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Important changes to the childhood immunisation programme

Important changes to the childhood immunisation programme. The addition of a pneumococcal conjugate vaccine (PCV) at 2, 4 and 13 months of age; A dose of MenC vaccine at 3 and 4 months; A booster dose of Hib and MenC vaccine (given as a combined Hib/MenC vaccine) at 12 months of age.

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Important changes to the childhood immunisation programme

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  1. Important changes to the childhood immunisation programme

  2. The addition of a pneumococcal conjugate vaccine (PCV) at 2, 4 and 13 months of age; A dose of MenC vaccine at 3 and 4 months; A booster dose of Hib and MenC vaccine (given as a combined Hib/MenC vaccine) at 12 months of age. Changes from 4th September 2006

  3. The childhood immunisation schedule

  4. to protect children < 2 years of age who are at increased risk of pneumococcal disease to boost children’s protection against Hib and MenC infections through their early childhood years Why are these changes being made?

  5. Facts about pneumococcal disease

  6. Describes infections caused by the bacterium S.pneumoniae Over 90 serotypes identified 20 – 30 serotypes responsible for majority of disease 7 serotypes responsible for 82% of disease in children under 5 years of age What ispneumococcal disease?

  7. Major cause of serious disease: meningitis, septicaemia and severe pneumonia (invasive pneumococcal disease - IPD) Less serious, but commoner diseases: otitis media, milder pneumonia and bronchitis (non invasive) Pneumococcal infection

  8. Severity of disease dependent on which part of the body is affected

  9. http://www.hpa.org.uk/infections/topics_az/pneumococcal/pneumo_powerpoint_2006.ppt#366,4,Slide 4

  10. Most common in: the very young – babies and children under 2 years of age the very old – over 65 years of age younger age groups with concurrent medical conditions Pneumococcal infection

  11. Invasive pneumococcal disease rates by age per 100,000 population per year

  12. 5000 cases of invasive pneumococcal disease (IPD) per year 530 children IPD < 2 years (England & Wales) Around 50 children < 2yrs die from IPD per yr1 2 thirds from pneumococcal meningitis 50% who survive pneumococcal meningitis have disabilities2 Pneumococcal infection 1. IspahaniP, Slack RC, Donald FE, et al (2004) Twenty-year surveillance of invasive pneumococcal disease in Nottingham: serogroups responsible and implication for immunisation. Arch Dis Child 89: 757-62 2. Bedford H, de Louvois J, Halket et al (2001) Meningitis in infancy in England and Wales: follow-up at 5 years. BMJ 323: 533-6

  13. Why change the Hib and MenC immunisation schedule?

  14. Regular reviews of immunisation programmes to ensure all children have the best possible protection against preventable diseases Research shows that longer-term protection against Hib and meningococcal C disease is achieved by modifying the existing programme Evidence for changes

  15. Meningococcal Disease

  16. Serogroups:B and C account for majority of disease in the UKA, W135, Y, 29E and Z in other countries Prior to MenC (1999/2000)vaccine campaign group C, disease accounted for 40% of cases – now < 10% High overall fatality rate Serious sequelae in survivors Meningococcal infection

  17. Most common presentation of meningococcal disease is meningitis and septicaemia Disease onset is sudden 1 in 8 people who recover are left with long term complications Case fatality rate is high but varies with age, serogroup, clinical presentation and prompt treatment Meningococcal disease (cont)

  18. Symptoms of Meningitis or Septicaemia • Rash • Fever/ Vomiting • Cold hands and feet • Rapid breathing • Joint/ stomach/ muscle ache • Drowsiness/ LOC • Stiff neck • Dislike of bright lights Photo courtesy of CDC

  19. Throughout the last 80 years irregular upsurges of meningococcal disease have occurred Historically approximately 60-70% of all meningococcal infections were serogroup B In 1998/99 a significant increase in incidence of group C disease was noted in infants, teenagers and young adults. Meningococcal C disease in England and Wales

  20. Development and evaluation of MenC vaccine accelerated in response to increase in disease Phased introduction between November 1999 to September 2000 Routine immunisation of infants (with DTP-Hib) Catch-up for all under 18 years targeting of the vaccine supplies against the highest risk groups given with other routine vaccines where possible Since 2002 inclusion of all under 25 years Introduction of Men C conjugate vaccine in the UK

  21. Studies show two doses of MenC in the first year of life provides the same level of protection as three doses No additional or increased protection from giving three doses of MenC in the first year of life An additional dose in the second year of life gives longer-term protection against meningococcal C disease Evidence for changes

  22. Hib Disease

  23. Most common presentation of invasive Hib is meningitis, frequently accompanied by bacteraemia (60%) 15% of cases present with epiglottitis Septicaemia without any other concomitant infection, occurs in 10% of cases Remainder made up of cases of septic arthritis, osteomyelitis, cellulitis, pneumonia, and pericarditis Features of Hib disease

  24. Complications of Hib meningitis • Deafness • Convulsions • Intellectual impairment • Case fatality rate 2-5% in spite of effective antimicrobial therapy Courtesy of Children’s Immunization Project, St. Paul, Minnesota

  25. Before 1992: 1 child in 600 developed some form of Hib disease by 5th birthday Hib Meningitis caused 30 deaths each year Approximately 80 children a year were left with deafness or permanent brain damage Hib disease in England and Wales

  26. Pure polysaccharide vaccines (1985-1989) not effective in infants under 18 months in whom risk of disease was highest October 1992 Hib conjugate vaccine introduced into routine routine infant vaccination at 2, 3 and 4 months of age October 1992-1993 Catch-up vaccination offered to all children under four years of age Three doses under 13 months of age One dose for 13 months and older Introduction of Hib conjugate vaccinein the UK

  27. Invasive Hib disease

  28. Short term exacerbation of the problem related to lower efficacy vaccine Infanrix-Hib used in response to vaccine shortage Accelerated schedule without booster 1993 Catch-up programme contributed to control of Hib Effect was probably temporary Protection from infant vaccination declines rapidly Efficacy of vaccine higher when given over age of 1 year Action in response: Booster programme for children aged 6 months – 4 years (2003) Reasons for increase

  29. Studies show an additional booster dose of Hib vaccine is needed in the second year of life to ensure that: Hib disease levels remain low protection given to children continues well into their childhood Evidence for changes

  30. No additional visits in the first year of life Infants will be offered different combinations of vaccines at the 2, 3 and 4 month visits Three injections will be offered to infants at 4 months of age A new 12 month vaccination visit will be introduced What do the changes mean?

  31. It’s been done before during the Hib booster campaign 2003 Infant anterolateral thigh can accommodate two injections along the length of the thigh At least 2.5cms (1 inch) apart so that reactions don’t overlap Record which vaccine was injected at which point on limb Common practice in United States where e.g. DTaP, Hep B, Hib and PCV may all be given in same visit Three injections for infants

  32. Simultaneous administration DTaP/IPV/Hib PCV MenC World Health Organisation (2004)

  33. To allow any localised reaction to be easily linked to the particular vaccine Why keep PCV separate?

  34. Prepare all 3 injections immediately prior to immunising 2 in 1 leg, PCV in other DH do not specify which leg Local decisions - may consider recommending always using the same leg Order of injections given

  35. It is not recommended that immunisations be given in the arm of infants under one year of age because: Risk of hitting radial nerve Muscle mass not properly developed Can the deltoid be used?

  36. DH recommends all three vaccines be given at the same time to ensure children are fully protected from serious disease as early as possible Parents have the right to refuse one or all injections HCW should never recommend delaying Could leave HCW open to criticism if relevant vaccine preventable infection occurred in the interim Can one vaccine be delayed?

  37. A single dose of Hib/MenC No catch-up for Hib/MenC booster Cannot be administered (at the moment) with PCV & MMR at 13 months as no data to show compatibility 12 month visit

  38. 1st MMR and booster PCV Cannot be administered (at the moment) with combined Hib/MenC vaccine as no data to show compatibility PCV catch-up for all children aged > 2 months and < 2 years of age 13 month visit

  39. Pneumococcal catch-up programme

  40. Children born 04.02.06 - 03.07.06 (> 2 months but < 8 months of age) Two doses of PCV two months apart with booster at 13 months Children over 2 months and under 8 months of age at the start of the programme.

  41. Children born 04.08.05 - 03.02.06 (8 months – 13 months of age) A single dose of PCV at 13 months of age Children over 8 months of age at the start of the programme.

  42. Children born 05.09.04-03.08.05 (> 13 months - < 2 years of age) A single dose of PVC Children over 12 months of age at the start of the programme.

  43. Asplenia or dysfunction of the spleen Chronic respiratory disease Chronic heart disease Chronic renal disease Chronic liver disease Diabetes Immunosuppression Cochlear implants CSF leaks < 5s with previous history of invasive disease At-risk children

  44. It is important that at-risk children of any age up to 5 years receive a complete course of PCV vaccination as soon as possible (regardless of catch-up scheduling) At-risk children

  45. PCV routinely at 2, 4 and 13 months of age At-risk children < 12 months of age2 doses of PCV (one month apart if necessary) before 12 months and one at 13 months of age At-risk children > 12 months and < 5 years of age should be offered a single dose of PCV All at-risk children should be offered a single dose of pneumococcal polysaccharide vaccine (PPV) when they are two years of age or over and at least 2 months after the final dose of PCV At-risk children

  46. Children aged 2 months and under 5 years of age with asplenia, splenic dysfunction or who are immunocompromised, require a second dose 2 months after the first dose as they may have a sub-optimal immunological response to the first dose of vaccine All children > 5 years with previous history of IPD should have PCV irrespective of previous vaccination history At-risk children presenting for first pneumococcal immunisation aged 5 years and over should be offered a single dose of PPV At-risk children

  47. Following completion of the catch-up programme, children who have not completed the routine programme require: Children < 12 months of age 2 doses of PCV, 2 months apart and further dose at 13 months of age Children > 12 months and < 2 years of age should be offered a single dose of PCV Vaccination of children with unknown or incomplete vaccination status

  48. Week commencing 7th and 14th August 2006first allocated delivery of two week supply on usual delivery date Week commencing 21st and 28th Augustno deliveries Week commencing 4th September 2006 – campaign starts Week commencing 4th and 11th September 2006second allocated delivery of two week supply “Free” ordering from midday 13th September 2006 Supplies

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