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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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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
  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