childhood immunisations: schedule changes and challenges
DESCRIPTION
Sarah Lang, Immunisation Advisor, Oxford Vaccine Group and Public Health England @ the Meningitis Research Foundation Symposium 2013TRANSCRIPT
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
Schedule changes
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Challenges
• Details of changes
• Rationale
Changes in 2013
Vaccine Advice for CliniCians Service
UK mechanisms for making and implementing of vaccination policy
Recommendations for vaccine policyJoint Committee on Vaccination and Immunisation (JCVI)
Vaccine policy decisionsDepartment of Health (DH)
Licensing of vaccineMedicines and Healthcare products Regulatory Agency
Purchase of vaccineDepartment of Health from pharmaceutical companies
Control of vaccine (including batch release)National Institute for Biological Standards and Control
CHALLENGES
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COMMUNICATION
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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."
Health Care Professionals
• Understanding schedule changes
• Education & training
• Communicating with parents and carers
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https://www.gov.uk/government/organisations/public-health-england/series/immunisation
Vaccine Advice for CliniCians Service
http://www.nhs.uk/Planners/vaccinations/Pages/aboutvaccinationhub.aspx
Vaccine Advice for CliniCians Service
http://www.ovg.ox.ac.uk/vaccine-knowledge-home
PROGRAMME CHANGES
1990s
Number of confirmed cases of Men C disease 1998/99
Men C vaccine: conjugate vaccine
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Source: Immunization you call the shots http://www2.cdc.gov/nip/isd/ycts/mod1/courses/genrec/10351.asp?seg=F
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
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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 http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1234859709051?p=1201094595391
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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
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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
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% children/ adolescents with ‘protective’ levels of bactericidal antibodies against MenC in 2013
Reference: Pollard, Green, Snape: Arch Dis Child 2013
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
ROTAVIRUS
Epidemiology of rotavirus in England and Wales – who is most at risk?
The infant rotavirus vaccination programme
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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
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
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• 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
Vaccination issues
• Live attenuated vaccine
• Oral administration
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Administration of Rotarix®
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
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
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Paediatric flu vaccine programme
• Full programme details to come
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The relative efficacy of trivalent live attenuated and inactivated influenza vaccines in children and adults
Influenza and Other Respiratory VirusesVolume 5, Issue 2, pages 67-75, 19 NOV 2010 DOI: 10.1111/j.1750-2659.2010.00183.xhttp://onlinelibrary.wiley.com/doi/10.1111/j.1750-2659.2010.00183.x/full#f1
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: http://webarchive.nationalarchives.gov.uk/20120907090205/https://www.wp.dh.gov.uk/transparency/files/2012/05/JCVI_draft-mintues-13-April-2012.pdf
SCHEDULE CHANGES
Will continue
CHALLENGES
Can be overcome