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Haemophilus influenzae type b

Hib vaccine for younger children – booster campaign 2007 to 2009 Adapted, with permission, for use in Scotland from materials produced by the Department of Health http://www.immunisation.nhs.uk/files/hib_presentation_handouts.pdf. Haemophilus influenzae type b.

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Haemophilus influenzae type b

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  1. Hib vaccine for younger children – booster campaign2007 to 2009Adapted, with permission, for use in Scotland from materials produced by the Department of Healthhttp://www.immunisation.nhs.uk/files/hib_presentation_handouts.pdf .

  2. Haemophilus influenzae type b • Bacterial infection of young children • 60% of invasive cases have meningitis +/- bacteraemia • 5% case fatality rate • 15-30% neurological complications • 10% septicaemia • Pneumonia, septic arthritis, osteomyelitis, pericarditis, cellullitis, epiglotitis

  3. Immunisation & epidemiology • 1992: Hib vaccine introduced → dramatic fall in cases • 1999 start of low level increase in cases → need for booster campaign • 2003: booster campaign for children 6 months to 4 years • September 2006: Introduction of routine booster at 12 months (Hib/MenC)

  4. Cohort being targeted • Children born 4 April 2003 to 3 September 2005 • Children born on or after 4 April 2003 – as they are too young to have had a booster in the 2003 booster campaign • Children born on or before 3 September 2005 - as they are too old to have received the new Hib/MenC booster at 12 months

  5. Rationale • Children being targeted will have lower levels of Hib immunity • Their risk is greater in relative terms than older or younger children who have received a booster • Absolute risk for this cohort is 30 cases across UK • JCVI recommendation

  6. JCVI Feb 2007 • Reviewed incidence of Hib disease in 3-4 year olds and older • More than expected • Fall in children targeted in 2003 booster campaign • But no strong herd effect

  7. Summary of campaign • Starts 5 November 2007; ends 3 March 2009 • For most of the cohort, PSB vaccine will change to product containing Hib • Children who have already had PSB – recall for Hib/MenC • Bring forward timing of routine PSB to 3 years after primary course completed

  8. Rationale for schedule • Adding Hib to PSB avoids extra injections & ensures higher coverage • All children should be offered PSB at age recommended in Green Book because: • It’s best practice • Otherwise youngest children in cohort wouldn’t receive Hib booster until 2010 • The only alternative to delay would be a separate catch-up campaign

  9. A locally phased campaign • Lowering the age for PSB will be phased in • By local agreement as there is variation in the age at which PSB is currently given • Temporary increase in clinic capacity will be needed

  10. Routine • By the end of the campaign it will become routine to call children for PSB at 3 yrs 4 months – 3yrs 6 months • Children who finish primary imms late should have PSB a min of 1 year later

  11. Vaccines to be used: • Hib/MenC for children who have already received PSB • Infanrix-IPV+Hib for the main body of children due their PSB • Pediacel if absolutely necessary

  12. Use of Infanrix-IPV+Hib • Use of Infanrix-IPV+Hib strongly recommended to conserve stocks of Pediacel for primary immunisation • Infanrix-IPV+Hib should not be used for primary immunisation as it has 3 component aP and doesn’t offer the same protection as the 5 component aP in Pediacel

  13. Re “off-label” use: • Infanrix-IPV+Hib SPC states upper age of 36 months • Expert review by JCVI takes precedence • NB Pediacel is frequently used off-label

  14. Infanrix-IPV+Hib • Single dose pack • Pre-filled syringe and vial contained Hib portion as powder • Green + blue needles included

  15. Vaccine supply issues • Infanrix-IPV+Hib, Menitorix & Pediacel should be ordered in the usual way • Local stocks of Repevax and Infanrix IPV should be depleted by 5 November launch

  16. Adverse reactions • aP vaccines less reactogenic than wP, but, booster doses of aP after priming with aP, associated with an increase in local reactions • Reaction usually develop within 24 hours and settle within 5 days – can be mistaken for cellulitis • More of a problem with 5th dose than 4th • Increased local reaction expected with any aP booster • First children primed with aP due for PSB in late 2007

  17. Resources • PGDs – will be updated locally • Leaflets for parents and a Q&A factsheet • Updated Health Scotland website www.healthscotland.com/immunisation/

  18. Children in cohort who may have already had a dose of Hib-containing vaccine over the age of 12 months • See Green Book page 132 • “…one dose of Hib is effective from one year of age…” • Therefore no further Hib booster required

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