The Institute for Public Health (IJZ) proposed to the Ministry of Health to amend the law in order to limit the stay of unvaccinated children in schools and kindergartens or to introduce temporary measures in municipalities where a smallpox epidemic has been reported. In that institution, they expect that the Ministry will take into account the suggestions and take urgent measures in order to reduce the risk of a large epidemic that can lead to an overload of the health system, severe clinical picture, complications and possible fatal outcomes.
A smallpox epidemic has been declared in Budva and Podgorica, and the authorities believe that the situation will worsen with the beginning of the school year. Among the 19 infected, as many as were registered from April to this week, none were properly vaccinated against measles.
There is no improvement without more radical measures
Yesterday, the IJZ assessed for "Vijesti" that the coverage of vaccinated children cannot be improved significantly and quickly without changing the legislation that would limit the stay in collectives - preschool institutions and schools, sports and recreational facilities, on trips and excursions for unvaccinated children. They recalled that they carried out intensive educational and promotional activities and warned all actors in society about the epidemic, giving suggestions for solutions.
According to the current Law on the Protection of the Population from Infectious Diseases, vaccination against ten infectious diseases, including smallpox, is mandatory. Parents are subject to fines of up to 2.000 euros if they refuse and do not allow their child of preschool or school age to be vaccinated against these diseases, except in the case of medical contraindications determined by a medical doctor or expert team.
The measure stipulating that unvaccinated children cannot be enrolled in kindergarten and school was never included in the amendments to the Law, as it was foreseen in the draft back in 2015.
The IJZ said yesterday that, until changes are made, the existing law allows for the adoption of special orders introducing temporary measures in municipalities where an epidemic has been reported.
"Both possible solutions (amendments to the law and adoption of orders based on the existing one) have been proposed to the Ministry of Health, and we expect that in the coming period they will be respected and urgent measures will be taken in order to reduce the risk of a large epidemic that can bring with it an overload of the health system, severe clinical images, complications and possible death outcomes", said the IJZ.
Children are the most vulnerable, adults are also at risk
The IJZ told "Vijesti" yesterday that the appearance of a measles epidemic is not something that surprises them, because they have been warning about it for years as a very certain possibility in our population. They assessed that measles vaccination coverage in a significant number of years is worryingly low, including all preschool years, as well as several generations in the lower grades of primary school.
"Due to impaired collective immunity, there are all the conditions for the development of a major epidemic in which, apart from unvaccinated children who are the most vulnerable, adults who are not fully vaccinated will also fall ill, because children no longer protect them with collective immunity," the answer reads.
The IJZ reminded that the only effective prevention measure is complete vaccination, with two doses of the MMR vaccine.
According to IJZ data, coverage with one dose of the MMR vaccine among preschool children in Montenegro is 59,7 percent. 83 percent of children born in 2018 and 76,7 percent of children born in 2019 received the MMR vaccine.
Among children born in 2020, coverage is 69,7 percent, while only half of children born in 2021 are protected from measles by vaccination. The coverage of vaccinated among children born in 2022 is 32,1, and in 2023 it is only 13,8 percent.
Recommendations for kindergartens and schools
According to the guide for research and action in the event of an epidemic of measles for preschool and school institutions, it is foreseen that in the event of a worsening of the epidemiological situation, a proposal can be made to prohibit attendance of classes after an epidemic is reported in the territory of a certain municipality.
"In case of epidemics in several municipalities, this measure can be adopted at the level of the entire country. This is regulated by orders whose proposal is given by the IJZ, adopted by the Ministry of Health, and after publication in the Official Gazette of Montenegro, the competent inspection controls the implementation of the measures defined by the order," it says in the recommendations updated this month.
Another possibility is that in the event of the appearance of measles patients in pre-school and school institutions, all children who have not been vaccinated in accordance with the age and vaccination calendar can be prevented from attending pre-school and school by the decision of the competent inspection until the expiration of two periods of maximum incubation since the last case in to that institution.
"In this case, the mentioned measure applies to the unit (facility) of the preschool/school institution where the illness occurred. For children in primary and secondary school who cannot physically attend classes on this basis, it is necessary to organize online classes," the IJZ guide says.
According to the recommendations ahead of the school year, which starts next week, it was recommended to the institutions that in case of symptoms of smallpox during classes, the child should be moved to a special room and the parents should be immediately called to pick him up. It is necessary to thoroughly ventilate that room and clean and disinfect surfaces and objects, and contact the territorially competent epidemiological service. Sensitive contacts, i.e. children, should be vaccinated as soon as possible.
"For contacts in whom vaccination is contraindicated or in whom more than 72 hours have passed since exposure to the virus, administration of immunoglobulin (if available) against measles within six days after exposure can alleviate the clinical course of infection or prevent symptoms," the recommendations state. During the incubation period (seven to 21 days after contact with the sick person), sensitive children who were in contact should not attend school or kindergarten, as well as other types of gatherings such as birthdays, celebrations, theater performances, trips, excursions, gatherings in playrooms and the like. During that period, it is necessary to avoid all contact with pregnant women, children under one year of age, as well as with people who may have problems with the functioning of the immune system, such as those suffering from malignant diseases.
No solution on self-isolation
The IJZ replied to "Vijesta" that the issuance of a health-sanitary inspection decision on the isolation of persons suffering from measles is not provided for by the existing law and in the absence of orders.
They emphasized, however, that measles is not like covid-19, from which, to a large extent, children are spared severe forms of the disease.
"In the case of measles, infants and small children who have not been vaccinated are one of the most vulnerable groups," said the IJZ.
They repeated that there is a very effective vaccine for measles, which is mandatory, and that advice was clearly given that unvaccinated people should not go to collectives.
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