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