The Vaccination Programme as Redesigned in Finland from the Beginning of 2005
Published: 09.02.06 Updated: 09.02.2006 14:45:53
Department of Vaccines, National Public Health Institute (KTL), Helsinki, Finland
With the vaccines used in the redesigned vaccination programme, Finnish children will, as before, be protected against severe infections caused by tuberculosis, diphtheria, tetanus, whooping cough, measles, mumps, rubella, polio and Haemophilus influenzae type b (Hib). Owing to the new combination vac¬cines the number of vaccinations required for good protection has been reduced considerably. With the introduction of new vaccine products adverse effects are also expected to be reduced.
The need for a reform in the vaccination programme is influenced by changes in the epidemiology of infectious diseases, the introduction of improved vaccines on the market and the adverse effects associated with vaccines. During 2002 and 2003 changes were made in the Finnish national vaccination programme that had remained unchanged for almost a decade. Target groups for the influenza vaccine were extended in the autumn of 2002 to include individuals in the category of conventional medical risk groups as well as all Finns of 65 years of age and older. The booster vaccine against diphtheria-tetanus-pertussis (DTaP, ap = acellular pertussis) given to children of pre-school age was added to the vaccination programme at the beginning of 2003. Polio vaccinations (inactivated polio vaccine, IPV) at the ages of 11 and 16–18 were abandoned at the same time, because adequate pro¬tective immunity in Finland is provi¬ded by the vaccination programme consisting of four injections of the polio vaccine by school age. Ad¬ditional booster injections are only required in exceptional cases.
Planning and decision-making in the vaccination programme
The Ministry of Social Affairs and Health (STM) is in charge of the general planning, guidelines and monitoring of the efforts involved in the prevention of communicable dise¬ases. The actual vaccination programme is designed and approved by the Advisory Board on Communicable Diseases, an expert body on the prevention of infectious diseases at the STM. The National Public Health Institute (KTL) is the expert institution involved. The national vaccination expert group, the vaccination recommenda¬tion working group of the KTL and various groups with expertise in vaccinology are involved in the decision-making process concerning the vaccination programme. In the design of a general vaccination programme consideration needs to be given to the importance of preventable diseases from the public health point of view, the seve¬rity of the disease and the risk of contracting the disease in various age groups, the maturity of immune response of the individual being vaccinated, the efficacy of the vacci¬ne, and any adverse effects from the viewpoint of both the individual and the society, including the operational and economic perspectives of health care. The design of the national vaccination programme is always the result of compromise. The aim is to reach an adequate level of protect¬ion as early as possible and with as low doses of vaccine and as few adverse effects as possible. The municipalities are responsible for the practical arrangements of vaccinations. Children’s vaccines and the vaccination schedule used in the national vaccination programme from 1.1.2005 are listed in Tables 1 and 2.
Vaccinations for special risk groups
Individuals at increased risk of contracting hepatitis A or B due to their living circumstances are given hepatitis vaccinations in accordance with the indications supplied by the KTL. Population groups at considerable health risk due to influenza are vaccinated against influenza every year before the start of the epidemic period.
Vaccinations introduced before 2005 are to be continued by special guidelines. These guidelines for the transi¬tion period will guarantee an equal basic coverage for all children irrespective of the stage at which they were in the vaccination programme at the beginning of 2005.
Vaccinations for adults
All adults should make sure that they have received the basic coverage of at least three tetanus, diphtheria and polio vaccinations. All adults should also be protected against measles, rubella and mumps either by having had the infection or by two MMR vaccine injections. A booster vaccination against diphtheria and tetanus is recommended every 10 years. A booster vaccination against polio (IPV) is required only in special circumstances.
For decades, vaccination of children at health care centres has been a routine for Finnish families. Prior to school age, children are vaccinated against nine severe infections. Polio, measles, mumps and rubella, which are covered by the general vaccination programme, have alrea¬dy been eradicated in Finland. Tu¬berculosis, diphtheria, tetanus and severe diseases caused by H. influenzae type b have almost totally di¬sappeared. Whooping cough has occurred, but significantly less fre¬quently compared with the period prior to the vaccination programme. This good outcome is the result of the extensive use of effective vacci¬nes; at least 93% of the children receive all the vaccinations by the age of 2 years in accordance with the Finnish vaccination programme.
1. Heikkinen T, Silvennoinen H, Peltola V, Ziegler T, Vainionpaa R, Vuorinen T, Kainulainen L, Puhakka T, Jartti T, Toikka P, Lehtinen P, Routi T, Juven T. Burden of influenza in children in the community. J Infect Dis. 2004;190: 1369-73
Table 1. Vaccines in the Finnish National Vaccination Programme
Table 2. Childhood immunization schedule