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HEALTH

Child mortality rate 1.5 times higher in England than Sweden – and poverty is a key factor, researchers argue

UPDATED: Children born in England are one-and-a-half times more likely to die before they reach the age of five than those born in Sweden, according to a new study published in The Lancet.

Child mortality rate 1.5 times higher in England than Sweden – and poverty is a key factor, researchers argue
This Swedish baby is 52 percent more likely to make it to four years old than one born in England. Photo: Christine Olsson/TT
Researchers from University College London and Sweden's Karolinska Institute found that while 19 out of 10,000 children born in Sweden between 2003 and 2012 died, in England the figure was 29 out of 10,000. They investigated children between the ages of two days old and four years old.
 
Around 77 percent of the difference came down to low birth weight, premature birth and congenital defects, such as heart problems, which were far more common in the UK.
 
According to Anders Hjern, a professor at Karolinska who helped carry out the study, this was largely because English mothers were more likely to be poor. 
 
“Some people say we should blame Margaret Thatcher for this, because she took away much of the welfare state that there was, so poor families in the UK have a much tougher situation than Sweden,” Hjern told The Local. 
 
In 2003-2005, the most deprived 20 percent of the UK's population had a seven-fold lower income than the least deprived 20 percent, while the gap in Sweden was only four times lower.
 
“The main message from our study is actually that it’s not the NHS,” Hjern said. “This study shows that the main explanations for the differences in child mortality rates between England and Sweden are systemic.” 
 
In a statement he said: “The key factors here are likely to include Sweden's broader welfare programmes that have provided families with an economic safety net for over 50 years, the free and accessible educational system, including early child care, and public health policies for many lifestyle issues such as obesity, smoking and alcohol use.”
 
 
“Being poor brings chronic stress,” Hjern told Sweden's TT newswire. “There's a lot of interesting research on how that sort of stress affects a pregnant woman.” 
 
“In addition, older children in Sweden go to kindergarten,” he added. “That's not nearly as common in England. It's much more common for the children of poor people to stay home with their unemployed mothers instead.” 
 
The lead author Dr Ania Zylbersztejn, from UCL Great Ormond Street Institute of Child Health, said that the best route to reducing infant mortality would be fight social disadvantage more broadly, and also to work to improve the health of mothers before and during pregnancy. 
 
“Families need to be better supported before and during pregnancy to improve maternal health, and in turn to give all children a healthy start in life,” she said. 
 

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HEALTH

Who should get vaccinated against TBE in Sweden?

Tick-borne encephalitis (TBE) has more than doubled in Sweden in the past decade. Who should get vaccinated against it and how much does it cost?

Who should get vaccinated against TBE in Sweden?

TBE, or Tick-borne encephalitis, is one of the two main tick-borne diseases in Sweden (Lyme disease is the other one).

It is a viral brain infection, which can cause a range of symptoms, usually starting with typical flu-like symptoms and then developing to include nausea, dizziness, and in around a third of cases, severe problems.

Symptoms usually appear around a week after the bite, but can take longer. There is no cure, but it can be treated, and there is a vaccination too.

The tick season tends to last from March to November, peaking in April to mid-June. According to the Public Health Agency, most TBE cases however tend to be recorded during the summer, as that’s the period when people spend the most time outdoors.

TBE is relatively rare, but has been on a fairly steady increase in Sweden in the past decade, from 178 confirmed cases in 2014 (or an incidence rate of 1.83 per 100,000 people) to 595 cases in 2023 (incidence rate 5.64), according to the Public Health Agency’s statistics.

Who should get vaccinated?

Because the infection can in a few cases lead to serious consequences, anyone who lives in an area where there’s a high concentration of ticks carrying TBE is recommended to get vaccinated.

That includes people who live there permanently and who have temporary summer homes, as well as people who spend a lot of time outdoors in these areas, but there’s no strict cut-off point.

Not all ticks carry TBE, and they have historically been concentrated in southern parts of Sweden and the Stockholm archipelago, but have been spreading across the country in recent years.

The regions that recorded the most number of cases last year were Stockholm (160, or an incidence rate of 6.52 per 100,000 people), Västra Götaland (121, or 6.85), Södermanland (55, or 18.22), Uppsala (52, or 12.85), Västmanland (33, or 11.75) and Värmland (31, or 10.93).

The only region that didn’t record a single case of TBE in 2023 was Gotland. Jämtland, Västerbotten and Västernorrland recorded one case each, and Norrbotten two cases.

You may want to contact your regional health services for specific information. Skåne, for example, only recorded 21 cases last year (an incidence rate of 1.48), but TBE is more common in certain parts of the region than others, and the region recommends that people living in these parts get vaccinated – there’s more information to be found on the region’s TBE vaccine page.

You can of course also get vaccinated even if you don’t live in a high-risk area, especially if you spend a lot of time in the forest or tall grass.

How can I get vaccinated?

You can search for healthcare centres near you through 1177.se or the website Fästing.nu (fästing is the Swedish word for tick – don’t confuse it with fästning, a fortress). To view regional information on 1177, go to the top of the page and click välj region (choose region).

The vaccine is not part of Sweden’s national vaccination programme, so you have to pay for it.

In Östergötland, the vaccine is subsidised by the region, so each dose of the initial three doses costs 200 kronor for adults. In a lot of other regions, including Stockholm, it costs around 400 kronor.

Only Sörmland, Uppsala, Västmanland, Östergötland and Jönköping offer the vaccine for free to children and teenagers, at least the basic vaccination schedule of the initial three doses.

How does the vaccine work?

You start with three doses (or four if you’re over 50), usually the first two within the space of one to three months and the third dose ahead of the next season, no more than a year after the second dose.

Each of these doses increases your level of protection, but because you need several to be fully protected, it’s recommended that you begin the vaccination programme well ahead of tick season.

You then get a fourth (or fifth if you’re over 50) top-up dose after three years, and will need top-ups every five years.

Children under the age of 15 are recommended to get the second dose one month after the first dose, then the third dose after 5-12 months. After that they follow the same schedule as adults, so a fourth dose after three years followed by top-ups every five years.

People with an impaired immune system due to underlying health issues are recommended to follow the same schedule as over-50s. They may not be able to reach a full level of defence against TBE, but the vaccine will offer enough protection that they are still recommended to get it.

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