What should change in 2018?
To the three obligatory vaccines against diphtheria, the tetanus and polio (DTP) will be added those against haemophilus influenzae (a bacteria that causes serious meningitis in young), whooping cough, measles, the rubella, the mumps, the’Hepatitis B, meningococcus C (main cause of meningococcal meningitis) and pneumococcus (also responsible for meningitis in children). These eleven vaccines require ten injections, spread over two years. Those in addition to DTP are already done in most children because they are recommended. When they hit the market, one after the other, the health authorities thought at the time that the recommendation was enough.
Why this extension of the vaccination obligation?
For the entire population to be protected, a sufficient proportion of people must be vaccinated. Thus, the dangerous microbe stops circulating and causing epidemics. This is called “group immunity”. Many vaccines protect those who are vaccinated, but also those who have not been or cannot be. Vaccination of toddlers against pneumococcus thus reduced the occurrence of pneumonia in the elderly by a third! With “simple” recommendations, the coverage rate for some vaccines is around 70 to 80%. It is insufficient. It would take 90-95% to achieve truly effective “group immunity”. This is why we continue to observe epidemic outbreaks of certain diseases. Measles affected some 25,000 people between 2008 and 2015, caused a thousand hospitalizations in intensive care and caused 10 deaths!
Is this measure unanimous among doctors?
The majority are in favor, but a small minority oppose it, fearing that the obligation will crystallize the “rejections”. The situation is not simple: “Directly subject to the concerns of patients, their beliefs and rumors, family physicians do not necessarily dare to impose vaccination even if they are in favor” believes Christian Bréchot, vice-president. of the Institut Pasteur. “A part of the population today cannot tolerate the occurrence of side effects, even small ones. If the vaccine is poorly supported, which can happen, the doctor fears being on the front line, accused by his patients, ”adds Marie-Paule Kieny, researcher.
What are the possible side effects of vaccines?
For the eleven vaccines selected by the ministry, the side effects are usually moderate. The child has a little fever, he is grumpy, is not hungry … More serious problems such as convulsions are exceptional. As for claims accusing the MMR vaccine of causing autistic disorders, they have been denied by several serious studies. But the rumor continues to circulate.
Why vaccinate against common childhood illnesses?
First, because they are very contagious, then because they can be very serious, which we sometimes forget. Childhood illnesses such as measles are wrongly considered “commonplace” on the grounds that in previous generations “everyone caught it one day”. But if in the majority of cases this disease was of no consequence, measles was once the world’s leading cause of death by infection in children. Not to mention those who are victims of severe neurological complications! The same goes for haemophilus influenzae, which has long been the main source of bacterial meningitis in children (500 to 600 cases per year before the arrival of the vaccine). Finally, rubella, when it occurs in a pregnant woman, can have serious consequences for her baby.
Will children be protected against meningitis?
Three planned vaccines protect against the three bacteria (haemophilus, meningococcus C, pneumococcus) responsible for the majority of meningitis in children and adolescents. And the measles vaccine also protects against encephalitis. If there are other strains of meningococcus and other bacteria that can cause meningitis(enterobacteriaceae, listeria, streptococcus), with the new vaccine policy, most bacterial meningitis will be avoided. The vaccine does not, however, protect against meningitis of viral origin. But they are less serious.
Are any exemptions being considered?
The government is thinking about it … There are situations where vaccination is not recommended, for example in children suffering from immune diseases or undergoing treatments that weaken their natural defenses. These will be exempted automatically. For the others, the refusal could be sanctioned, but by showing “pedagogy”. These would not be coercive or punitive measures, but this decision could have consequences on access to communities: crèche, day center, public school, etc.
How is it going in other countries?
All in all, rather better than with us. It is in Pasteur’s country that the protest is most virulent! If the Swedish parliament opposed a bill to make vaccination compulsory, it is quite simply because it was not useful: the vaccination coverage rate in this country spontaneously turns around 97%. But Italy, which now wants to make twelve vaccines compulsory, has also seen the dispute flourish.
Are adjuvants essential?
For live attenuated vaccines, they are unnecessary. There is therefore no adjuvant in the MMR or the vaccine against flu. But sometimes it is necessary to add it to stimulate the immune system so that it reacts more effectively to the vaccination. For some vaccines, in fact, only fractions of microbes or antigens are used. However, these elements are incapable of provoking a sufficient immune reaction without adjuvant. Since 1926, aluminum salts (aluminum hydroxide and aluminum phosphate) have been used to boost the effectiveness of many vaccines.
Are we looking for new adjuvants?
Research is very active. Both because aluminum salts are not suitable for all vaccines and also to be able to manufacture vaccines with the lowest possible doses. Several adjuvants have thus been developed or are in progress since the 1990s, such as squalene, bacterial derivatives or even artificial vesicles comprising viral proteins. They must of course prove their worth over the long term. A few cases of narcolepsy (sleep disorder) had given rise to suspicion of the adjuvant of one of the vaccines used during the H1N1 influenza epidemic in 2009. This vaccine is no longer used today.
Are all vaccines effective for that long?
Some are lifelong, like the one against yellow fever. In the past, we used to do recalls every ten years. Since then, it has been shown that a single injection was sufficient. For MMR, it is the opposite. It was believed that a single injection provided lifelong immunity, but we realized that it was better to give two. As for DTP, it requires regular reminders, until adulthood. Then, a booster every twenty years until 65 years.
Why does the number of injections and boosters vary?
Because not all vaccines are “immunogenic” in the same way. “For everyone, we try to find the right dose, explains Dr. Jean-François Blanchemain, occupational physician. That is, the minimum effective dose. For hepatitis B, we were offering boosters. Today, we first perform a serology (search for protective antibodies). If it is positive, we no longer perform a systematic recall. “
How long does it take for a vaccine to work?
Not all of them trigger the same immune reaction, at the same speed, or with the same intensity, so it is on a case-by-case basis. Most vaccines only require one dose. It takes an average of a week to ten days to be immunized. For others, such as meningitis C, multiple doses are needed. Immunization is acquired about ten days after the injection of the last dose.
Can we eradicate a disease by vaccination?
Yes, the smallpox case proves it. An effective and widespread vaccination policy can eradicate a disease after a few decades. But several conditions must be met. First, the disease must be a human infection without an animal “reservoir” (like influenza), or persistence of the germ in the environment (like tetanus). We also need an effective and inexpensive vaccine with long-lasting effects. After smallpox, the “easiest” to eradicate in the world will probably be polio. But others, like measles, rubella or mumps are on the list.
The “anti” and the “pro” are the buzz!
The usefulness of vaccines is being questioned in all developed countries, particularly in the United States, under pressure from very powerful lobbies. In France, the announcement of compulsory vaccination has led to the appearance of numerous citizens’ online petitions and “chains” (circulating by email) peddling the craziest information on the dangers of vaccines. On the side of the E3M association, we are particularly asking for the development of vaccines without aluminum and the development of new adjuvants. On the other hand, other associations actively campaign for vaccination. This is the case of those which bring together families who have lost a child as a result of meningitis or a complication of measles.
Are you up to date with your vaccines?
The vaccination schedule is regularly updated based on data from pharmacovigilance. The Ministry of Health publishes it every year. What will the new law change in practice? It all depends on the age and the situation.
– 2 years
The new law must be applied. And therefore carry out the compulsory vaccinations, which represents ten injections spread over two years.
+ 2 years
In practice, nothing changes. But parents will be advised to “catch up” if the children have not been vaccinated against the eleven diseases.
Adults
No vaccination is compulsory.
But it is strongly recommended to check your immunity to tetanus and to perform a DTP booster every twenty years. After 60 years, protection against influenza (every year) and pneumococcus (every five years) is recommended.
Others
Certain vaccinations may be desirable.
It all depends on the risks to which we are exposed because of our lifestyle or profession (hepatitis A or B, leptospirosis …) or if we plan to have children (whooping cough…).
Our experts:
Marie-Paule Kieny researcher, former WHO Assistant Director-General for Health Systems and Innovation
Christian Bréchot, former director of Inserm, vice-president of the Institut Pasteur
Prof. Marc Girard, former Director General of the Mérieux Foundation and of the European Virology Research Center, professor at the Institut Pasteur
Read also:
Eleven compulsory vaccines for children
Vaccination: a new government site to see more clearly
Vaccines: the French are less and less confident
