[Effects of the immunization program in Vojvodina]

A Mumps Outbreak in Vojvodina, Serbia, in 2012 Underlines the Need for Additional Vaccination Opportunities for Young Adults

In 2012, mumps was introduced from Bosnia and Herzegovina to Vojvodina, causing an outbreak with 335 reported cases. The present manuscript analyses the epidemiological and laboratory characteristics of this outbreak, identifies its main causes and suggests potential future preventive measures. Sera of 133 patients were tested for mumps-specific antibodies by ELISA and 15 nose/throat swabs were investigated for mumps virus RNA by RT-PCR. IgG antibodies were found in 127 patients (95.5%). Mumps infection was laboratory-confirmed in 53 patients, including 44 IgM and 9 PCR positive cases. All other 282 cases were classified as epidemiologically-confirmed. More than half of the patients (n = 181, 54%) were 20–29 years old, followed by the 15–19 age bracket (n = 95, 28.4%). Twice as many males as females were affected (67% versus 33%). Disease complications were reported in 13 cases (3.9%), including 9 patients with orchitis and 4 with pancreatitis. According to medical records or anamnestic data, 190 patients (56.7%) were immunized with two doses and 35 (10.4%) with one dose of mumps-containing vaccine. The Serbian sequences corresponded to a minor genotype G variant detected during the 2011/2012 mumps outbreak in Bosnia and Herzegovina. Vaccine failures, the initial one-dose immunization policy and a vaccine shortage between 1999 and 2002 contributed to the outbreak. Additional vaccination opportunities should be offered to young adults during transition periods in their life trajectories.

[Risk of vaccination in children with epilepsy]

INTRODUCTION

The central nervous system, previously considered as "immune privileged", does exhibit features of inflammation in response to injury, infection or disease. We do not know its reactions on immunization. We do not know how common febrile seizures after vaccination are and if there are subgroups of children at higher risk. What is the long term outcome for children who had afebrile seizure after vaccination? Can the vaccine be a direct cause of a condition called an epileptic encephalopathy, where seizures damage the brain with the resulting epilepsy?

DISCUSSION AND CONCLUSION

It should not be forgotten that "benign infective childhood diseases" can, and do, kill, and that vaccines are a public health intervention saving many millions of lives around the world. Parents as well as doctors have fear: whether vaccinations can cause convulsions, epilepsy or encephalopathy. Large studies of this issue have produced conflicting results, although the recent consensus is that the risk of vaccine-induced epilepsy and or encephalopathy, if it exists at all, is extremely low. It is necessary to establish a proposed immunization program for children at neurologically high risk and for children with epilepsy to protect them and the whole population from infectious diseases, children from immunization adverse events, and avoid possibilities of legal trial. It is necessary to know everything about the risks and benefits of immunizations for each child. For each child, the risks of the disease, and its squeal, must be compared with the vaccine's protective efficacy and potential adverse reactions. Vaccination is given preference in nearly all children with epilepsy.