Childhood immunisations: schedule changes and challenges


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Sarah Lang, Immunisation Advisor, Oxford Vaccine Group and Public Health England @ the Meningitis Research Foundation Symposium 2013

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  • No one mentioned this but the NHS re-organisation is a challenge: briefly say why.People are working really hard to build new networks and collaborations to ensure that immunisation programmes continue to be delivered to achieve high coverage and quality.
  • How are changes communicatedHCP: rely on official information from DH via Immunisation letters, Vaccine update or Online Green Book chapters being udpated but more often than not the media get there first.
  • Media published this last JulyPeople are already then thinking about what they feel about this.Note the comments
  • Some of the 511 comments
  • Mention translation options here
  • The above figures shows that meningococcal disease caused by serogroup C has fallen by 95% since the introduction of the MenC vaccination programme.
  • This chart summarises laboratory confirmed cases of meningococcal disease in England and Wales since 1998/99 and only includes cases of invasive disease.There has been a general decline in the numbers of invasive cases confirmed since 2000, with cases due to Neisseriameningitidis Group C becoming increasingly rare. In England and Wales as a whole during the 2011/12 epidemiological year, 80.2% of invasive cases confirmed by the Manchester Reference Unit (MRU) were due to Neisseriameningitidis Group B and only 3.8% were due to Group C. This is in contrast to 1998/99 when 50.5% of invasive cases were due to Neisseriameningitidis Group B and 34.4% were due to Group C.Welsh dataDuring the 2011/12 epidemiological year there were 34 invasive cases of meningococcal disease in Wales confirmed by the MRU, 76.5% of these were due to Neisseriameningitidis Group B and the remaining cases were caused by capsular groups W135 or Y, none were caused by Neisseriameningitidis Group C.
  • Authors estimate that around 10% of individuals aged 2-18 yrs have protective level of Men C antibodyChildren immunised over the age of 6 years seem to have longer lasting immunity and there is an older cohort of children/young adults who are protected and protecting via herd immunity. But the younger cohorts coming through are vulnerable as they head to adolsecence.Adolsecent boosters: eviednec of high levels of SBA which are sustained.
  • In view of this the JCVI have advised that an adolescent dose of serogroup C meningococcal conjugate vaccine (MenC) be introduced and a dose of MenC vaccine in infants be removed. freshers(temporary catch up for new starters at university setting under 25 years commencing in 2014) are also being offered another dose of MenC vaccine because of an increased risk of disease and sub-optimal protection from vaccination under 10 years of ageFollowing a study that showed a single priming dose in infancy at three months of age would be sufficient to prime infants against meningococcal serogroup C disease, and provide protection for the first year of life.22 JCVI has recommended that the second priming dose at 4 months of age be removed from the routine schedule. Recently published studies show that vaccination against meningococcal serogroup C disease in early childhood provides a short-term protective immune response.23-25 Vaccination later in childhood provides higher levels of antibody that persist for longer.26New starters to university (freshers) (defined as 24yrs and 364 days.) who live in halls of residence have elevated risk of meningococcal disease compared to other college students.16,17
  • Explain what rotavirus is: virus, causinggastronenteritis younger your are the more severe it can be. 5 main strains, very infectious and can exist in the environment for prolonged periods of time. Very seasonal infectio Jan - March
  • This graph shows the age of the laboratory confirmed cases of rotavirus in England and Wales between 2000 and 2012. Most of these occurred in children under 5 years of age and about two thirds of these were in children less than 2 years old.  
  • Rotavirus vaccine has been shown to be very effective in protecting against the most common strains of rotavirus and severe rotavirus infection (infection resulting in hospitalisation). Rotavirus vaccine will not prevent diarrhoea or vomiting caused by other pathogens. The vaccine is over 85% effective at protecting against severe rotavirus gastroenteritis in the first two years of life (more details of the vaccine efficacy from the clinical trails are available in the Rotarix® SPC13).Rotavirus vaccines, including the Rotarix® vaccine which will be used in the UK, are already used to routinely vaccinate children in the USA and many other countries. In the USA, studies have shown that rotavirus-related hospital admissions for young children have been cut by more than two thirds since rotavirus vaccination was introduced14. A study has estimated that vaccinating a birth cohort of infants in England and Wales may prevent around 90,000 infections and 10,000 hospitalisations and around two deaths due to rotavirus in that cohort over the first five years of life15. It may also provide some additional protection to the wider population through herd immunity16
  • Immunosupressed,contradinidications, precautions.
  • Remove the protective tip cap from the oral applicator  The child should be seated in a reclining position.  Administer orally i.e. into the child’s mouth, towards the inner cheek, the entire content of the oral applicator.  Do not inject the content, this is an oral vaccine If the infants spits out or regurgitates most of the vaccine, a single replacement dose may be given at the same vaccination visit.  There are no restrictions on infant’s feeding before or after vaccination.  Based on evidence generated in clinical trials, breast-feeding does not reduce the protection against rotavirus gastroenteritis afforded by Rotarix®. Therefore, breast-feeding may be continued during the vaccination schedule13.
  • Intussusception is a naturally-occurring condition, with a background annual incidence of around 120 cases per 100,000 children aged under one year.  Intussusception occurs when a section of the bowel folds in on itself, like a telescope closing, typically at the junction of the ileum and the colon. The usual symptoms are episodes of pain, pallor and vomiting. It can lead to disruption of the blood supply to the bowel and can lead to perforation and gangrene.  Research from some countries suggests that Rotarix® may be associated with a very small increased risk of intussusception within seven days of vaccination, possibly 2 cases per 100,000 first doses given. The benefits of vaccination in preventing the consequences of rotavirus infection outweigh this small potential risk in young children. Because of the potential risk, and to reduce the likelihood of a temporal association with rotavirus vaccine, the first dose of vaccine should not be given after 15 weeks of age18. Parents should be advised that if the infant develops severe vomiting, abdominal pain and pass what looks like redcurrent jelly in their stools they should contact their doctor immediately.
  • Childhood immunisations: schedule changes and challenges

    1. 1. Childhood immunisations: schedule changes and challenges Sarah Lang, Immunisation Advisor, Thames Valley PHE centre & Oxford Vaccine Group Meningitis Research Foundation Symposium 3rd July, 2013 Acknowledgements: some slides have been reproduced from the PHE training slides and Karen Ford at Oxford Vaccine Group
    2. 2. Schedule changes VACCSline Challenges • Details of changes • Rationale
    3. 3. Changes in 2013 Vaccine Advice for CliniCians Service
    4. 4. UK mechanisms for making and implementing of vaccination policy Recommendations for vaccine policy Joint Committee on Vaccination and Immunisation (JCVI) Vaccine policy decisions Department of Health (DH) Licensing of vaccine Medicines and Healthcare products Regulatory Agency Purchase of vaccine Department of Health from pharmaceutical companies Control of vaccine (including batch release) National Institute for Biological Standards and Control
    5. 5. CHALLENGES
    6. 6. VACCSline
    8. 8. VACCSline
    9. 9. VACCSline Young children's immune systems are already 'overloaded' with the volume of vaccines now being given, their own 'natural immunity' towards flu, and childhood illnesses is extremely low. I agree with xxxx why do we suffer with as many allergies now? Especially peanut! Just follow the money. Another scam "The medical authorities keep lying. Vaccination has been a disaster on the immune system. It actually causes a lot of illnesses. We are changing our genetic code through vaccination."
    10. 10. Health Care Professionals • Understanding schedule changes • Education & training • Communicating with parents and carers VACCSline
    11. 11. health-england/series/immunisation
    12. 12. Vaccine Advice for CliniCians Service
    13. 13. Vaccine Advice for CliniCians Service
    15. 15. 1990s Number of confirmed cases of Men C disease 1998/99
    16. 16. Men C vaccine: conjugate vaccine VACCSline Source: Immunization you call the shots
    17. 17. Men C vaccine history 1999: • All <18 yrs were offered MenC vaccine • Men C introduced to infant schedule @ 2,3& 4 months 2002: • Extended to 20-24 year olds VACCSline
    18. 18. Impact of MenC vaccination programme Number of laboratory confirmed serogroup C cases in England and Wales, 1998-2010 Source: Public Health England, Infectious Disease Epidemiological Data 18
    19. 19. Meningococcal disease cases by group and epidemiological year in England and Wales Source: Public Health England, Meningococcal Reference Unit, Invasive meningococcal infections laboratory reports, England and Wales, as at 14/09/2012 19
    20. 20. Men C vaccine history 1999: • All <18 yrs were offered MenC vaccine • Men C introduced to infant schedule @ 2,3& 4 months 2002: • Extended to 20-24 year olds Sept 2006: • 12 mth booster introduced • Infant schedule one dose removed, now given @ 3 & 4 mths VACCSline
    21. 21. VACCSline % children/ adolescents with ‘protective’ levels of bactericidal antibodies against MenC in 2013 Reference: Pollard, Green, Snape: Arch Dis Child 2013
    22. 22. Changes to the MenC vaccination schedule? Single dose in infancy = protection until 12/13 mth booster Individual protection wanes in younger children Adolescent booster: individual and herd immunity Temporary catch up: “freshers” <25yrs of age
    23. 23. ROTAVIRUS
    24. 24. Epidemiology of rotavirus in England and Wales – who is most at risk? The infant rotavirus vaccination programme 24 Numbers of laboratory confirmed cases of rotavirus infection in E&W July 2000-June 2012 In England and Wales estimated • 130 000 episodes of rotavirus per year • 12 700 children hospitalised • ? Deaths Rotavirus detected in • 51.1% of children under 5 with gastroenteritis • 23.2% of children with no symptoms
    25. 25. Why vaccinate against rotavirus? • Very effective at protecting against the most common strains of rotavirus • Very effective in protecting against severe rotavirus infection requiring hospitalisation The infant rotavirus vaccination programme 25
    26. 26. • 71% decline in rotavirus- coded hospital admissions in children – (261/100 000 to 75/100 000) • 38% decline in non-rotavirus coded gastroenteritis admissions • Represented 7700 fewer admissions in 2009 – 2010 • Reductions also observed in 5 to 19 year olds. The Australian experience Dey et al Med J Aust 2012
    27. 27. Vaccination issues • Live attenuated vaccine • Oral administration VACCSline
    28. 28. Administration of Rotarix®
    29. 29. Intussusception • A naturally occurring condition of the intestines • Research from some countries suggests that Rotarix® may be associated with a very small increased risk of intussusception • Even with this small potential risk, the benefits of vaccination in preventing the consequences of rotavirus infection outweigh any possible side effects The infant rotavirus vaccination programme
    30. 30. Strict guidance on timelines Dose 1: Between 6 weeks & 14 weeks 6 days Dose 2: 4 weeks after dose 1 aim to complete by 16 weeks of age max age limit 24 weeks VACCSline
    31. 31. Paediatric flu vaccine programme • Full programme details to come VACCSline
    32. 32. The relative efficacy of trivalent live attenuated and inactivated influenza vaccines in children and adults Influenza and Other Respiratory Viruses Volume 5, Issue 2, pages 67-75, 19 NOV 2010 DOI: 10.1111/j.1750-2659.2010.00183.x
    33. 33. Children’s flu programme • Benefit to children and wider population • Attitudinal research indicates lack of understanding around influenza: recommended an education programme for parents & children JCVI minutes: es/2012/05/JCVI_draft-mintues-13-April-2012.pdf
    34. 34. Will continue Can be overcome
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