with these antibodies increases with age. A long examination of recent studies did not show that there was a statistical association between anti-squalene antibodies and chronic syndromes such as Gulf War Syndrome. In the countries around the Mediterranean, epidemiological investigations have revealed a low incidence of cancer (especially breast cancer in women) than in other developed countries. This protection is said to be caused by a high consumption of olive oil. Olive oil contains a number of so-called phytonutrients, including squalene. And this squalane is attributed to this positive effect of olive oil. In countries where there is not a high consumption of olive oil, a diet enriched with natural sources of squalene (amaranth seeds, cereal sprouts, etc.) could provide a higher squalene yield comparable to that of squalene in countries with a high consumption of olive oil. Research has shown that the squalene adjuvant does not increase the incidence of autoimmune diseases.

Chitosan appears to have a very good safety profile, but its intramuscular application has not yet been studied much. 

Vitamin D is more of an experimental adjuvant. It is characterized by higher pain at the injection site but probably has no other local side effects.

CpG oligonucleotides are experimental adjuvants that mimic bacterial DNA. It has more light local reactions (pain and redness around the injection).

Stearyltyrosine and octadecyltyrosine were studied in the 1980s and 1990s; although their safety profile appears to be very good, development has not continued.

Liposomes were found to be safe in the early 1990s, but were less immunogenic. It is possible that modern approaches will still improve their immunogenicity.

Thiomersal, merthiolate is a mercury salt (organic substance of ethylmercury), which was used as a preservative much earlier in 2000, especially in multidose packaging to prevent its contamination after opening the vial. This form of mercury is also found in the bodies of long-lived fish, such as sharks. The elimination half-life of ethylmercaptan from the body is 10 days. The amount of thiomersal in the vaccines is very low. It caused redness at the injection site. Today it is no longer present in children's vaccines. It has been used in vaccines since the 1930s as an antibacterial and antifungal agent. Thiomersal, like squalene, was investigated in 2010 in the influenza A (H1N1) vaccine. There is no reliable evidence to suggest that exposure to a small amount of thiomersal would aggravate health. Systemic reactions with thiomersal vaccines may occur but are not serious. Similarly, the relationship between thiomersal in vaccines and autism or any other neurological development disorder has not been established. Since there were significant protests against mercury among the population in the 1990s (for example against amalgam fillings in the teeth), the companies producing vaccines simply eliminated thiomersal either without substitution or replaced it with another preservative. An exception is the hepatitis B vaccine, which has a reduced amount of thiomersal (2ug / dose), which is assessed as insignificant and furthermore against one type of influenza vaccine.

Side effects of vaccination

Vaccinations may have some unintended effects that can be beneficial to human health.

Protection against the formation of melanoma

It has long been pointed out that immunity protects us against cancer. If the immune system is not actively maintained, some tumors develop. Research with live, weakened vaccines was carried out. According to it, tuberculosis and smallpox vaccines, as well as severe infectious diseases, induce the same protective mechanisms that significantly reduce the risk of melanoma skin cancer. Therefore, the authors recommended a rethinking of the attitude towards a withdrawal from the blanket vaccination with these vaccines.

Adverse effects of vaccination

Like any medicine, vaccination may also have side effects on those vaccinated. These can be divided into several groups:

• Expected side effects - are common and mostly unobtrusive. Dangers can only be caused by the giving of insufficiently weakened vaccines (described in Sabin's vaccine and probably also during historical variolization), when such an undesirable effect is the causing of the disease which is being vaccinated against. In the Czech Republic, vaccines are still under control in SIDC laboratories, where, for example, insufficiently crushed influenza virions have been detected, and vaccines have been returned to the manufacturer. So we cannot encounter a vaccine in our country that will induce the disease it is protecting against. For reliably attenuated strains and dead vaccines, side effects caused by the act of vaccination (injection) and immune system stimulation come into consideration. These reactions are usually transient, insignificant and harmless. These include, in particular, redness and pain at the injection site and elevated temperature, and in young children this may also result in temporary restlessness, more severe crying or sleep disturbance.
• Side effects that result from the vaccinated - these are side effects that are caused by the specific condition of the patient. The most serious problem is the divergent status of the immune system of the vaccinated, especially an unrecognized congenital or acquired immunodeficiency. In this case, the administration of a weakened vaccine can cause serious illness. However, we are more likely to encounter inadequate responses to the vaccine due to the current state of the individual (corticosteroid treatment, acute disease and antibiotic use, the high age of the person being vaccinated).
• Undesirable effects due to cross reactivity - such side effects would mean inadequate vaccine testing. By processing the vaccine, the antigenic structure may slightly alter and the administered vaccine results, for example, in the production of antibodies against the individual's own antigens. The question is whether it is an undesirable effect when the encountered infection which is being vaccinated against has the same abilities as the formation of transient reactive arthritis (inflammation of the joints) after viral diseases or some bacterial diseases.

Myths about vaccination

Some vaccine opponents claim that vaccination may be the trigger factor of the disease underlying the pathologically ongoing immune system responses. These concerns have a rational basis in the sense that in the past there have indeed been cases of vaccines that triggered a serious illness due to the technologically unmanageable production or unexpected antigenic similarity of the inactivated vaccine with its own human antigens. An example of this may be a borreliosis vaccine, where on account of the similarity the articular lining with the antigenic structures, arthritis occurred after vaccination (joint inflammation). For this reason, it is not yet possible to vaccinate against borreliosis, and if a vaccine is developed in the future, then borrelia structures that have no similarity to human ones must be used. Such a disease occurs within 10 to 30 days of vaccination.

Here are some examples of fiction and half truths:

Vaccination may trigger autoimmune diseases

The exact causes of autoimmune diseases is unknown, but for now the need for a specific genetic basis and a launcher is proven, which often tends to be an infectious disease, during the course of which the autotolerance of the immune system is broken.

Vaccination against influenza and Guillain-Barré syndrome

Guillain-Barré Syndrome is a rare inflammatory disease that affects the nervous system, especially the peripheral nerves originating from the spinal cord. Paralysis affects the lower legs and progresses during the hours and days up through the trunk and upper limbs. The symptoms are very dramatic. After a certain period of time, the disease tends to slowly, within weeks and months, self-regulate. The cause of the development of this condition is not entirely clear. Its occurrence is usually preceded by physical or psychological strain. In addition, the onset of the syndrome is associated with a viral infection, after which the immune system of the body will mistakenly focus on its own tissues, in this case our nerve fibers and their sheathing. Therefore, this syndrome is also classified as autoimmune disease.

In 1976, a vaccine against the influenza A virus H14N1 was used in the US, which was a significant factor then causing the severe Guillain-Barré Syndrome. The molecular character was the induction of GM1 ganglioside antibodies. This vaccine was then discarded. This is supposed to be the only case when influenza vaccination has caused this disease. Vellozzi et al. in their study published in 2014 show that when comparing vaccinated and unvaccinated populations, those vaccinated have a less frequent incidence of Guillian-Barre Syndrome than unvaccinated, as it is generally known that the Guillain-Barré syndrome trigger is a viral disease, not a vaccination.
Here, I would also like to mention the yellow fever vaccine, a live attenuated vaccine and a neurotropic disease called YEL-AND (vaccine associated neurotropic disease). These include very rare, though serious complications of fever, confusion, brain inflammation, neurological polio or Guillain-Baré syndrome. Exceptionally, within 10 days after vaccination, a viscerotrophic disease called YEL-AVD, which is reminiscent of yellow fever with organ failure, was described. Those afflicted were mostly older than 60 years old. So far, this complication has only occurred when boosted after 10 years. Since it was shown that antibodies last for more than 10 years, presumably life-long, they were dropped from booster injections after 10 years old.

After other live measles, rubella and mumps vaccines, nothing like this has ever been recorded.

Vaccination against hepatitis B and multiple sclerosis

Multiple sclerosis is also an autoimmune disease where the immune system attacks its own tissues. There are many different factors involved in triggering this attack: genetic disposition, for example, there is a high risk for single-sex twins, the environment and unknown factors. Antibodies attack myelin sheaths. This disease is even climatically stratified, so it is found only in medium and cold latitudes, in the Czech Republic, especially in northern Bohemia. As a result, it is nonsense to expect geographically different outcomes from a blanket hepatitis B vaccination.

A study published in 2014 by A. Langer-Gould and the team showed that in the long run, the incidence of illness among the vaccinated and unvaccinated practically does not differ.

He admits, however, that vaccination may slightly accelerate the transition of an existing disease from a latent phase to a clinical manifestation, but that vaccination alone does not cause or increase the risk of its occurrence in a healthy person. The disease affects young adults aged 20-40 years and woman. However, vaccination against hepatitis is performed in children where MS is not observed.

In 2002 and 2008, the WHO took the view that there was no link between hepatitis B vaccination and multiple sclerosis.

In scientific circles, it was considered in the 1990s that the multiple sclerosis trigger is not a virus of infectious EBV mononucleosis because the antibodies of this disease were found in practically every patient. In fact, the adult population is highly overrun (75-80%) with this virus from childhood, so it is understandable that antibodies have also been found even in patients.

Vaccination and autism

Autism is a developmental disorder that is manifested in particular by social interaction disorders. It is probably a congenital disorder that manifests itself before the third year of age in a child whose development was ongoing to that point without difficulty. In this manner, a time coincidence with vaccination occurs.
In 1998, British gastroenthropist Andrew Wakefield published a study according to which a risk factor for autism is the vaccination against measles, mumps and rubella (MRD). The study was published in the prestigious journal The Lancet. In addition, it was found that at the time of publication of this work, Dr. Wakefield participated in the patent for a new measles vaccine competing with existing products (Deer, 2004). In 2010, Wakefield's study was withdrawn for serious misconduct. Gradually, however, widely distorted information that strengthened their fear of vaccination spread among parents.

Therefore, in 2014, a meta-analysis of more than 1.3 million children was newly published and is currently published in the prestigious scientific journal Vaccine. It clearly disproved the possible relationship between vaccination and autism or autistic spectrum disorders. This reversed the scientific deception of Andrew Wakefield from the 1990s.

Opponents of vaccination in general mostly cite a study that looked at how the viral infection of the mother during pregnancy can harm the brain of the developing fetus, which is a commonly known fact. The experiment describes a viral infection in early gestation when the central nervous system of the fetus is very sensitive to any noxious substances. It is important to note that the immune response to viral infection is not identical to the immune response that occurs after vaccination. Therefore, it is not possible to claim that what the infection causes will also be caused by the vaccination.

The National Institute for Autism (NAUTIS), which focuses on people with Autistic Spectrum Disorders and their families, is very sharply against the interpretation of the opponents of vaccination. "There is no new scientific discovery describing the mechanism of the connection between vaccination and autism. The information disseminated by the Society of Post-Vaccination Patients is just another head on the body of antivaccination hydra, which exploits autism to its ideological goals. The public is bombarded by dilettante interpretations of scientific studies and distorted information about the epidemic spread of autism. All this causes the fear of vaccination in their parents, "says Kateřina Thorová, a psychologist and director of the NAUTIS Methodology Center. According to her, the mechanism of the origin and development of autism is not yet known precisely, "it opens the door to a variety of charlatan speculations and treatments. There is a consensus among scholars and expert institutions from current research that autism and vaccination are not related," he adds. In NAUTIS, autism was also diagnosed in some siblings of children with autism who were not vaccinated.

On the contrary, parents refusing to vaccinate their children are putting them at an even higher risk than they can imagine.

Overloading of the immune system

The number of vaccines may sometimes raise the concern that childhood immunization is "overloading" the developing immune system of the child. We know that the immune system of a newborn and infant has enormous capacity to cope with a number of stimuli, just realize that bacterial colonization of the intestine is initiated after birth and the child meets the full spectrum of microbes in the environment. During vaccination, especially in the case of subunit vaccines, far fewer types of antigen and antigenic burden is given than the capacity of the immune system, which easily copes with this burden. The immune system has the capacity to respond to billions of different immunogenic proteins. On the contrary, it has been shown that if the child does not experience immune stimuli in the first few years, immune system disorders such as allergic or autoimmune diseases and, consequently, tumor diseases occur more frequently. "To argue that vaccination, i.e. the application of immunogenic substances, weakens and exhausts immunity is similar to saying that breathing weakens the lungs, food depletes the intestines, or that thinking damages the brain" (Michal Křupka).

Even the sterile environment around young children is of no benefit because the child's organism is set to meet the greatest number of microorganisms at a certain time, thereby enhancing cellular immunity.

A dirty home, a healthy child is a well-known slogan.

However, if we believe the immune system is well supported in the vaccine-free collective, then the time when dangerous illnesses disabled children will again return, and there is still a small risk of death from meningococcus. Currently, only vaccinations for example against chicken pox are limited because of the lighter course, and children usually are afflicted by it in pre-school age. Many mothers have the child intentionally infected, in order for the illness to be experienced in childhood when the course is to be the lightest. In some cases, it is true, in others a small child aged 3 years or older also suffers from varicella inflammation of the brain. Yet there is not so much clamour around it, such as when a child cries for some time after vaccination, or their foot hurts.

Vaccination is the only source of profit for pharmaceutical companies

According to the official statistics of the General Health Insurance Company, the average cost of treatment for one insured person in 2013 was almost CZK 24,000, of which the cost of medication was about CZK 3,700. The cost of vaccines per one insured person amounted to CZK 95 during the same period. Compared to the total cost of medication, the cost for the purchase of vaccines is only a few percent (about 2.5%) , only about 0.4% of the total cost of medical care. It is thus quite clear that if pharmaceutical companies wanted to significantly increase their profits in the disinformation campaign, they would logically resort to another area. For example, just the development and testing of a new vaccine currently requires costs in the order of at least a few billion, but more like tens of billions of crowns (therefore, it can be funded by only a few of the largest pharmaceutical companies, similar investments would be difficult to bear even for the national budgets of most European Countries). In addition, the relatively expensive production process, mostly using sophisticated biotechnology processes and extreme product purity requirements, must be taken into account. There is a bit of a question here as to how the price of homeopathic products, for example, which are not tested at all and whose manufacturing process consists only in thinning a small amount of raw material in water, are created. Unfortunately, with these people, resistance to vaccination is a significant source of revenue from the sale of services and products, for example Mrs. MUDr. E. charges CZK 1,000 per hour for "post-vaccination detoxification" and homeopathy for such counseling. And unfortunately, the social networks will carry any kind of information, regardless of whether it is true or false.

In conclusion, can we answer the questions about what vaccinations have brought us and whether it is good or bad? What is certain is that this is the most effective way to protect against the emergence and spread of infections. As an infectious disease specialist, I often treat autoimmune complications after being afflicted by an infectious disease for which there is no vaccination - and there are quite a few of them. The notion that we would be back struggling against resistant forms of tuberculosis, serious complications from measles, seeing a child choking with diphtheria and whooping cough, or vainly attempting to help someone dying from tetanus or taking care of a deaf child after pneumococcal meningitis or paralysis from polio, is really scary to me. It seems that many people do not realize that we do not have antiviral drugs against serious viral diseases, so we can not provide a sick child with fast and effective treatment. I vaccinated my own children against all important diseases, that is, besides the basic vaccination she had from childhood, I vaccinated them against meningococcus, tick encephalitis and hepatitis A. I even personally vaccinated them with the vaccine against tuberculosis when they were experimentally not vaccinating against it in South Bohemia in the 1990s. The flu vaccination does not seem to be very effective to me, because every year you must vaccinate again, but once they produce a vaccine that works on just one dose for one's whole life, then I would not hesitate.

I wish all able and healthy children.

Article from 31 March 2017