What is Pediatric Immunization?

In the most basic biological terms an immunization is an injection of a dead or modified virus that triggers the body’s immune response in a less threatening, lower risk situation. This dead or weakened pathogen when introduced to the immune system is cataloged in the memory of its antibodies and in future infections of dangerous and communicable viruses the body is prepared to battle the disease. Often these vaccinations cannot completely prevent a disease from being contracted, but the effect is markedly less dangerous and noticeable.

Different types of vaccines work differently, there are those that you only need a single shot like those of HPV or Tdap (Tetanus, diphtheria, acellular pertussis), while others require multiple shots over a period of years to build up the body’s immunity.

Pediatrics by definition is: "a branch of medicine dealing with the development, care, and diseases of infants, children, and adolescents" (Merriam Webster). Therefore pediatric immunization concerns itself with the vaccination of children from birth to 18 years.

Which Vaccine Preventable Diseases Exist in Minnesota?

Vaccine preventable diseases are prevalent globally, and therefore a marked threat in the state of Minnesota as well. These include:

Bacterial meningitis,
Chickenpox,
Diphtheria, tetanus, and pertussis (also known as whooping cough),
Flu (influenza),
Haemophilus influenzae type b disease (Hib disease),
Hepatitis A,
Hepatitis B,
Human papillomavirus (HPV),
Measles, mumps, and rubella,
Pneumococcal disease,
Polio,
Rotavirus

With such a magnitude of diseases and their respective vaccination a timeline is suggested and required to accumulate immunity to these dangerous diseases. A Minnesotan child's timeline would encompass:

Let's see some data

From evidence in the graphic to the left and in comparison to national immunization rates, Minnesota is at the higher end of the spectrum for vaccine coverage. However, with the overall coverage ranging around 70% for required vaccinations in the first year of life, this leaves millions in the Minnesotan population that have unfinished vaccination series or are completely unvaccinated and exposed to the dangerous vaccine-preventable diseases (VPDs).

How do Immunizations work in Guatemala?

Introduction to vaccine-preventable diseases (VPDs) in Guatemala.

As a country they administer the same basic child immunizations of the highly communicable and preventable diseases present worldwide. These vaccinations include:

DtP,
Hib,
Polio,
Pneumococcal,
Measles/mumps,
Hep B (birth dose),
Hep B,
Rotavirus,
Rubella,
BCG (Bacillus Calmette–Guérin) which is specific to endemic areas for tuberculosis.
Newly introduced vaccinations as of the years 2018-2020 are aP (pertussis), HPV, and IPV (Inactivated-Poliovirus).

Coverage ranges between the different regions of Guatemala but overall WHO/UNICEF Joint Reporting Forms on Immunizations reports:

Effectively pretty high ranges in the average range of 85% for all VPDs except the Hep B birth dose. This discrepancy in coverage however can be explained in that it was recently introduced into the national immunization schedule in 2018.

However, WHO and the Ministerio de Salud Pública y Asistencia Social (MSPAS), the Guatemalan Ministry of Health, both lack information on coverage for the essential pediatric immunizations of Meningitis, Influenza, HPV, and accommodations for high risk patients. In this way the Guatemalan department of Health and coverage is in difficulty compared to Minnesotan records of these VPDs. In addition, these high rates of vaccination only encompass regions of child populations closer to the urban areas near Guatemala City. The data is therefore skewed more towards higher coverage of vaccination, because the populations of vaccinated children near the city are much higher in comparison to the nearly non-vaccinated children in rural Guatemala.

What are Guatemalan problem diseases?

The most deadly communicable diseases that impact Guatemala:

Malaria, Dengue Fever (endemic in Guatemala), Zika in pregnant women, TB (tuberculosis), and Neonatal diseases of all communicable types. The largest issue is most of these communicable diseases do not have a commercially available or accessible vaccine.

Malaria: Vaccine was recently developed in October 2021 and primarily administered to high risk areas that don’t include Guatemala.
Zika: Currently there are no vaccines to prevent this disease, and only symptom reducing and pain-relieving drugs can be administered to reduce side-effects. But research has repeatedly informed of birth defects that impact the child of an infected mother.
Dengue Fever: Vaccine Dengvaxia has been commercially available as of 2021, but distribution, funding, and the COVID-19 pandemic has hindered arrival to endemically impacted populations within Guatemala.
TB (Tuberculosis): The BCG vaccine must be administered more comprehensively as the easily communicable disease has induced death in 2.3 out of 100,000 people living in Guatemala according to WHO.org data. But overall effectiveness is low because of severe side effects that occur in the shot area of the skin.

How does the government combat VPDs with child immunization?

In order to prevent largely global VPDs the Ministerio de Salud Pública y Asistencia Social (MSPAS) in Guatemala implemented a recommended pediatric schedule of immunizations to mitigate commonly dangerous and communicable diseases. In summation the schedule encompassed below includes all of the VPDs also covered in Minnesota and recommended by CDC guidelines.

In addition governmental policies that Guatemala implements to aid in immunization involve largely funding and promotion through digital mediums. In specific, the national government budget does include the purchase of routine vaccinations and supplies, and the total expenditure on immunization is 100% financed by the public sector (governmentally run). But the Guatemalan government and Ministry of Health have not recently or actively assessed reasons for under-vaccination. In addition to lacking data on the under-vaccinated communities, Guatemala currently lacks any financial support or financially binding legislation on immunization. In addition there are no legislative requirements for proof of vaccination to enroll in school or childcare for children of any age. However, there is a routine immunization schedule that is administered at public schools. In order to combat these discrepancies The Guatemalan National Immunization Programme was created and as of 1997. NGOs have worked to provide mobile services in rural communities, which are those most undocumented and requiring the most immunization aid.

Pediatric Immunization in Minnesota versus in Guatemala

The hindrances in Minnesotan pediatric coverage come largely from lack of governmental enforcement of immunization recommendations and also vaccine resistance from the parents. Especially in regards to MMR vaccine Minnesotan pediatric facilities have received much resistance against immunizing children for Measles, Mumps, and Rubella. In fact, Minnesota experienced the largest Measles outbreak in many decades recently in 2017.

Ideologically passionate and under-educated parents are primarily afraid of claimed side-effects of such vaccinations. One scientist in particular claimed a correlation between the MMR vaccine and Autism, and therefore frightful parents refuse to consent to various immunizations. Additionally, the lack of governmental enforcement and support can be described as lack of accountability for parents to vaccinate and document their child's immunizations as no effective state legislation requires such accountability.

Where in Minnesota the worry arises mostly in the worries of accountability and the misinformation that impacts families causing them to avoid vaccination, in Guatemala the lack of national communication and difficulty of distribution and storage largely impact the ability for children to receive their due immunizations. The urban versus indigenous or rural disparities are the true barriers Guatemala faces in getting their child population vaccinated. With unequal distribution of vaccines benefitting solely the populated areas of Guatemala, socioeconomic inequalities are highlighted in specific for the large indigenous and rural population that do not receive vaccination largely because of their remote locations. Many times the lack of vaccinations include the poor overall communication from the government to the more remote areas because only some 20-25% of the Indigenous peoples own some sort of digital device. Therefore, a more accessible mode of communication is community radio and word of mouth. The difficulty of storage and distribution also arises because there is only 1 doctor for 3,000 Guatemalans in the population.

With such a large gap of physicians but the constant need for them, in rural areas pediatricians are forced to walk door to door to vaccinate children. With the expanse of land and the need for precise refrigeration of vaccinations such as the IPV (Inactivated Polio Virus), or even the Hexavalent (6 vaccinations in 1) the logistics become either extremely expensive for the community or largely impossible.

Overall the trend displays that Minnesota suffers less from socioeconomic struggles to not get immunized but largely more ideological barriers against medicine itself. Whereas Guatemala lacks the infrastructure and governmental structure to promote and distribute fully accessible pediatric immunizations.