Introduction of pneumococcal conjugate vaccine PCV and schedule changes 2006: Adapted for NHS Taysid

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Introduction of pneumococcal conjugate vaccine
(PCV) and schedule changes 2006 Adapted for NHS
Tayside useDr Chris McGuigan, CPHM/Immunisation
Co-ordinator, NHS TaysideShona Halley, Senior
Health Protection Nurse Specialist, NHS Tayside
July 2006
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Changes to Childhood Vaccination Schedule
2 months DTaP/IPV/Hib (Pediacel) Meningococcal
C (Neisvac C) - Changed 3 months       DTaP/I
PV/Hib (Pediacel) Meningococcal C (Neisvac
C) 4 months DTaP/IPV/Hib (Pediacel)
Meningococcal C (Neisvac C) 12 months    
Pneumococcal (Prevenar)
Pneumococcal (Prevenar)
Meningococcal C / HiB (Menitorix)
13 months MMR (Priorix or MMR II)
Pneumococcal (Prevenar)
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What causes pneumococcal disease?

• Streptococcus pneumoniae
• Gram-positive diplococci
• gt 90 different serotypes

• Colonises the nasopharynx
• Spread by direct/indirect contact with
  respiratory droplets
• Self infection

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Transmission Clinical Presentation
Local spread
Meningitis
Otitis Media
Septicaemia
Local spread
Peritonitis
Blood stream
Naso-pharynx
Septic arthritis
Bacteraemia
Endocarditis
Aspiration
Pleuritis / Empyema
Pneumonia
Pericarditis / Empyema
Local spread
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Incidence of invasive pneumococcal disease in
Scotland by age-group, 1999-2001sourceSPIDER
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The Pneumococcal Conjugate Vaccine (PCV)

• Pneumococcal conjugate vaccine (PCV)
• Polysaccharide joined to protein (CRM197)
• Effective against the 7 serotypes that cause 82
  of Invasive Pneumococcal Disease (IPD) in
  children lt 5 (CDR Weekly 2003)
• PNE04, 06B, 09V,14, 18C,19F, 23F

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How effective is PCV?

• 96 effective at preventing IPD when given as a 2
  dose schedule in first year of life (Whitney
  2004)
• 18 ? pneumococcal pneumonia in children lt 5
  years (Black et al 2002)
• 57 ? episodes of otitis media caused by vaccine
  serotypes (Eskola et al 2001)

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PCV - Side effects

• Most common
• Swelling and redness at injection site
• Low grade fever
• Irritability, drowsiness, restless sleep
• Less Common ( 1 and lt 10)
• Swelling and redness gt 2.4cm
• Fever gt 39 C
• Rare ( 0.01 and lt 0.1)
• Hypersensitivity reactions
• Hypotonic hyporesponsive episodes

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PCV - Contraindications

• A confirmed anaphylactic reaction to a previous
  dose
• A confirmed anaphylactic reaction to any
  component of the vaccine (inc. diphtheria toxoid)
• Postpone vaccination if child has a fever
• Babies with minor illness (no fever) can be
  immunised (e.g., a cold)

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PCV catch-up campaign

• Children over 2 months and under 8 months will be
  given 2 doses of PCV separated by 2 months, and a
  third dose at 13 months or at least 2 months
  after 2nd dose
• Children aged 8 months to 13 months will have 1
  dose at 13 months (along with MMR)
• Children over 13 months and aged up to
  1 year 364 days of age will have 1 dose

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Children lt 5 who have had Invasive Pneumococcal
Disease

• If under 13 months, complete schedule
• All others under 5 years 1 dose of PCV
• Investigate for immunological disease
• Pneumococcal Polysaccharide Vaccine PPV as
  appropriate (if gt 2 years of age) if found to be
  in an at risk group (see Green Book
  www.dh.gov.uk)

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Booster doses of Men C Hib why?

• New evidence that immunity to Men C wanes in the
  second year of life (Trotter et al 2004)
• Recent evidence that to maintain low levels of
  Hib disease, a booster is necessary
• The vaccine Menitorix. Combined Hib/Men C

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Meningococcal disease 1998 2005 (to week 40)
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No catch-up for Hib-Men C booster

• Children older than 2 months at start of
  programme will still receive 3 doses of Men C
  vaccine
• All children becoming 12 months will receive
  Hib-Men C booster
• No Hib-Men C booster for children older than 12
  months at start of programme

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Adverse effects

• Most common
• Pain, redness, swelling
• Fever
• Loss of appetite
• Irritability, drowsiness
• Uncommon (gt 1/1000, lt 1/100)
• D V
• Malaise
• Fever (rectal gt 39.5C)
• No reports of allergic reactions

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Reporting of adverse effects

• Prevenar and Menitorix are both black triangle
  products (?)
• Monitored by MHRA
• Report all suspected reactions
• www.yellowcard.gov.uk

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Summary of Changes

• Introduction of Pneumococcal Conjugate Vaccine
  at 2, 4 and 13 months of age
• Single Men C vaccine no longer given at 2 months
  of age still 3 4 months
• Introduction of combined Hib/Men C booster at 12
  months of age
• Pneumococcal Conjugate Vaccine catch-up campaign
  for all children under 2 years of age.

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Invasive Pneumococcal Disease at risk children

• An add-on benefit of having PCV as part of the
  routine childhood primary immunisation programme
  is that at risk children can now be protected
  before the age of 2 years (i.e. from 2 months of
  age). See Green Book www.dh.gov.uk

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Implementation issues

• As PCV new to schedule, consider immunising each
  child in different limb, opposite to DTaP/IPV/Hib
  (pediacel) and Men C and document incase of
  adverse events
• Additional resources Financial costs associated
  with additional vaccine/refrigeration/staff/clinic
  /GP fees
• Storage problems for additional vaccine Cold
  chain, bigger fridges

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Implementation issues

• Review of Tayside Routine Childhood Immunisation
  Policy
• Local Tayside timetable needs to be built in to
  SIRS
• Training and education
• Short-term - Update sessions
• Mid/long-term HPS/NES distance learning package
  Promoting Effective Immunisation Practice
  launch on 4.9.06 in Stirling

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Enquiries

• 1. Chris McGuigan
• CPHM/Immunisation Co-ordinator
• Tel - 01382 596987
• E-mail chris.mcguigan_at_nhs.net
• 2. Shona Halley
• Senior Health Protection Nurse Specialist
• Tel - 01382 596987
• E-mail - shona.halley_at_thb.scot.nhs.uk
• 3. Andrew Radley
• Acting Consultant in Pharmaceutical Public
  Health
• Tel - 01382 425680
• E-mail - andrew.radley_at_nhs.net