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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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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
to boost children’s protection against Hib and MenC infections through their early childhood yearsWhy are these changes being made?
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 ageWhat ispneumococcal disease?
dependent on which part of the body is affected
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 disabilities2Pneumococcal 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
Research shows that longer-term protection against Hib and meningococcal C disease is achieved by modifying the existing programmeEvidence for changes
Prior to MenC (1999/2000)vaccine campaign group C, disease accounted for 40% of cases – now < 10%
High overall fatality rate
Serious sequelae in survivorsMeningococcal infection
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 treatmentMeningococcal disease (cont)
Photo courtesy of CDC
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
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 yearsIntroduction of Men C conjugate vaccine in the UK
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 diseaseEvidence for changes
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 pericarditisFeatures of Hib disease
Courtesy of Children’s Immunization Project, St. Paul, Minnesota
Hib conjugate vaccine introduced into routine routine infant vaccination at 2, 3 and 4 months of age
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 olderIntroduction of Hib conjugate vaccinein the UK
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
Hib disease levels remain low
protection given to children continues well into their childhoodEvidence for changes
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 visitThree injections for infants
World Health Organisation (2004)
2 in 1 leg, PCV in other
DH do not specify which leg
Local decisions - may consider recommending always using the same legOrder of injections given
Risk of hitting radial nerve
Muscle mass not properly developedCan the deltoid be used?
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 interimCan one vaccine be delayed?
(> 2 months but < 8 months of age)
Two doses of PCV two months apart with booster at 13 monthsChildren over 2 months and under 8 months of age at the start of the programme.
A single dose of PCV at 13 months of ageChildren over 8 months of age at the start of the programme.
A single dose of PVCChildren over 12 months of age at the start of the programme.
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 PCVAt-risk children
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 PPVAt-risk children
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 PCVVaccination of children with unknown or incomplete vaccination status
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 2006Supplies
Early 2007 Date to be confirmed - Start catch up programmeWhen will Manchester Introduce the changes?
Will generate appointments for those children to be included in the catch up dependant on age of child and where they will fit into the catch up programme
If you wish to amend your appointments contact Child Health: 958 4090/4099Child health support
The proposed new primary changes will protect babies as early as possible from serious diseases such pneumococcal meningitis.
The proposed booster doses in the second year of life will extend protection against Hib, meningococcal and pnumococcal meningitis further.In Summary
NHS Immunisation website
The ‘Green Book’
Rosemary McCann GMHPU
Judith Moreton and David Salisbury DH
Julie Annakin and Leasa Benson