An address sent to the Estonian immunoprophylactic expert committee reads that family doctors have recently voiced opinions according to which the vaccine for chickenpox should be added to the national immunization schedule ahead of that for Streptococcus pneumoniae. Pediatricians disagree.

Pneumococcus that spreads via droplets could cause severe middle-ear infection, sinusitis or pneumonia or in more serious cases even meningitis or sepsis.

Doctors believe that pneumococcus statistics in Estonia hardly reflects the actual situation. While the official number of diagnosed infections is modest, the actual number of cases of pneumococcal disease is likely considerably higher.

Diagnosis requires specific analyses pediatricians say aren't ordered nearly as often as needed, while it is impossible to get mucus samples from young children. Additionally, some patients have received antibacterial treatment before samples are taken, causing tests to come back negative. That is why a number of cases are not reflected in the Health Board's statistics.

Nevertheless, official figures for invasive pneumococcus disease have grown in the past three years: from 143 cases in 2016 to 195 in 2017 and 197 in the first ten months of this year. Pneumococcus infections killed 11 people in 2017 and 10 last year.

This year has seen nine cases of rare pneumococcus meningitis, with three infants and one small child diagnosed.

"The World Health Organization finds that existing conjugate vaccines against pneumococcal infection should be administered to all children under the age of two, to avoid invasive infections, meningitis, sepsis or bacteremic pneumococcal pneumonia, as well as non-invasive – ear infections, sinusitis, pneumonia and the bacteria invading the nasopharyngeal duct," pediatricians point out.

Pneumococcal vaccines are rarely used in Estonia as parents have to pay for them out of pocket. The vaccines are included in many national immunization plans, with Estonia, Croatia and Malta the only European countries where that is not the case. The latter have already decided to include the vaccine in their schedules.

Children start attending daycare even before they turn two and bacterial infections can be serious or severe for children, next to more widespread viral infections.

"Therefore, pediatricians and ear-nose-throat doctors believe that including the pneumococcus vaccine for infants and small children in the national immunization schedule should not just be considered but should definitely be done," the doctors said.

They believe vaccinating against pneumococcus disease should be part of the national immunization plan for children up to two years of age and those belonging to risk groups aged 0-18.

The doctors find that the chickenpox vaccine could be added to the schedule for risk groups or all children in the future. Based on the workload of the Tallinn Children's Hospital during the flu season, the schedule could also include seasonal flu vaccines for children in a certain age group, as is the case in Finland or Latvia for example.

The address has been signed for the hospital's pediatricians and the Estonian Pediatric Association's Tallinn department by Reet Raukas, head of the Tallinn Children's Hospital's Pediatric Clinic.

The Estonian Ear, Nose and Throat and Head and Neck Surgeons Society proposed adding the pneumococcus vaccine to the national schedule in October. Back then, the Ministry of Social Affairs' reply read that the national immunoprophylactic expert committee has proposed ensuring vaccines for children belonging to risk groups first.

The expert committee is scheduled to meet on December 3.

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