VACCINATION CRISIS AS AN ENVIRONMENTAL THREAT TO PUBLIC HEALTH. AN ANALYSIS OF THE RESURGENCE OF DIPHTHERIA, PERTUSSIS AND MEASLES IN POLAND
Abstract
Introduction and Purpose of the Study: Protective vaccinations represent one of the greatest achievements in medicine. They have led to the elimination or reduction of many life-threatening infectious diseases. However, their success has also led to diminished awareness of the real threat posed by diseases, causing their resurgence in Poland and worldwide in recent years. This paper aims to analyze the current epidemiological situation of diphtheria, pertussis, and measles in Poland based on data concerning case numbers and the vaccination status of the population between 2010 and 2024.
Current state of Knowledge: Analysis of National Institute of Public Health data has revealed a systematic decline in the percentage of individuals vaccinated against all three diseases, often falling below the herd immunity threshold. This resulted in a significant increase in the measles cases in 2019 and an alarming surge in pertussis cases in the 2024- 2025. After years of absence, there have also been isolated cases of diphtheria. Data indicate insufficient adult immunity, low booster uptake, and persistent vaccine-related myths.
Conclusions: These findings clearly indicate that diphtheria, pertussis, and measles can pose a real threat to public health in Poland that can be directly linked to the decline in vaccination coverage. Urgent measures are needed, including improving coverage, promoting booster vaccinations in adults, education, and addressing vaccine hesitancy. Herd immunity remains essential for protecting public health and is a shared public responsibility.
References
Minta AA, Ferrari M, Antoni S, Lambert B, Sayi TS, Hsu CH, et al. Progress Toward Measles Elimination - Worldwide, 2000-2023. MMWR Morb Mortal Wkly Rep. 2024 Nov 14;73(45):1036–42.
Hinman A. ERADICATION OF VACCINE-PREVENTABLE DISEASES. Annu Rev Public Health. 1999 May 1;20(Volume 20, 1999):211–29.
Bullen M, Heriot GS, Jamrozik E. Herd immunity, vaccination and moral obligation. J Med Ethics. 2023 Sept;49(9):636–41.
NIZP PZH – PIB. (accessed on 25 April 2025). Bulletin: “Protective Vaccinations in Poland”. http://wwwold.pzh.gov.pl/oldpage/epimeld/index_p.html#05.
Stasiuk K, Maciuszek J, Polak M, Dolinski D. Profiles of Vaccine Hesitancy: The Relation Between Personal Experience With Vaccines, Attitude Towards Mandatory Vaccination, and Support for Anti-Vaccine Arguments Among Vaccine Hesitant Individuals. Soc Psychol Bull. 2021 July 30;16.
World Health Organization. (accessed on 25 April 2025). Pertussis. http://www.who.int/immunization/diseases/pertussis/en/.
Chief Sanitary Inspector. (31 october 2024). Statement of the Chief Sanitary Inspector regarding the Protective Vaccination Program for 2025. (Dz. Urz. Min. Zdr. z 2024 r. poz. 93). https://dziennikmz.mz.gov.pl/legalact/2024/93/.
Wendelboe AM, Van Rie A, Salmaso S, Englund JA. Duration of immunity against pertussis after natural infection or vaccination. Pediatr Infect Dis J. 2005 May;24(5 Suppl):S58-61.
NIZP PZH – PIB. (accessed on 25 April 2025). Reports on infectious disease cases, infections, and poisonings in Poland. http://wwwold.pzh.gov.pl/oldpage/epimeld/index_p.html#01.
World Health Organization. (accessed on 25 April 2025). Pertussis Reported Cases and Incidence https://immunizationdata.who.int/global/wiise-detail-page/pertussis-reported-cases-and-incidence?GROUP=WHO_REGIONS&YEAR=.
Pertussis vaccines: WHO position paper - September 2015. Releve Epidemiol Hebd. 2015 Aug 28;90(35):433–58.
Skoff TH, Deng L, Bozio CH, Hariri S. US Infant Pertussis Incidence Trends Before and After Implementation of the Maternal Tetanus, Diphtheria, and Pertussis Vaccine. JAMA Pediatr. 2023 Apr 1;177(4):395–400.
Becerra-Culqui TA, Getahun D, Chiu V, Sy LS, Tseng HF. Prenatal Tetanus, Diphtheria, Acellular Pertussis Vaccination and Autism Spectrum Disorder. Pediatrics. 2018 Sept;142(3):e20180120.
Berenson AB, Hirth ,Jacqueline M., Rahman ,Mahbubur, Laz ,Tabassum H., Rupp ,Richard E., and Sarpong KO. Maternal and infant outcomes among women vaccinated against pertussis during pregnancy. Hum Vaccines Immunother. 2016 Aug 2;12(8):1965–71.
Donegan K, King B, Bryan P. Safety of pertussis vaccination in pregnant women in UK: observational study. The BMJ [Internet]. 2014;349. Available from: https://api.semanticscholar.org/CorpusID:21620556
Morgan JL, Baggari SR, McIntire DD, Sheffield JS. Pregnancy Outcomes After Antepartum Tetanus, Diphtheria, and Acellular Pertussis Vaccination. Obstet Gynecol [Internet]. 2015;125(6). Available from: https://journals.lww.com/greenjournal/fulltext/2015/06000/pregnancy_outcomes_after_antepartum_tetanus,.23.aspx
Shakib JH, Korgenski K, Sheng X, Varner MW, Pavia AT, Byington CL. Tetanus, Diphtheria, Acellular Pertussis Vaccine during Pregnancy: Pregnancy and Infant Health Outcomes. J Pediatr. 2013 Nov 1;163(5):1422-1426.e4.
Griffin JB, Yu L, Watson D, Turner N, Walls T, Howe AS, et al. Pertussis Immunisation in Pregnancy Safety (PIPS) Study: A retrospective cohort study of safety outcomes in pregnant women vaccinated with Tdap vaccine. Vaccine. 2018 Aug 16;36(34):5173–9.
Gall SA, Myers J, Pichichero M. Maternal immunization with tetanus–diphtheria–pertussis vaccine: effect on maternal and neonatal serum antibody levels. Am J Obstet Gynecol. 2011 Apr 1;204(4):334.e1-334.e5.
Maertens K, Caboré RN, Huygen K, Hens N, Van Damme P, Leuridan E. Pertussis vaccination during pregnancy in Belgium: Results of a prospective controlled cohort study. Vaccine. 2016 Jan 2;34(1):142–50.
Amirthalingam G, Andrews N, Campbell H, Ribeiro S, Kara E, Donegan K, et al. Effectiveness of maternal pertussis vaccination in England: an observational study. The Lancet. 2014 Oct 25;384(9953):1521–8.
Ladhani SN, Andrews NJ, Southern J, Jones CE, Amirthalingam G, Waight PA, et al. Antibody responses after primary immunization in infants born to women receiving a pertussis-containing vaccine during pregnancy: single arm observational study with a historical comparator. Clin Infect Dis Off Publ Infect Dis Soc Am. 2015 Dec 1;61(11):1637–44.
Paradowska-Stankiewicz I, Rumik A, Bogusz J, Zbrzeźniak J, Rastawicki W, Śmietańska K, et al. Duration of protection against Bordetella pertussis infection elicited by whole-cell and acellular vaccine priming in Polish children and adolescents. Vaccine. 2021 Oct 1;39(41):6067–73.
Blain A, Lewis M, Banerjee E, Kudish K, Liko J, McGuire S, et al. An Assessment of the Cocooning Strategy for Preventing Infant Pertussis—United States, 2011. Clin Infect Dis. 2016 Dec 1;63:S221–6.
Carcione D, Regan AK, Tracey L, Mak DB, Gibbs R, Dowse GK, et al. The impact of parental postpartum pertussis vaccination on infection in infants: A population-based study of cocooning in Western Australia. Vaccine. 2015 Oct 13;33(42):5654–61.
World Health Organization. (accessed on 25 April 2025). What is diphtheria? https://www.who.int/news-room/questions-and-answers/item/diphtheria.
Kin FS, Azman M, Yi BQ, Jeing YD. Strangling angel of children- diphtheria: A case series of airway management and disease progress in diphtheria. Int J Pediatr Otorhinolaryngol Case Rep. 2019 Sept 1;25:100671.
Zulfan G, Sihombing J, Amin D, Widiantari A, Berti M, Murtiani F. Clinical Manifestation of Childhood Diphtheria. J Ilm Kedokt Wijaya Kusuma. 2023 Mar 31;12:1.
gov.pl (accessed on 25 April 2025). Diphtheria. https://www.gov.pl/web/wsse-warszawa/blonica.
Berbers G, van Gageldonk P, Kassteele J van de, Wiedermann U, Desombere I, Dalby T, et al. Circulation of pertussis and poor protection against diphtheria among middle-aged adults in 18 European countries. Nat Commun. 2021 May 17;12(1):2871.
Weinberger B, Schirmer M, Matteucci Gothe R, Siebert U, Fuchs D, Grubeck-Loebenstein B. Recall responses to tetanus and diphtheria vaccination are frequently insufficient in elderly persons. PloS One. 2013;8(12):e82967.
Madubueze CE, Tijani KA, Fatmawati. A deterministic mathematical model for optimal control of diphtheria disease with booster vaccination. Healthc Anal. 2023 Dec 1;4:100281.
Olayiwola MO, Alaje AI. Mathematical modelling of diphtheria transmission and vaccine efficacy using Nigeria. Model Earth Syst Environ. 2024 June 1;10(3):3941–67.
Slifka AM, Park B, Gao L, Slifka MK. Incidence of Tetanus and Diphtheria in Relation to Adult Vaccination Schedules. Clin Infect Dis. 2021 Jan 15;72(2):285–92.
World Health Organization. (accessed on 25 April 2025). Measles. https://www.who.int/news-room/fact-sheets/detail/measles.
World Health Organization. (accessed on 25 March 2025). European Region reports highest number of measles cases in more than 25 years – UNICEF, WHO/Europe https://www.who.int/europe/news/item/13-03-2025-european-region-reports-highest-number-of-measles-cases-in-more-than-25-years---unicef--who-europe.
Centers for Disease Control and Prevention. (accessed on 25 March 2025). Measles Cases and Outbreaks https://www.cdc.gov/measles/data-research/index.html.
Retraction--Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet Lond Engl. 2010 Feb 6;375(9713):445.
Peltola H, Patja A, Leinikki P, Valle M, Davidkin I, Paunio M. No evidence for measles, mumps, and rubella vaccine-associated inflammatory bowel disease or autism in a 14-year prospective study. Lancet Lond Engl. 1998 May 2;351(9112):1327–8.
Patja A, Davidkin I, Kurki T, Kallio MJ, Valle M, Peltola H. Serious adverse events after measles-mumps-rubella vaccination during a fourteen-year prospective follow-up. Pediatr Infect Dis J. 2000 Dec;19(12):1127–34.
DeStefano F, Bhasin TK, Thompson WW, Yeargin-Allsopp M, Boyle C. Age at first measles-mumps-rubella vaccination in children with autism and school-matched control subjects: a population-based study in metropolitan atlanta. Pediatrics. 2004 Feb;113(2):259–66.
Taylor B, Miller E, Lingam R, Andrews N, Simmons A, Stowe J. Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: population study. BMJ. 2002 Feb 16;324(7334):393–6.
DeWilde S, Carey IM, Richards N, Hilton SR, Cook DG. Do children who become autistic consult more often after MMR vaccination? Br J Gen Pract J R Coll Gen Pract. 2001 Mar;51(464):226–7.
Lindsay P. Books: long read: The Doctor Who Fooled The World. Andrew Wakefield’s War On Vaccines: I Looked on Immunisation as an Example of Modern Living and Progress… and Then Came Andrew Wakefield. Br J Gen Pract J R Coll Gen Pract. 2021 Jan;71(702):34–5.
Mellott CE, Jaworski ,Rafal, Carrico ,Justin, Talbird ,Sandra E., Dobrowolska ,Iwona, Golicki ,Dominik, et al. Public health impact and return on investment of the pediatric immunization program in Poland. Expert Rev Vaccines. 2023 Dec 31;22(1):1114–25.
Bienkowski C, Kowalczyk M, Golik A, Kacperczyk-Bartnik J, Bartnik P, Dobrowolska-Redo A, et al. The attitude of Polish women planning pregnancy and/or having children towards vaccinations: a cross-sectional survey study. Ginekol Pol. 2022;93(8):655–61.
Gabutti G, Cetin I, Conversano M, Costantino C, Durando P, Giuffrida S. Experts’ Opinion for Improving Pertussis Vaccination Rates in Adolescents and Adults: A Call to Action. Int J Environ Res Public Health. 2022 Jan;19(7):4412. Gabutti G, Cetin I, Conversano M, et al. Experts’ opinion for improving pertussis vaccination rates in adolescents and adults: a call to action. Int J Environ Res Public Health. 2022;19(7):4412. https://doi.org/10.3390/ijerph19074412
Views:
16
Downloads:
2
Copyright (c) 2025 Emilia Biczak, Oliwia Biegańska, Grzegorz Przywara, Hanna Barska-Kobylińska, Martyna Byrska, Maja Weimann, Marta Janura
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
