Do you know the tetanus vaccine that, together with others in the same injection, is given when the baby is more than one year old? As the Ministry of Health has decided to heed the recommendations of the Spanish Association of Pediatrics (AEP), which already said in its calendar of vaccines in January said to remove it, and recently announced that it will stop administering. I speak of the pentavalent vaccine that protected against tetanus, diphtheria, whooping cough, Haemophilus influenzae b and polio.
The fourth dose that the AEP eliminated in January
As we have commented, earlier this year the AEP chose to eliminate this dose of pentavalent vaccine in order to modify the pattern of the hexavalent and pentavalent that is given to babies (usually at 2, 4 and 6 months and the pentavalent to 18), and go from four to three doses.
They are not exactly the same vaccine, but there is talk of four doses because formerly the pentavalent was administered four times and apart from that of hepatitis B in three doses, and for a few years the latter joined the first three pentavalent to form the vaccine hexavalent Then, the usual pattern was 2,4,6 and 18 months, with the first three hexavalent and the last pentavalent, for not carrying hepatitis B.
Well, the Ministry of Health has decided to adopt the pattern suggested by the AEP for the year 2017 and the vaccine will be administered at 2, 4 and 11 months, as we read in the statement they have made about it:
The childhood vaccination calendar, which for the first time was common for all Autonomous Communities in the last legislature and is updated based on the epidemiological situation and the innovations that occur, has been modified to introduce a new guideline for hexavalent vaccine.Based on the scientific evidence and with the agreement of all Autonomous Communities, this new guideline is 2 doses administered at 2 months and 4 months and a recall dose at 11 months. These children will receive another souvenir dose against diphtheria, tetanus, whooping cough and polio at 6 years. The modification will be incorporated in all the Autonomous Communities from January 2017.
This modification in the administration of the hexavalent vaccine, which ensures protection against diseases for which it immunizes (diphtheria, tetanus, whooping cough, polio, Haemophilus influenzae type b and hepatitis B), adds to the vaccination against pneumococcus and chickenpox in the children's age approved in 2015.
Why do they remove it?
I suppose you have asked yourself the same question I asked myself when I found out. If they put four, why now three? Will babies be well vaccinated? Will it be to save? And the definitive answer I don't have, but I suppose that the thing goes a little out there, and a little because for several months there are problems with the availability of some vaccines that include pertussis.
According to the data known by the data sheet, the vaccine can be administered both in a 4-dose regimen and in a 3-dose regimen, and apparently it is practically as effective in the second situation as in the first, as we can see in the following table. of the mentioned file:
In fact, there are several countries (such as France and Denmark), which have been carrying out this pattern for a long time. Why then put four? Well, I imagine that because protection does not cease to be, at the statistical level, a little better. But if that little bit is as low as we see in the graph, many of the diseases are very controlled and the savings of putting a vaccine less makes it possible to administer that of pneumococcus, chickenpox, and who knows if in the future that of meningitis BWell, go ahead.
And protection against whooping cough?
We are in a somewhat convulsive situation as far as the pertussis vaccine is concerned. There is hardly any dose of DTPa vaccine given at 4-6 years and many children are not getting vaccinated for it. In addition, there are few doses of the aforementioned pentavalent (in many cases a fourth hexavalent is administered, to which this new pattern would give solution), but at a time when several babies have died from this disease (a girl died yesterday in Jaén, who due to his age had not yet received the first vaccine), it seems unwise to take a dose.
However, in a document of the Ministry of Health in which the effectiveness and clinical data of the hexavalent vaccine from two different manufacturers are evaluated, we read that:
With a two-dose vaccination schedule (3.5 months) and a 12-month recall dose, the results of long-term follow-up carried out in Sweden demonstrated that vaccines containing Pa are effective. However, it was observed that protection against pertussis would be about 7-8 years. Therefore, it was considered to include in the data sheet the need to administer a second dose of memory against pertussis at 5-7 years in previously vaccinated children following the guidelines 3, 5 and 12 months.
And that vaccine of 5-7 years is the one that has been part of the calendar for years but is not available right now (it should be when children with three doses, and not four, reach that age, because they will not have so much margin of maneuver).
In short, we could say that they have seen that one of the vaccines that were given to children is not so necessary at the present time and they have chosen to modify the pattern and withdraw it, in the same way as now, instead of putting three vaccines for meningitis C in the first two years of life they put two in many autonomous communities because thanks to vaccination for more 15 years of cases of meningitis C have been drastically reduced.
