a whole life dedicated to the service of immunization in Puerto Rico

Dr. Iris Cardona has served the Island and has helped, in the last twenty years, to protect children, adolescents and adults from preventable diseases.

Dr. Iris Cardina, main official doctor of the Department of Health of Puerto Rico. Photo: Journal of Medicine and Public Health.

She is the woman who best dominates the subject of vaccination in Puerto Rico, she has dedicated twenty years of her life working with the vaccination program. Iris Cardona is the chief medical officer of the Puerto Rico Department of Health. She is a doctor by profession, she has made a specialty in pediatrics and a subspecialty in pediatric infectious diseases.

In his eagerness to serve the Island, he took a specific course to learn more about vaccine-preventable diseases, with the Center for Disease Control and Prevention. Subsequently, she collaborated with the health department as a clinical consultant.

Today he recalls that there has been an increase in scientific research in relation to diseases that can be prevented, the itinerary and the possibilities of vaccination have been expanded. “Today we have 19 pediatric diseases that can be prevented and in the adult population we have an additional one,” says the specialist.

Her greatest contribution to the Island has been for years behind the vaccination itineraries and serving as a doctor. Today, she proudly and happily maintains that she has spent more than twenty years vaccinating children and adolescents, as well as adults.

Creation and development of vaccines

“In general terms, vaccines are biological products, that is, they are developed from living organisms; some part is used, some protein or a segment that is recreated in the laboratory, some component of this living being, which are, normally, infectious agents”, indicates the expert.

Cardona explains that: “once the vaccine is produced and administered, it works by causing a kind of shield that will prevent us from getting sick or having complications associated with these diseases.” Cardona adds that: “Most of the vaccines are aimed at the pediatric population, hence the interest of a pediatrician in this subject.” Fundamentally, scientific research has advanced. Decades or a century ago, these diseases caused terrible manifestations, particularly in the pediatric population, such as smallpox, polio, measles.

“Vaccines made their entrance. The first vaccine dates back many centuries, exactly, it dates back to the 18th century, but in the 20th century we have the first generation of vaccines administered to a large segment of the pediatric population, that is, the vaccine that prevents diphtheria, tetanus, whooping cough , measles and the consequences caused by polio”, explains Cardona.

Dr. Iris Cardona, has been a fundamental part of the care process in the population due to the COVID-19 pandemic. Photo: Journal of Medicine and Public Health. Fabiola Plaza.

The doctor notes that measles is endemic in many regions, just as there are still places in the world where there is evidence of disease activity caused by polioviruses, but measles exists in countries in Asia, the Middle East, Africa; has not been completely removed. There is no circulation of what is called the endemic disease in Puerto Rico or in the United States, but where there are low levels of vaccination against measles -which is one of the most contagious diseases that exists- there is the possibility of importing it and dozens of , hundreds or thousands of cases in this part of the world.

No cases of measles have been seen in the last twenty years. However, the United States in 2014 saw an outbreak that crossed state borders (some 17 states were affected), starting in California, at an amusement park, with a visitor from the Philippines. After that, in 2019, the United States sees another outbreak that starts in the East region, particularly in New York, with an unvaccinated child from the Jewish community who travels to Israel, where there was a situation with common measles, and brought measles to the United States. There were about a thousand cases in that year.

But, when looking at the data from the World Health Organization, highlights the specialist, we are going to see that “measles still kills about one hundred thousand children, every year, in the different countries of the world.”

Vaccination is a lifelong process, which begins from the mother’s pregnancy until the baby is born, and then goes through different stages. The first vaccine administered to the child is the hepatitis B vaccine, which must be administered during the first 24 hours after birth; then comes the primary vaccination series, administering different vaccines at 2, 4 and 6 months. There are vaccines a year, booster doses, especially at school age. In adolescence there are other vaccines, as in adult life.

Vaccination and COVID

The vaccination process was affected with the arrival of SARS-CoV-2 and COVID-19, therefore, the vaccine orders that are dispatched fell; the administration of the vaccines falls by approximately 30% in the months of March, April, and May of the year 2020. For the months of July and August, the process begins to recover and show progress. But this created a delay in coverage of adequately vaccinated children.

Today, the job is to recover this coverage and that infectious diseases do not reach your space.

Parents can collaborate by providing the State with the vaccination card, especially for young children, since, at school age, the staff has a way to notify parents, by the student vaccination law; On the other hand, in young children it could be that they lacked a booster or that they started the vaccine late, so they should be brought up to date.

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The doctor has also participated in the regular vaccination sessions. Photo: Courtesy of VOCES.

Various strategies have been implemented to notify parents, by mail, calls, messages, but parents can provide the card to pediatricians and ask them to verify.

Most vaccines should be covered in series, Cardona points out, in young children the first series is at two, four, six months of age, with boosters six months later, another booster at four years, for vaccines against diphtheria, tetanus and whooping cough.

There are vaccines that, depending on age, can be administered in four doses, or three doses, such as vaccines against pneumococcus and Haemophilus influenzae.

As for live attenuated virus vaccines, these tend to cause longer-lasting immunity, such as the vaccine against common measles, for example, mumps or chickenpox, but two doses are still required to guarantee adequate protection.

In relation to covid-19, many people thought that they would get the vaccine and that’s it, but the specialist recalls that, initially, there was talk of what the primary series was, which consisted of two doses and guaranteed a certain immunity, but “science he is telling us that reinforcements are necessary. We still don’t know when this is going to stop, I don’t think a reinforcement will come every three months forever, but some information will come about the need, probably, to reinforce this periodically, although it is not known how long that periodicity will be, “says the expert .

“At the moment, and in a public health emergency, the best thing we can do is get vaccinated,” adds the doctor.

Cardona emphasizes that: “Vaccines are considered the best prevention tools. We don’t have a vaccine for everything, but we do have vaccines for diseases that affect young children, we have vaccines for a certain group of people who have other diseases that put them at risk, or complications if they get infections like pneumococcus. There are also people who had to have their spleen removed, an organ that is located on their left side, above the stomach and below the ribs, due to an accident, and these people are recommended specific vaccines”.

In addition to this, Cardona concludes with the sentence: “Vaccines save lives. We have to get vaccinated.” The recommendation is to talk about this issue with the family doctor to receive good guidance.

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