The reappearance of diseases hitherto controlled by vaccination is a specter that haunts countries that record a steady decline in vaccination coverage, such as Brazil.1. After an outbreak of the disease recorded in the country throughout 2018, the country lost the certification of measles-free country granted by the Pan American Health Organization (PAHO) the following year. Since then, cases of measles have been reported every year in Brazil, even during the coronavirus pandemic.1.
With the recent recording of the first case of wild polio in three decades in Malawi and the outbreak of polio linked to the vaccine virus in Israel2, has lit the red light in several countries, including Brazil, as vaccination coverage against the disease has been declining for at least seven years. In 2013, 100% of children who needed to be vaccinated against poliomyelitis went to health posts. But in 2020, only 75.86% were vaccinated, and last year that number was even lower: only 63.75% of eligible children received the polio vaccine.3. “By doing a simple calculation, we can say that, out of 100 children, 30 are not properly vaccinated and are at risk”, underlines Juarez Cunha, pediatrician and president of the Brazilian Vaccination Society (SBIm). “And, since we have had low vaccination coverage since 2015, can you imagine the number of children susceptible to the disease?” he asks.
Before the start of polio vaccination campaigns in the 1980s4, the disease was a constant preoccupation in the lives of mothers and fathers. Although its most frequent symptoms are usually mild, such as fever, malaise, headache, sore throat and body aches, in the most severe forms of the disease there are sequelae such as flaccidity muscular, problems and pains in the joints, different growth of the legs, paralysis of the muscles, including those of speech and swallowing, among other incurable motor problems5. In some cases, poliomyelitis can cause death.6. “Polio was a dramatic disease, as many children went to bed feverish and woke up paralyzed. It started with a paralysis, the “little legs”, generally in the lower limbs and sometimes it went up, it went up, it reached the thighs, the arms. When the children were healed, and most were healed, they were left with scars. We all know someone who has had poliomyelitis in the past and who suffered from it, sometimes permanently. He needed devices to be able to walk, move around. Poliomyelitis is therefore a serious disease, yes,” says Renato Kfouri, infectious disease specialist, president of the vaccination department of the Brazilian Society of Pediatrics (SBP).
“The last case of poliomyelitis in Brazil dates back to the distant year of 1989, and the certificate of free country was granted to Brazil in 1994.7. So many years without sick children or children with sequelae of poliomyelitis may have led to a false perception of the safety of today’s mothers and fathers, which would be one of the reasons for the reluctance to vaccinate. , that is, caregivers stop vaccinating their children, even with the polio immunizing agent available free through the SUS,” says Cunha. “In 2019, the World Health Organization placed vaccine hesitancy as one of the threats (to global health)8. And one of the reasons for not getting vaccinated is perhaps this false sense of security, because there are diseases that a large part of the population does not know, has never seen, so they think that don’t need to have their children vaccinated. He does not see the risk, but the risk is there, it is real”, adds the president of the SBIm.
“And nowadays, because of these low vaccination coverages, the threat of a return of poliomyelitis in Brazil is real”, explains pediatrician and infectiologist Renato Kfouri. “The risk of reintroduction of infantile paralysis in Brazil after so many years without registration of the disease exists. Other countries, such as Israel for example, are already facing cases of poliomyelitis: there have been seven cases, because (the country) does not vaccinate (on the right), because neither do we,” he adds.
To get this threat out of the rearview mirror, there’s only one way to go: get parents and mothers to understand that vaccination against polio and all vaccine-preventable diseases is essential, says pediatrician and infectious disease specialist Luiza Helena Falleiros Arlant, President of the Technical Chamber of Polio Eradication Certification in Brazil by the Pan American Health Organization (PAHO). “If you maintain 95% vaccination coverage for children, any virus that enters the country will do nothing. With an adequately immunized population, the virus can circulate in the community and it will be immunized, people will be protected”, he guarantees.
1 boletim-epidemiologico-vol-53-no03.pdf (www.gov.br)
2 The Global Polio Eradication Initiative calls for renewed commitments to fulfill the promise of a polio-free world (unicef.org)
3 Bio-Manguinhos and SBIm are partners in a project to resume vaccination coverage – SBIm
4 Poliomyelitis (fiocruz.br)
5 Poliomyelitis (infantile paralysis) | MS Health Virtual Library (saude.gov.br)
6 Poliomyelitis – PAHO/WHO | Pan American Health Organization (paho.org)
⁷ Poliomyelitis – PAHO/WHO | Pan American Health Organization (paho.org)
8 Ten health threats WHO will tackle in 2019 – PAHO/WHO | Pan American Health Organization (paho.org)
The importance of keeping children vaccinated
For premature babies, attention to timing is even more important
Pediatricians and infectious disease specialists always stress the importance of strictly following the vaccination schedule of our children, in order to protect them from vaccine-preventable diseases. But since 2015, Brazil has faced declining childhood vaccination rates for most diseases.1including poliomyelitis, and the resurgence of diseases that have already been eliminated, such as measles, for example2. While in 2013 virtually all eligible children were vaccinated against infantile paralysis, last year that number fell to 67.58%3. This reduction has occurred with most essential vaccines in the first years of a baby’s life, such as BCG, which protects against tuberculosis; MMR against measles, rubella and mumps; and meningitis C, to name a few examples.4
And when we think of premature babies, those babies born before 37 weeks of gestation, timely vaccination is essential, as they are part of a group of newborns who are even more vulnerable to infections.5 “These babies have immature and developing immune systems. And, since they spent less time in their mother’s womb, they received fewer antibodies from the mother than full-term babies,” explains neonatologist Lílian Sadeck, director of the Brazilian Pediatric Society. “But what we see is that the vaccination of premature babies, which must be done at the same chronological age as babies born ‘at the right time’, is often delayed. And there are several factors for this delay; one of them is sorry for the baby, who is still underweight and has to go to the health center to receive several injections. But we managed to improve this vaccination schedule,” he adds.
The incorporation by the National Vaccination Program (PNI) of the Ministry of Health of combined vaccines, those that offer protection against more than one disease with the application of a single injection, can help parents of premature babies in this task of protecting their children, he assesses. The Reference Centers for Specialized Immunobiology (Cree) make these vaccines available to very premature babies, those born weighing less than 1 kg or up to 31 weeks of gestation.6. The goal was to make vaccination less painful and with fewer reactions for this baby.7 Thus, premature babies can be protected against up to six diseases, including poliomyelitis and whooping cough, with just one injection.
“These special vaccines are also acellular, that is to say they are composed only of the proteins responsible for generating the immune response and not of whole cells, which reduces their side effects”, explains the pediatrician and infectologist Ana Paula Burian, president of the regional do Espírito Santo of the Brazilian Society of Vaccinations (SBIm), herself the mother of twins born premature at 36 weeks. The doctor recalls that all vaccines used by the Ministry of Health are “immunogenic, reliable and safe” and stresses that it is important for families of premature babies to know that the SUS offers this immunizing agent to this specific group of babies . “We can have mothers in the countryside, far from the capital, who do not know that they are entitled to combined vaccines. If the vaccinator does not have this information, the mother can contact the Department of Health, which is the one that orders this vaccine for the whole city,” he explains.
The polio immunization schedule includes five doses of vaccine for both premature babies and full-term babies. Premature infants have always received the first three doses of the injectable inactivated polio vaccine, inactivated poliomyelitis vaccine (IPV), at 2, 4 and 6 months of age.8. Since 2016, full-term babies also receive the first three doses of VIP. The two booster doses, given between 15 and 18 months and between 4 and 5 years, can be either the oral vaccine – the “drop” (Sabin) – or the injectable9. SBIm recommends that all doses offered be of inactivated vaccine where possible, in line with a recommendation from the World Health Organization ten.
1 The fall of childhood vaccination: Revista Pesquisa Fapesp
2 Measles – SBIm Family
3 The fall of childhood vaccination: Revista Pesquisa Fapesp
4 The fall of childhood vaccination: Revista Pesquisa Fapesp
5 The low demand for vaccination is worrying, especially among premature babies – NGO Prematuridade.com
6 inform-incorporacao-penta-hexa-acellulares-210104.pdf (sbim.org.br)
7 Brazil. Ministry of Health. Health monitoring service. Department of Immunization and Communicable Diseases. Available at: https://sbim.org.br/images/files/notas-tecnicas/informe-incorporacao-penta-hexa-acellulares-210104.pdf. Consultation in May 2022
8 Premature – SBIm Family
9 Brazilian Vaccination Society – calend-sbim-crianca.pdf
10 Polio Vaccines – SBIm Family