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

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


1
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
2
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)
3
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

4
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
5
Incidence of invasive pneumococcal disease in
Scotland by age-group, 1999-2001sourceSPIDER
6
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7
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

8
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)

9
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10
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

11
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)

12
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

13
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)

14
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

15
Meningococcal disease 1998 2005 (to week 40)
16
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17
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

18
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

19
Reporting of adverse effects
  • Prevenar and Menitorix are both black triangle
    products (?)
  • Monitored by MHRA
  • Report all suspected reactions
  • www.yellowcard.gov.uk

20
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.

21
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

22
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

23
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

24
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
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