Slide 1

Changes to the infant

pneumococcal conjugate vaccine

schedule April 2020

Information for registered healthcare

practitioners

Slide 2

NHS Education for Scotland

• The UK pneumococcal conjugate vaccine (PCV) immunisation programme has successfully achieved high levels of population (herd) protection for all age groups

• Currently, circulation of the 13 pneumococcal serotypes contained in the vaccine, and therefore, the risk of disease due to these serotypes, is very low in the UK

• The PCV13 immunisation schedule has therefore been changed as follows from 6th April 2020:➢ Children unvaccinated with PCV will follow a 1+1 schedule,

with the first PCV dose at age 12 weeks➢ Children who have already received one PCV dose will continue on the

2+1 schedule, receiving a second dose and then the booster

• The 1+1 schedule should continue to provide individual protection and maintain population protection against pneumococcal disease

Key Messages

Pneumococcal: The Green Book Chapter 25, https://www.gov.uk/government/publications/pneumococcal-the-green-book-chapter-25

Slide 3

NHS Education for Scotland

To ensure that all immunisers involved in the pneumococcal conjugate vaccination programme are aware of changes to the schedule in Scotland due to take place from 6th April 2020

Aim of Resource

Slide 4

NHS Education for Scotland

• Describe the benefits of the childhood PCV programme

• Discuss the rationale for changes to the programme

• Describe the new PCV13 schedule from 6th April 2020 in Scotland

Learning Outcomes

Slide 5

NHS Education for Scotland

• The routine childhoodPCV programme was introduced in 2006, initially using a 7-valent vaccine (PCV7), this was replaced with a 13-valent vaccine (PCV13) in 2010

• PCV13 has proven to be effective and there has been a high uptake of the vaccine for a number of years (>90%)

• This is a highly successful programme with large and sustained decreases in pneumococcal disease due to the 13 vaccine serotypes across the population and especially in young children

• Multiple doses of PCV13 are considered to no longer be required in the childhood immunisation programme, given low rates of carriage or disease due to the PCV13 serotypes

• Following a detailed review of epidemiological modelling, coverage data and a stakeholder consultation, the JCVI has agreed that a move from the current 2+1 schedule (8w, 16w, 1y) to a 1+1 schedule (12w, 1y) is appropriate for the UK situation1

Rationale for Change to Schedule

1. Joint Committee on Vaccination and Immunisation (JCVI). Minutes of the meeting on 06 June 2018. Available at:

www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation#minutes

Slide 6

NHS Education for Scotland

• A 12-week dose will provide infants with some protection against pneumococcal infection and will prime their immune system for a good response to booster dose given at 1y of age

• The booster dose is particularly important, not only for individual protection, but also in preventing carriage of pneumococcal bacteria in nasopharynx and passing bacteria on to others

• Interruption of transmission is vital to sustaining high levels of herd protection for unvaccinated susceptible individuals achieved to date in the UK

Rationale for Change to Schedule Cont’d

Slide 7

NHS Education for Scotland

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Number of invasive pneumococcal disease cases caused by PCV13 serotypes, Scotland 2002-2018

Data courtesy of HPS: This graph shows the reduction in invasive pneumococcal disease cases caused by PCV 13 serotypes in Scotland between 2002 and 2018 in all ages.

Slide 8

NHS Education for Scotland

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Number of invasive pneumococcal disease cases in children aged under 5 years caused by PCV13 serotypes, Scotland 2003-2018

Data courtesy of HPS: This graph shows the reduction over time of the number of invasive disease cases in children aged under 5yrs caused by PCV 13 serotypes in Scotland between 2003 and 2018

Slide 9

NHS Education for Scotland

• The change in recommendation is supported by several studies, including a clinical trial comparing the immunogenicity of the 2+1 and 1+1 schedules

• Moving to 1+1 schedule provides: ➢opportunity to reduce the number of vaccines

administered at immunisation appointments

➢space in the vaccine schedule should any new vaccines need to be introduced in the future

Changes to the PCV 13 Vaccine Schedule

Goldblatt D, Southern J, Andrews N et al. Pneumococcal conjugate vaccine 13 delivered as one primary and one booster dose (1 + 1) compared with two primary doses and a booster (2 + 1) in UK infants: a multicentre, parallel group randomised controlled trial. The Lancet Infectious Diseases, February 2018; 18(2): 171-179 Choi YH, Andrews N, Miller E Estimated impact of revising the 13-valent pneumococcal conjugate vaccine schedule from 2+1 to 1+1 in England and Wales: A modelling study. PLoS Med. 2019 Jul 3;16(7):e1002845. doi: 10.1371/journal.pmed.1002845. eCollection 2019 Jul. Jayasinghe, S. Menzies, R. Chiu, C. Toms, C. Blyth, C. C. Krause, V. McIntyre, P. Long-term Impact of a “3 + 0” Schedule for 7- and 13-Valent Pneumococcal Conjugate Vaccines on Invasive Pneumococcal Disease in Australia, 2002–2014, Clinical Infectious Diseases, Volume 64, Issue 2, 15 January 2017, Pages 175

Slide 10

NHS Education for Scotland

Children and adults in at-risk groups as outlined in table 25.2 of the pneumococcal chapter of the Green Book may require additional pneumococcal vaccination depending on their age at presentation (diagnosis), vaccination status and underlying condition (see summary at table 25.3 of the pneumococcal chapter of the Green Book).

Risk Groups

Green Book chapter 25 can be found at the following link: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/857267/GB_Chapter_25_pneumococcal_January_2020.pdf

Slide 11

NHS Education for Scotland

Prevenar 13® will continue to be used, the change is to the schedule only

Infant Pneumococcal Conjugate Vaccine

Image courtesy of Pfizer

Slide 12

NHS Education for Scotland

• Pneumococcal: Green Book Chapter 25

• PGD

• NES

• NHS Inform

Further Information and Resources

Slide 13

NHS Education for Scotland

• The UK pneumococcal conjugate vaccine (PCV) immunisation programme has successfully achieved high levels of population (herd) protection for all age groups

• Currently, circulation of the 13 pneumococcal serotypes contained in the vaccine, and therefore, the risk of disease due to these serotypes, is very low in the UK

• The PCV13 immunisation schedule has therefore been changed as follows from 6th April 2020:➢ Infants unvaccinated with PCV will follow a 1+1 schedule,

with the first PCV dose at age 12 weeks➢ Infants who have already received one PCV dose will continue on the

2+1 schedule, receiving a second dose and then the booster

• The 1+1 schedule should continue to provide individual protection and maintain population protection against pneumococcal disease

Key Messages

Green Book chapter 25 can be found at the following link: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/857267/GB_Chapter_25_pneumococcal_January_2020.pdf

Slide 14