Debate over children's vaccination in Latvia after diphtheria tragedy

None of the children who died of diphtheria in Latvia this century had been vaccinated, said the Children's Clinical University Hospital (BKUS) in a statement September 17.

After a week and a half of doctors fighting for a four-year-old's life, the child died in hospital on September 16, his organ systems unable to recover due to exposure to diphtheria toxins, according to doctors.

"Diphtheria is a deadly but vaccine-preventable disease. Effective vaccines are available and have been paid for by the Latvian state for many decades. This tragic case reaffirms the importance of vaccination," the hospital says. Doctors stress that diphtheria is deadly or very dangerous for unvaccinated people. Although vaccines were invented last century, children are still dying of diphtheria in Latvia this century.

In 2003, a child aged 3-5 years died; in 2005, two children aged 3-5 years died; in 2006, one child aged 5-10 years died.

"However, for almost 20 years there has not been a case of diphtheria at the Children's Hospital as severe as the patient brought in on September 5. This may have led some to believe that diphtheria is no longer a threat, but this tragic case reminds us otherwise.

"It is particularly worrying that two children have already died of vaccine-preventable infections at the Children's Hospital this year - one from whooping cough and one from diphtheria,"

said Ilze Olšteina, the hospital's public relations representative, adding that all the children who have died in Latvia this century as a result of diphtheria were not vaccinated, including the boy who died on September 16.

Each European country has a different legal framework for controlling dangerous infections. Several countries, including France, Italy, the Czech Republic and Hungary, have a mandatory vaccination calendar against diseases such as diphtheria, polio, measles and others.

Against this backdrop, Health Minister Hosams Abu Meri (New Unity) is convening a meeting of the National Council on Immunisation this week to discuss proposals for action with experts, including initiatives to change legislation.

"It is unacceptable that in the era of modern medicine, children are dying from vaccine-preventable diseases," said the Minister.

Doctors at the Children's Hospital are once again calling for a check today that all family members have been vaccinated and received boosters against diphtheria and other dangerous vaccine-preventable infectious diseases. If not, this should be done immediately. If the first symptoms of diphtheria appear, immediate medical attention should be sought and isolation and testing of all contacts is mandatory.

In cases where the doctor considers that vaccination is in the best interests of the child, but the parents do not agree, the doctor can submit an application to the orphans' court, which may give consent instead of the parents, ombudsman Juris Jansons told LSM.lv.

"This possibility can help ensure the child's right to protection of health and life," he adds.

In Latvia, children must be vaccinated against 14 infectious diseases - tuberculosis, diphtheria, tetanus, whooping cough, poliomyelitis, measles, rubella, epidemic parotitis, Haemophilus influenzae type B infection, hepatitis B, chickenpox, pneumococcal infection, rotavirus infection, human papillomavirus infection.

Although vaccination against these diseases is compulsory for children, according to paragraph 28 of the Vaccination Regulation, the parent or other legal representative has the right to refuse the vaccination of the child. 

"If the legislation allows the refusal of vaccination of a child, the parent (or other legal representative) has acted within the legal framework in accordance with his/her own convictions. Not vaccinating a child is not an unlawful, culpable act, for which the law provides for liability.

"It is possible to ensure that vaccination is compulsory in another way - by obtaining the permission of the orphan's court to vaccinate the child instead of the consent of the parents or other legal representative," explains the Ombudsman.

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