FACTSHEET IMMUNISATION AND ECZEMA. Introduction. What is immunisation?

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1 Introduction Immunisation protects against diseases that can kill or cause lasting damage to health. In the United Kingdom under the NHS babies and children are offered a routine programme of immunisation against certain diseases. Additional immunisation is recommended for those considered be at risk of developing complications from common infections (e.g. flu) or who may be exposed to serious diseases through their family, community or workplace/occupation. Immunisation is also available for people travelling abroad to countries where diseases not found in the UK are prevalent. Following a brief overview of immunisation, this factsheet focuses on safety concerns that adults with eczema or parents of children with eczema may have around immunisation: in particular, whether immunisation can cause eczema or make pre-existing eczema worse, potential allergic reactions and contraindications for people receiving certain types of eczema treatments. Please note: This factsheet focuses on immunisations for adults and children with eczema and is not intended to be a comprehensive guide to immunisation or a substitute for professional medical advice. If you have any concerns, you should discuss these with those responsible for the health care of you or your child (e.g. GP, dermatologist, dermatology nurse, health visitor, practice nurse, paediatrician). At the end of this factsheet are links to useful sources of public health information about vaccines. If you are unsure about any aspects of immunisation, you should seek the advice of a healthcare professional. What is immunisation? Immunisation means giving vaccines. Vaccines are substances that prepare the body s natural defence system (known as the immune system) against particular infections. Vaccines can be live (prepared from living micro-organisms, such as viruses or bacteria, which have been attenuated or modified so they cannot cause the disease) or not live (the virus or bacteria has been deactivated or killed) (see Table 1). Antibodies are produced in response to the vaccine and fight off the particular infection if the person comes into contact with it in the future. Most vaccines are given as injections but there are some exceptions for example, the flu vaccine for children is usually in the form of a nasal spray and the vaccine to protect against rotavirus is given by mouth. HELPLINE: * helpline@eczema.org * website: * Page 1

2 TABLE 1 LIVE AND NOT LIVE VACCINES AVAILABLE IN THE UK PROTECTION AGAINST LIVE (ATTENUATED) NOT LIVE (DEACTIVATED) Anthrax 5-in-1: Diphtheria, tetanus, pertussis (whooping cough), polio and Hib (Haemophilus influenza type b) Hepatitis A: Monovalent hepatitis A A and B combined A + typhoid Hepatitis B Influenza: Nasal spray: Fluenza Tetra ) (used for children) All others Japanese encephalitis MMR: Measles, mumps, rubella (German measles) Meningococcal disease: Vaccinations available for types A B C W Y Pneumococcal infection: PPV PCV Polio: Oral OPV Injectable IPV Rabies HDVC PCEC Rotavirus Shingles Tetanus Tick-borne encephalitis Tuberculosis Typhoid: Oral (Ty21a) Injectable Vi polysaccharide Varicella (chickenpox) Yellow fever HELPLINE: * helpline@eczema.org * website: * Page 2

3 Is immunisation necessary? Immunisation protects against diseases that can be fatal or cause serious or long-term harm. In the UK immunisation is voluntary rather than something you are obliged to do. Your health visitor and GP will encourage you to have your child vaccinated, as without routine immunisation they will have an increased risk of health problems. In many cases immunisations are also recommended for adults (check with your GP whether you ae eligible for a free vaccination under the NHS). Some possible reasons are given below: A flu jab is recommended for adults who may develop complications from this common virus for example, the elderly, pregnant women and people with certain medical conditions such as respiratory problems, diabetes or heart disease. Vaccines not only protect the individual who receives them but can indirectly protect others. For example, giving the rubella (German measles) vaccine to children makes it less likely that pregnant women will come into contact with this virus, which could harm their unborn babies. It is true that some diseases are much rarer than they used to be. However, diseases can spread from other countries, and unprotected babies and children can be especially vulnerable to infection. Tuberculosis (TB) is a case in point. It had almost died out in the UK, but there has been a resurgence in some urban areas, with certain communities more at risk, particularly those with connections to parts of the world where this disease is rife. If you are travelling abroad, you and your child may need additional protection from diseases not found in the UK. Ask about this at your doctor s surgery well in advance of travel as certain vaccines need to be given some weeks beforehand. How safe are childhood vaccinations? Parents often have concerns about the immunisation programme. Whilst no-one likes to expose their children to unnecessary risks, media reports tend to highlight rare cases of possible harm caused by vaccines. The programme of childhood immunisation is reviewed regularly in order to give children the best protection with currently available vaccines. Your health visitor and GP will offer this full programme, provided that there are no contraindications (see below) for your child. Your permission is needed for each vaccine. HELPLINE: * helpline@eczema.org * website: * Page 3

4 Some parents still question whether it is safer to give single vaccines against measles, mumps and rubella on separate occasions rather than give all three components at once, but experts have agreed that this precaution is not necessary. The MMR vaccine has been around for nearly 30 years and has been used in more than 90 countries. No country in the world recommends giving MMR vaccine as three separate injections. There is no licensed single measles or mumps vaccine in the UK; these single vaccines are only available on private prescription and are unlicensed, which means that there is no British testing of their safety and efficacy. Can childhood vaccines cause or exacerbate eczema? Parents of children with atopic eczema or those who have a family history of eczema often ask this question. There are two reasons for this concern: first, the knowledge that eczema involves the body s immune system; and second, reports from parents whose children have had a flare-up of their eczema following immunisation. The Department of Health s (DoH) Green Book (see Further Information) has clearly stated that eczema (and the other atopic conditions, asthma and hay fever) in themselves are not a reason to avoid routine immunisation but that in certain situations additional precautions may be required. Immediate reactions after immunisation, including pain, swelling or redness at the injection site are common and should be anticipated (small lumps where the needle was inserted can sometimes last a few weeks). However, this is no more likely in individuals with eczema than in those with normal skin, provided that sensible precautions are taken. (The doctor or nurse should avoid areas where the skin is already sore, inflamed or broken. When two or more injections are required at once, these should ideally be given in different limbs. If this is not possible, injections in the same limb should be given 2.5 cm apart.) Local reactions start within a few hours after immunisation and can occur after the 5-in-1 vaccine against diphtheria, tetanus, whooping cough, polio and Hib (given at 2, 3 and 4 months of age); however, in recent years the whooping cough (pertussis) component has changed and causes fewer local reactions than its predecessor. The measles, mumps and rubella (MMR) vaccine sometimes causes a measles-like rash 7 10 days after vaccination (this can be accompanied by a high temperature and the child may feel unwell). The second dose of MMR vaccine is less likely to cause these side-effects. Sometimes these local reactions are referred to as hypersensistivity reactions but these are not allergies and should not contradict against further doses with the same vaccine. HELPLINE: * helpline@eczema.org * website: * Page 4

5 Contraindications and other issues (adults and children with eczema) Live vaccines (see Table 1) are contraindicated for adults and children who are immunosuppressed. In practice this means that children and adults may need to have their immunisations delayed if their eczema is being treated (or has recently been treated) with immunosuppressant drugs such as azathioprine, ciclosporin or methotrexate or oral steroids (e.g. prednisolone). In such cases, medical advice should always be sought from a healthcare professional. Topical steroids (or those given by inhaler) do not pose any risks with vaccination. You should also seek advice if you or your child is being treated with the topical ointment tacrolimus (Protopic) or pimecrolimus (Elidel). Because of the potential risk of vaccination failure, the manufacturer of tacrolimus advises that vaccination should be administered either prior to commencement of treatment with tacrolimus or after a tacrolimus-free interval of 2 weeks. It also appears to be wise to avoid treatment with topical tacrolimus for 3 weeks after vaccination. In the case of live vaccines, treatment with topical tacrolimus is best avoided for 28 days before and after vaccination, to avoid the additional theoretical possibility of an infection. No effect on the immune system with vaccination and tacrolimus has been observed. This advice should also be followed for pimecrolimus, as a precaution. Individuals with an infection or fever will usually need to recover before vaccines are given. This recovery period also applies to badly infected eczema. Allergic reactions Allergic reactions after immunisation are rare and are not a reason to withhold further immunisations unless there has been a confirmed anaphylactic reaction (causing breathing difficulties/collapse) to a previous dose or to any of the ingredients contained in the vaccine (including any history of severe latex allergy as some vials/syringes may contain traces of latex, which in theory could cause a reaction). Some vaccines contain very small amounts of antibiotics, which are capable of triggering an allergic reaction in some people. The MMR vaccines ( MMRVaxPro and Priorix ) are two examples of vaccines that contain traces of the antibiotic neomycin. Examples of other antibiotics to look out for in vaccines are streptomycin, polymyxin B, amphotericin B and chlortetracycline. If you or your child has a known allergy to any of these HELPLINE: * helpline@eczema.org * website: * Page 5

6 ingredients, discuss with your doctor before vaccination. For more information on the actual ingredients contained in all current vaccines it is always best to check the updated information in the DoH Green Book. The only food allergies that may be a problem with vaccination are severe allergy to egg and/or gelatin. The following vaccines in the UK contain small amounts of egg protein: The MMR vaccine against measles, mumps and rubella is grown on cells from chick embryos rather than on hens eggs and recent research has shown that 99% of children with egg allergy can safely receive it. However, if your child has ever suffered an anaphylactic reaction to egg, with symptoms including severe rash, swollen mouth or throat, difficulty in breathing or collapse after eating egg, you should let your health visitor or GP know as they can arrange for special care to be taken when your child receives the MMR vaccine. Most flu vaccines (including the nasal spray given to children) are developed from viruses grown on hens eggs, so are not recommended for individuals with a severe egg allergy. These individuals will normally be advised to have an egg-free injectable flu vaccine instead. People with a confirmed anaphylactic reaction to egg should not receive the following travel vaccinations: Yellow fever vaccine. Tick-borne encephalitis vaccine. Please also note that there are two types of vaccination that protect against different strains of rabies: PCEC (cultured using chick embryos) and HDCV. Check with your doctor if you have a confirmed egg allergy and need to receive PCEC. Examples of vaccines in the UK that contain gelatin include the children s nasal flu spray, measles, mumps, and rubella (MMR), shingles, chickenpox (varicella), yellow fever, shingles,,rabies, Japanese encephalitis. Some parents worry about vaccines containing thimerosal (mercury), which is used as a preservative and has a small risk of producing allergic skin reactions. Nowadays none of the vaccines given to babies and young children as part of the routine NHS immunisation programme contain this ingredient. However, some other vaccinations may contain traces, so ask your healthcare professional/check the DoH Green Book if you have a known allergy to this ingredient. HELPLINE: * helpline@eczema.org * website: * Page 6

7 Always tell your doctor about known allergies before you or your child receives any vaccination. A complete list of ingredients in each vaccine is given in the Patient Information Leaflet (PIL). The electronic Medicines Compendium (emc) website (see Further Information) enables you to search the PIL by brand name. Summary Overall, unless there are special considerations (as outlined above under contraindications or allergic reactions) immunisation is highly recommended to protect adults as well as children from dangerous diseases. Parents of children with eczema are advised that they are not putting them at increased risk by following the normal immunisation programme. Remember that protection from infectious disease is important for you, your child and your community as a whole. FURTHER INFORMATION The Department of Health and the NHS produce a number of publications. These may be available from your health visitor, GP surgery or local child health clinic. Alternatively, you can find information online: Department of Health Green Book NHS Choices Meningitis Research Foundation electronic Medicines Compendium (emc) National Eczema Society December 2015 HELPLINE: * helpline@eczema.org * website: * Page 7

8 National Eczema Society 2015 The National Eczema Society is a charity registered in England and Wales (number ) and in Scotland (number SCO43669) and is a company limited by guarantee, (registered in England number ). Registered office 11 Murray Street, LONDON, NW1 9RE. We are dedicated to improving the quality of life of people with eczema and their carers. Eczema affects FIVE MILLION adults and children in the UK every year. All our information is clinically evidence based and written by or verified by dermatology experts. The National Eczema Society receives no Government or Health Service funding, relying entirely on voluntary income from the general public, companies and Trusts. DISCLAIMER These details are provided only as a general guide. Individual circumstances differ and the National Eczema Society does not prescribe, give medical advice or endorse products or treatments. We hope you will find the information useful but it does not replace and should not replace the essential guidance given by your general practitioner, dermatologist or dermatology nurse. HELPLINE: * helpline@eczema.org * website: * Page 8