Russian Healthcare & Reform
29 March 2006

Childcare and Vaccination

The comparison of the approach of Russian healthcare in regards of their children with the United States will show that the vaccinations are a necessity and in some cases lacking on the part of the Russian society. This will be described via a detailed listing of time periods when certain vaccinations are given, be reflected by the types of vaccinations and certain problems that have arisen from administering one type of vaccination over another. The youth of a child will determine their life and how they will live once they hit maturity. An unhealthy childhood can and will leave a life long impact and in some cases the lack of life to have.

To start with the discussion of the different forms of vaccinations and how they function is necessary. There is “killed whole organisms” which is used in order to make the organism completely harmless but allows the body to learn to recognize it and protect against it. This particular type is used when they make the vaccination against typhoid. This is a very safe but not always effective vaccination. There is a chance the body might not deem the threat as such and put it into its memory to be protected against.

Then there is the “attenuated organisms” which is a cultured form of a threat and is in a weakened state when given in the inoculation. This is how they design tuberculosis vaccination, BCG, which is a bacterium which has been known to cause tuberculosis in cows. This particular vaccination we will discuss in more detail later as that it is used in Russia but not in the United States. The downfall to this particular type of vaccination is the threat is still present to get the disease from the vaccination but is not strong enough in most situations to post any threat at all to the person being injected.

“Toxoids” are a type that has been damaged by toxins to weaken them to the point that the threat can not release the proteins that would normally trigger the disease. They allow for the molecule to retain some of its properties and epitopes so that the threat will be recognized by the defense system but at the same time weakens it to a point that it is not a threat. This is how the healthcare industry deals with creating vaccinations for diphtheria and tetanus.

 

The industry also uses a form of weakening process that uses the surface of the molecule to allow it to be recognized as a threat while added multiple forms of strains of threats to be within the vaccination so that many of the same threat are all recognized but not requiring an injection of each different strain. This process is used for Hepatitis B, Influenza and even with a multitude of the common and threatening strains of Streptococcus pneumoniae.

The “inactivated virus” is similar to the killed bacteria in that it contains a whole particle but has been treated similar to the toxiod so that the epitopes are still present and easy for the body to recognize. This is how the Salk (IPV) vaccine is made to protect against polio.

“Attenuated virus” is used in vaccines to provide a form of the threat but still a threat to ensure the recognition by the body’s defense system. Sadly these weakened forms of the virus, though very rarely, can revive to their full strength and it only takes on to cause the disease. This has been used in treating the polio virus through a oral vaccination which allows for other members of the polio family to be immunized against as well but because of this small but still potentially life changing threat, the United State uses the Salk vaccination over the OPV. This is also how the vaccination of measles, mumps, and rubella (MMR) is formed.

The schedule on how these medications are administered determines how soon you are covered by them. That schedule is left up to the head of our country to determine but the World Health Organization (World Health Organization) determines what must be administered and keeps track of statistics on how many are complying and how well they are complying with this guide to health.

As you can see in the chart provided, there is some variation between countries on when they should be provided. The other difference between the Russian and United States is that the Russian immunizations are the base requirements according to World Health Organization. The United States listing is what is required by the state of Iowa before you can enter the educational system.

 

Russia	Scheduled immunization		United States (Iowa)
BCG	Birth7-14 years
DTwP (Tetracoq)(3 dosages required)	3 months4.5 months6 months 18 months	2 months4 months6 months15-18 months4-6 years	DTaP
		2 months4 months6 months15-18 months4-6 years	DTaPHepIPV(combination option)
		2 months4 months6 months15-18 months	DTaPHib(combination option)
		Based on risk	HepA
HepB	Birth1 month6 months	Birth-2 months1-4 months6 months	HepB
HIB3 dosages		2months4 months6 months12-15 months	Hib
		6-23 months24 months – 49 years>=50 years	Influenza
IPV	3 months4.5 months6 months18 months20 months14 years	2 months4 months6 months12-15 monthsIowa requires at age 4-6 years	IPV
Measels	12 months6 years
MM	12 months6 years
MMR	12 months6 years	12-15 months4-6 years	MMR
Mumps	12 months6 years
OPV	3 months4.5 months6 months18 months20 months14 years
		2 months4 months5 months12-15 months	Pneumo_conj (PCV)
Pneumo_ps	Based on risk	>=65 yearsBased on risk	Pneumo_ps
Rubella	12 months6 years13 years
Td	14 yearsFollowed by every 10	11-18 yearsBooster every 10yrs	Td
Typhoid	Based on risk
		12-18 monthsAnd susceptible adults     Iowa requires another dose about 11-16 years	Varicella

 

To clarify what these medications do for a child I will discuss the diseases they protect from and what their chances to cause permanent harm to their life.

DTaP and DTwP are two different forms of the same type of treatment for diphtheria, pertussis, and tetanus. These three diseases are easily spread, the first two being spread by human contact and the third through a cut or wound on the skin’s surface. Diphtheria forms a thick covering in the back of the throat that can cause problems such as difficulty breathing, paralysis, heart failure and sometimes even death. Pertussis also causes problems with your breathing in the form of horrible coughing spells that can make it extremely difficult to eat, drink, and breathe at all. Pertussis can last for weeks and move into pneumonia, seizures, brain damage and even death. The third component, tetanus, causes excruciating painfully tightening of the muscles all over the body, but is nicknamed “lockjaw” due to the stiffening of a jaw can make it nearly impossible to drink or eat due to the inability to move the jaw or throat muscles. Death occurs in about 1 out of every 10 cases. These immunizations are not a permanent and boosters for the diphtheria and tetanus are given approximately ever 10 years. If you are exposed to threats, such as in the medical field or your work causes lots of abrasions, it is advised every 6 years.

The HepB vaccination is often advertised as the first cancer vaccination. This is because it can stop the virus that attacks the liver and in many cases leads to liver cancer later in life. Hepatitis B, which is how the vaccination got its name, has its highest chance of long term chronic damage if it can successfully infect infants and children under the age of 4. HepB is transferred via exposure to infected blood or body fluids. Most infection occurs in newborns due to infected mothers transferring the infection. The chances of a chronic infection drop drastically as children get older, so early immunization is imperative.

Hib is a vaccination that helps protect against a multitude of different threats while also minimizing potential additional threats which the Haemophilus influenzae often lead to meningitis. This vaccine also protects against pneumonia, pericarditis (an infection affecting the membrane covering the heart), and potential infections of the bones, blood and joints caused by bacteria.

IPV and OPV are two different forms of prevention for the polio virus. Unfortunately the OPV is highly dangerous in that it, as said before, can lead to getting the polio virus due to the weakened state but not dead form it can regain full strength and infect the person taking it orally. Polio is potentially fatal but is also life changing in that it can permanently paralyze if you do survive the infection. It has been found that IPV is much safer, but does not keep the virus from being transmittable in the case someone who is immunized with IPV does contract the virus but is not affected by the virus due to the immunization.

Measles, mumps, and rubella (also known as the German measles) are protected by the MMR vaccination. This is a very effective vaccination but is still necessary because these diseases are still prevalent in other countries. Measles is highly contagious and very unpleasant. The main treatment before was complete isolation and medication to minimize fevers, syrup to help with the coughing and lotions to combat the skin’s dryness and itch. Rubella is known as the German measles due to its similarity to the measles symptoms and unpleasantness to have. The rubella virus normally only lasts a few days compared to week long pains from the measles. Rubella was not as prevalent but when it did surface it would become a small epidemic. Mumps vaccination is also included with the MMR series to protect against a viral disease that attacks the salivary glands, causing fever and swelling. This particular topic will be covered again later in the paper for an example of the differences world wide and the potential harms. It’s believed that once having this vaccination the defense against these viruses is life long.

Pneumo_conj vaccination is short for pneumococcal conjugate which has been a leading cause of pneumoncoccal infections as well as a step stool for meningitis, ear infections and blood infections. These can cause permanent hearing loss, pneumonia, brain damage, and even death. Vaccinations start early to protect against this.

Varicella is a commonly known as chicken pox and was considered a “rite of passage”. This minimal annoyance at younger ages which is when it is normally contracted by residents did not warrant a vaccination until recently. Due to the large quantities of immigrants coming into the United States that had not been exposed to the chicken pox prior entry are often dieing from the exposure. At younger ages the cases are mild and rarely more than just dermal. As the age of the person exposed so does the chance of fatality due to its extreme spread. At older ages it has been known to get under the eyelids, down throats, up the sinus passages and into the lungs. With this level of exposure the inability to eat, difficulties breathing often cause death.

There has been a fairly steady decline of diphtheria in Russia, with approximately 505 cases in 2004. The measles took a huge hit in 2002 dropping it down to under 600 cases but as of 2004 there is approximately 2500 cases. Pertussis also has had a similar jump to the Measles. Rubella has been on a fairly steady decline over the last 5 years by almost 1/3 of its previous listings.

Tetanus is sadly not declining despite the fact they do immunize. The low numbers are probably the reason they have not increased the amount of vaccinations to be comparable to the five required dosages unlike their three required. The standard reported vaccination schedule according to what World Health Organization has been notified by Russian officials actually entails a fourth dosage at the age of 18 months. This information conflicts with the report on a Russian hospitals prenatal information site that states that World Health Organization only requires a total of 3 immunizations.

In the United States, the strain of diphtheria has been nearly eradicated with no reports of any cases in 2004. So far there have been no more than 50 cases of the measles in the United States since 2001, and compared to 1990’s near 28,000 cases, that is less than 1% of the previous infections. Infections with the mumps in recent years have actually been fluctuating between 200 and 400 cases per year. This year, 2006 will be a record breaker and I will discuss shortly what the potential reasons for this and explain in detail the issue at hand. Pertussis was actually slowly increasing until the year 2004. Unlike Russia the United States had an explosion but not to the extent Russia’s population did. There was 235% increase in the United States compared to the near 415% increase in Russia. Polio has also been nearly eradicated in the United States with no reports of infection since 1980. Rubella has fluctuated on a very minute scale over the last 5 years, with fewer than 25 infections per year reported. Tetanus as well has been a steady problem in the United States but its numbers are lower than Russia’s. Comparably the ratio of the United States population to the Russian would suggest that there would be need for an increase of necessity of an extra dosage implemented for Russia.

Now there are some who have suggested and even formed collations to argue that vaccinations are not worth while and that we should not do such things to our children. The following facts suggest otherwise.

• Average annual number of smallpox cases in 1900-1904: 48,164.
  United States cases per year since 1950: 0.
  Worldwide cases per year since 1977: 0.
• Average annual number of diphtheria cases in the U.S. in 1920-1922: 175,885.
  U.S. cases in 1998: 1.
• Average annual number of pertussis cases in 1922-1925: 147,271.
  U.S. cases in 1998: 6,279.
• Estimated average annual number of tetanus cases in 1922-1926: 1,314.
  U.S. cases in 1998: 34.
• Average annual number of paralytic polio cases in 1951-1954: 16,316.
  U.S. cases of wild type poliovirus in 1998: 0.
• Average annual number of measles cases in 1958-1962: 503,282.
  U.S. cases in 1998: 89.
• The number of mumps cases in 1968: 152,209.
  U.S. cases in 1998: 606.
• Average annual number of rubella cases in 1966-1968: 47,745.
  U.S. cases in 1998: 345.
• Estimated average annual number of cases of congenital rubella syndrome in 1966-1968: 823.
  U.S. cases in 1998: 5.
• Estimated average annual number of Hib cases before vaccine licensure: 20,000.
  U.S. cases in 1998: 54. (Barrett)

If you look at the time periods offered and then compare to the later dates and the amounts of people infected it suggests that that not only is there a need but as I said before many of these diseases we are immunizing against can be fatal or can lead to another disease that is known to cause fatalities. No parent wants their child to die. I doubt many of the people involved in these anti-immunization groups have children or have children that were not influenced by the shot in a negative way. In the discussion of the OPV I pointed out that there has been a very small percentage, but one to recognize that children were in fact infected with the polio virus because of regaining enough strength to pose a threat. As a parent, I recognize the risk and the factors that could cause my son to have gotten infected with the shots. But I also look at the statistics of how fast it can infect and even kill and the risk is worth it.

Now as said before, I was going to discuss the current issues of the mumps outbreak here locally. “300 confirmed or suspected cases of mumps have been reported in 39 Iowa counties since Jan. 1,” Courier writer Jens Krogstad says. It was posed in this article as well that there is potential that this strain that is affecting our state and now spreading out of our state boundaries actually came from the United Kingdom.

With the large amounts of foreign exchange students that come here to study and the many students that go over seas, it is quite possible someone contracted the virus and brought it back to expose the United States population. Ironically this strain is attacking primarily late teens and early twenty year olds. Similar age ranges to those of the college years, leading this assumption to be a strong possibility of being the starting point.

Many of those contracting the virus have been immunized and not actually contracted the virus itself, which means their body has a 95% chance of immunity to the measles, mumps, and rubella. Due to a close tie between the University of Northern Iowa and Malcolm Price Laboratory School the virus has since moved into this all age school. The close interactions with those from the University of Northern Iowa in most cases would not be a threat but as of the 6^th of April, over half of the reported cases in the county were located at the university. It’s safe to suggest the entire population of children at this school have been exposed; due to the more recent exposure to the immunizations the younger populations are not suffering as extreme symptoms.

This, I have reason to believe, is because my son, Joseph, is currently suffering from some minor fevers and swellings on his throat that showed up early evening April 12^th, 2006. Now being that they were hard to see I sent him to school the next day thinking they were gone and it was just a bug bite. Apparently they were not gone and the school had me pick him up and take him into the physician to have him checked out. They ran three different types of tests and told us it takes 3 days for the tests to be processed for mumps.

There is a requested quarantine of 5 days after the onset of symptoms being implemented. After speaking with a county health official on the 18^th after a positive test result finally came back, I learned that they are actually requiring all swelling to be gone which in most cases 5 days is enough. Unfortunately, my son is home for his 7^th day and the swelling increased in size due to a joyful and incapable-to-sit-still day occurred which used a lot of his energy to combat the virus. It is my understanding that the mumps incubation period is usually 16 to 18 days, although it may vary from 14 to 25 days. The health officials believe that the contraction of the virus occurred right around the time of the school’s spring break. To ensure it was not a public event he got it at they asked if he had been at any events during that time. To my knowledge there were no such events.

Mumps is contagious seven days prior to and up to nine days after the onset of symptoms. The movement of people in society makes this disease capable of spreading very easily and very fast, especially with the fact that there is such a long period of being contagious without any signs or symptoms for warning.

There is suggestion that this is a strain based out of Europe; potentially a super bug that has built up potency against the vaccinations. Now if this is the case it only proves my argument that there needs to be a universal standard that is absolutely being implemented across the world. The current standards appear to be working in almost all cases, but for the sake of the Russian population being sure to get all the vaccinations, not just one and call it good, is a necessity for the country to protect its place in the world. Without a population, there isn’t a country.

 

Krogstad, Jens Manuel. “Mumps Epidemic Continues to Spread.” Waterloo Cedar Falls Courier. 6 April 2006 <http://www.wcfcourier.com/ >

Downing, Eric. “Russian Vaccination Schedule”. 8 Jan. 2001. 17 April 2006 <http://www.russianadoption.org/Rusvac.htm>

Medem International Clinic and Hospital. Well-Baby Program. 2005. MEDEM International Clinic & Hospital.12 March 2006 <http://www.medem.ru/english/program/baby/>

World Health Organization. 2006. World Health Organization. 12 March 2006 <http://www.who.int/en/>

Centers for Disease Control and Prevention. Vaccine Information Statements. 25 April 2006 Center for Disease Control. 12 April 2006 <http://www.cdc.gov/nip/publications/VIS/>

Advisory Committee on Immunization Practices, American Academy of Pediatrics, and American Academy of Family Physicians. “Recommended Childhood Immunization Schedule”. 1999 Iowa Department of Public Health. 17 April 2006 <http://www.idph.state.ia.us/isiis/99sched.htm>

Iowa Department of Public Health. “Public health officials identifying approaches to stop spread among Iowans”. 13 April 2006. Iowa Department of Public Health. 17 April 2006 <http://www.idph.state.ia.us/common/press_releases/2006/mumps_investigation_041306.asp>

Iowa Department of Public Health.  “Mumps Cases Continue to Increase”. 17 March 2006. Iowa Department of Public Health. 17 April 2006 <http://www.idph.state.ia.us/common/press_releases/2006/mumps_031706.asp>

Centers for Disease Control and Prevention. “Parents’ Guide to Childhood Immunization” 2006. Every Child by Two. 17 April 2006 <http://www.ecbt.org/parents.htm#guide>

Barrett, Stephen M.D. “Misconceptions about Immunization”. 21 April 2001.Quakewatch.17 April 2006 <http://www.quackwatch.org/03HealthPromotion/immu/immu00.html>

Kids Health. “Common Children Illnesses and Infections”. 2001. Prairie Public Broadcasting. 12 April 2006 <http://www.prairiepublic.org/features/healthworks/kids/mumps.htm>