New-old infections, children and vaccinations – what to do

Recently, the world has been living in constant tension: the coronavirus pandemic, then hepatitis in babies, and now also monkeypox. How to protect children?

With the help of German specialists, they dealt with topical issues Deutsche Welle. The publication turned to the DGKJ – the German Society for Pediatric and Adolescent Medicine, and asked them to answer the burning questions of parents. General Secretary of the DGKJ Burkgard Rodek spoke in detail and competently about everything.

Question: We have not yet managed to move away from the coronavirus pandemic, and monkeypox is spreading around the world. Will there be another pandemic? Should we seriously be afraid of a new virus?

Answer: We will definitely not have to announce the highest level of threat yet. Monkeypox is a disease that has been known for a long time in the countries of Central and West Africa. The new aspect that we are now seeing is that this virus was not brought to the Americas and Europe as a result of population migration or tourism. Its spread has been documented from person to person within these countries.

The number of cases of infection is not so high yet. The variant that we are now seeing in European countries is the West African one. It causes a milder course of the disease than the Central African variant.

Yes, you can definitely get sick. The main carriers of smallpox are rodents. Monkeypox is transmitted to humans from animals, primarily from rodents and monkeys. But the course of the disease is quite mild, as a rule. The peculiarity of the situation in Germany is that until 1976 there were regulations for vaccination against smallpox. In lands belonging to the former GDR, even by the early 1980s. That is, that part of the population that was born before the abolition of vaccination against smallpox, and now, most likely, has a high degree of protection against monkeypox. (According to the Robert Koch Institute (RKI), smallpox vaccination was discontinued in Germany in 1983.) All those born later are not immune from smallpox. Accordingly, children do not have such protection. And this is one of the reasons why the monkeypox virus is now spreading.

Question: What does this mean for concerned parents? Do I need to run and register my child for vaccination?

Answer: There is a smallpox vaccine. And the federal government has already placed a corresponding order for the vaccine, which was cleared in Europe in 2013. It is better tolerated than previous vaccines, but is available to people 18 years of age and older. The Standing Commission on Vaccination (Stiko) is of course working on the issue of vaccination in case monkeypox spreads. Most likely, a recommendation will be given to vaccinate people who have had contact with patients. I don’t think there will be a universal recommendation for everyone.

Question: Are there cases of infection of children in Europe?

I don’t know any cases of infection among children yet. (At the time of publication, it is already known that WHO reported on July 6: monkeypox began to be detected in children, about a third of them under the age of 10 years, half before 5 years. ed.). Transmission of the virus from person to person is possible both sexually and by contact. You should avoid singling out any particular group of people. Everyone can get infected: both children and adults. And if monkeypox was found in parents, then the child can become infected from them. But I repeat that the probability of infection is very low. Therefore, there is no reason for concern. And it’s definitely not worth fearing a similar pandemic, as with a coronavirus infection, when infection is possible by airborne droplets and aerosols. It’s a completely different virus.

Question: As a doctor, how do you assess the reaction of society and the media to viruses?

Answer: Of course, we are all worried. Public attention and media coverage of this topic is now more attentive and more frequent than the pandemic. And of course, the perception of the population itself is more sensitive. And yes, you’re right, this is starting to make more of a problem than it really is.

Question: The smallpox vaccination was canceled after the disease was practically eradicated. A similar situation was with tuberculosis in European countries. Suppose that monkeypox will spread further. Will the vaccination of children be discussed then?

Answer: We have to wait. We must collect all the data, evaluate the picture of the disease, track the chains of infection. Until all this is done, the question of vaccinating children cannot be answered. And the second moment. Before a vaccine can be made available in an appropriate population, it must be tested in that population. As we have seen in the case of coronavirus vaccines. To vaccinate children, you need to obtain a special permit. This is very important to ensure the safety of vaccination. You cannot, out of fear of some disease, which may not be as serious as, for example, in the case of smallpox, demand a vaccine for children. After all, the vaccine itself can carry risks, so this issue requires careful study.

Q: How does monkeypox progress?

Quite a mild course of the disease. We are familiar with varicella (chickenpox) – a viral infection belonging to another group of viruses, its causative agents are herpetic viruses. Monkeypox is caused by poxviruses, but the disease itself is similar to, or even milder than, chickenpox. Most children do not have a severe course of the disease when they become infected with chickenpox, the disease goes away on its own, and now there are medications that can be used in case of a severe course.

Question: I can’t help but ask a question about another viral disease – hepatitis. According to the WHO, a number of cases of severe hepatitis of unknown origin have been reported in children in recent weeks.

Answer: Public attention to hepatitis is great. The number of infections is rather insignificant, as in the case of monkeypox: about 600-650 cases worldwide. Hepatitis of unknown origin has been diagnosed in children under six years of age. It is important to say here: yes, we are familiar with this disease, we have dealt with it in the past. There is nothing new here for epidemiologists. And the fact that most severe cases of hepatitis have no known cause is nothing new.

Approximately 50% of children in need of a liver transplant have been infected with acute hepatitis, the causes of which are not clearly established. This means that doctors suspect a viral infection but cannot prove it. In topical cases, adenoviruses were found in some patients – in about 70% of patients. These adenoviruses are also known to us. As a rule, they do not lead to a severe course of hepatitis, difficulties arise only in children with a weakened immune system, but not in healthy ones. It is important for parents to pay attention to the primary symptoms, for example, the yellow tint of the whites of the eyes and others.

Suspicions that coronavirus may be the cause of hepatitis are still speculative. Of course, this assumption cannot be completely ruled out, but we have been living in a pandemic for two years now, and then such cases would be known. In addition, only a small proportion of children with hepatitis have contracted the coronavirus. Another common assumption casts doubt on the vaccine against coronavirus infection: they say that it is the cause of acute hepatitis. Here we can say with certainty: “No.” All children under six years of age who had a severe course of hepatitis were not vaccinated. For this age group, a coronavirus vaccine has not yet been approved – neither in Germany nor in other European countries.

Question: With regard to vaccinating children against coronavirus, now many are beginning to say that a new wave of COVID-19 may await us in the fall. Would you recommend vaccination for children?

Answer: We have current Stiko recommendations: vaccination is recommended for children from five to 11 years old. It makes sense. Enough data has already been collected, a lot of research has been completed. Risks from this vaccine are available or virtually non-existent. Therefore, I would be guided by the recommendation of Stiko.

Question: Should we learn to look at viruses like doctors? In the professional community of doctors, they have long been saying that there are a lot of viruses on earth.

Answer: There are two things to be said here. For decades, we thought we had conquered infectious diseases. It must be admitted that this is not so. In the last century, we have already seen this in the example of HIV. Now with a crown. The world is arranged in such a way that there are microorganisms in it. And we will need to deal with them. And most importantly, they change. Therefore, the risk of contracting an infectious disease in the future exists, and we will not be able to reduce it to zero. Therefore, you need to remain vigilant and exercise caution. At the same time, we need to be realistic about pandemics. In Germany, most people have already been vaccinated against coronavirus or they have been ill, so the likelihood of a new wave is low, although, of course, it cannot be completely ruled out. Even if another wave awaits us in the autumn, for the majority it will not pose a serious threat.

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