Modifying the childhood immunisation schedule

Transcription

1 Modifying the childhood immunisation schedule With thanks to Dr. Marilyn Lansley for allowing adaptation and use of her presentations Vaccine Advice for CliniCians Service

2 Objectives Understand the flexibility of the schedule Modify the schedule for individuals with incomplete or unknown immunisation status Identify local and national resources to help

3 Current routine schedule At birth: (if required) Hep B (and then at 4 and 8 weeks), BCG (if required) At 2 months: dip, tet, pert, hib, po & pneumococcal At 3 months: dip, tet, pert, hib, po & Men C At 4 months: dip, tet, pert, hib, po + pneumococcal + Men C At months: Hib/Men C + MMR + pneumococcal + hep B (if required) Pre-school: Dip, tet, po, pert + MMR + hep B (if required) School year 8: HPV x 3 (girls aged years) School year 10: Dip, tet, po

4 Why does the schedule look like this? Factors taken into account: Age: Vaccines need to be given as early in life as possible so children are protected when at highest risk of complications from the diseases eg Men C, hib, pneumococcal Vaccines are recommended for the youngest age group at risk of experiencing the disease for whom the vaccine s efficacy and safety have been demonstrated They must be avoided when there is potential interference with the immune response by passively transferred maternal antibody : MMR interval spacing needed between doses of the vaccine compatibility with other vaccines given at same time whether the vaccine can be combined with another number of doses that need to be given for protective response to be made whether booster doses are needed and if so, when and how many

5 The schedule is not set in stone

6 How flexible is the schedule? Can we change the age at which a course is started? Can we change the gap between the doses of a course? What about leaving gaps between different vaccines?

7 Can we change the age at which a course is started? Can we start early? Yes, if necessary The first set of primary immunisations can be safely and effectively given from age 6 weeks if necessary e.g. for travel BUT giving primary vaccinations before 6 weeks of age is not recommended routinely as the immune response may be suboptimal - If started early give 2 nd & 3 rd doses at schedule age e.g. 12 & 16 weeks Can we start late? It is best not to as we want to protect the baby as soon as possible.

8 Can we change the gap between the doses of a course?

9 Antibodies levels Primary immune response develops in the weeks following first exposure Secondary immune response is faster and more powerful Higher level of response More specific response More sustained memory

10 Can we change the gap between the doses of a course? Doses of the same inactivated vaccine 4 weeks apart except PCV (8 weeks) Doses of the same live vaccines 4 weeks apart except MMR in children under 18 months then leave 3 months

11 Can we change the gap between the doses of a course? Longer intervals? Not ideal to have a bigger gap than recommended because that would delay protection But if any course of immunisations is interrupted, it should be resumed and completed as soon as possible. It is not necessary to restart the course as immunological memory ensures response to subsequent doses is not impaired (even after an extended interval) Shorter intervals? Administration of doses at shorter than recommended intervals may be detrimental as this can result in a reduced immune response Shorter intervals should therefore be avoided some exceptions eg child traveling before 2 nd set primary imms due, can give 2 nd set no less than 3w since previous

12 What about leaving gaps between different vaccines? No specific intervals need be observed between: live and inactivated vaccines eg MMR and Hib/MenC doses of different inactivated vaccines eg Hib/MenC & Prevenar-13 Inactivated vaccine can be administered either simultaneously or at any time before or after a different inactivated vaccine or live vaccine

13 OK = no specific gap Inactivated vaccine Inactivated vaccine Live vaccine Inactivated vaccine Live vaccine Inactivated vaccine OK OK OK Live vaccine Live vaccine Either give simultaneously or leave a 4 week gap

14 Planning schedules for individuals of incomplete immunisation status

15

16 Planning schedules for individuals of incomplete immunisation status Follow the HPA flow chart Aim to protect individual in shortest time possible minimum number of visits there is no limit to the number of vaccines that can be administered at any one time. Simultaneous administration is safe and does not cause 'immune overload Transfer individual onto UK schedule if they are from overseas and will be staying here for some time Consider vaccines that may not have been given to children coming from abroad e.g. Men C, Hib, PCV Complete courses started abroad eg Hepatitis B

17 Courses of Hib, Men C, PCV before the age of 1 year gives good early protection but not long term protection For long term protection a single dose only is required after the age of 1 year no need to give the primary course After the age of 2 years PCV no longer recommended nationally as the risk of pneumococcal disease has reduced, locally recommend up until the age of 5 years After the age of 10 years Hib and pertussis no longer required.

18 Planning schedules for individuals of uncertain immunisation status Try to find out UK: Red Book, GP records, Child Health records Non-UK: patient-held records, websites (see workbook) Once you have found out treat as for the incomplete If you can t find out assume they are unimmunised and use the HPA flow chart No danger from immunising someone who is already immune Risks if an individual is left unimmunised

19 Additional doses Vaccinating Protect Reactogenicity Not vaccinating Risk of disease Associated morbidity

20 Why is it safe to give additional doses? Effect Reactivate the immune system Live vaccines e.g. MMR Any pre-existing immunity inhibits replication of the vaccine virus Result Increased level of antibody Increased level of protection Expected side effects e.g sore arm, temperature Exception BCG immune response after 2 nd dose maybe vigorous

21 Schedules as outlined on HPA algorithm Vaccination of individuals with uncertain or incomplete immunisation status Vaccine Advice for CliniCians Service

22 From 2 months to 1 st birthday Pediacel (DTaP/IPV/Hib) + PCV 4 weeks later: Pediacel + Men C 4 weeks later: Pediacel + Men C + PCV Notes: 1 month between the 2 doses on Men C 2 months between the 2 doses of PCV These early doses of Men C, PCV and Hib (in Pediacel) give good early protection but not long term protection Boosters as per schedule

23 From 1 st birthday until 2 nd birthday Pediacel + PCV + MMR + Men C 4 weeks later: Pediacel 4 weeks later: Pediacel Note: after 12 months of age, only need a single dose of Hib (which is in Pediacel), Men C and PCV to give good long term protection Boosters as per schedule

24 From 2 nd birthday until 10 th birthday Pediacel + MMR + Men C 4 weeks later: Pediacel + MMR 4 weeks later: Pediacel Notes: Children aged 24 months or over are at less risk of getting pneumococcal disease than those under 24 months Need a single dose of Hib (in Pediacel) and Men C to give good long term protection MMR can be given a month apart to children over 18 months of age Pre-school booster can be given as early as 1 year after the completion of the primary course if that is an easy way to get the child back on track Second booster as per schedule

25 From 10 th birthday onwards Td/IPV (Revaxis) + MMR + Men C 4 weeks later: Td/IPV + MMR 4 weeks later: Td/IPV Notes: Children aged 10 years or over are at less risk from Hib disease and pertussis than those under 10 years Men C recommended for those up the age of 24 years 1 st booster: preferably 5 years after completion of the primary course 2 nd booster: at least 5 years and preferably 10 years after the 1 st booster