New children’s vaccines, new direction

The introduction of pneumococcal vaccination for infants has not come too soon for Dr George Kassianos

The CMO’s letter of 12 June 2006 confirmed 4 September 2006 as the day for the introduction of routine immunisation of infants against pneumo- coccal disease.

Prior to the announcement of these latest immunisation schedule changes, a number of issues have challenged immunisation policy makers.

Not least of these has been  the issue of how to fit another vaccine into the immunisation schedule at a time when remuneration for the provision of childhood immunisation within the GMS contract has been at its most contentious.

It also comes at a time when resources within primary care to deliver this service are at their most stretched.

The anti-vaccination lobbies accuse immunisation policy makers of overloading the children’s immune system by introducing more vaccines. However, one wonders how much regard these lobbies pay to immunology and the children’s need to avoid vaccine-preventable infectious disease.

Pneumococcal disease

In its severe form, pneumococcal disease affects about 5,000 patients every year in England and Wales of whom around 530 are children under two years.

About 50 children die every year as a result of severe pneumococcal disease.

Two thirds of these deaths are due to pneumococcal meningitis.

Of those who survive this meningitis, half are left with permanent disabilities such as blindness, deafness and cerebral palsy. One in seven will develop epilepsy and one in six will develop mental retardation.

An effective conjugate pneumococcal vaccine for children has been available in the UK since 2001, able to address the appreciable morbidity and mortality associated with pneumococcal meningitis, bacteraemia and pneumonia (the invasive pneumococcal disease — IPD) in the very young.

The IPD burden has remained virtually unchanged in the preceding decades, despite new antimicrobials and better disease management.

In UK clinical trials, the 7-valent pneumococcal conjugate vaccine (PCV-7) has shown 96 per cent effectiveness in preventing IPD caused by the seven pneumococcal serotypes in the vaccine. These are responsible for 80 per cent of IPD in young children.

The vaccine was introduced in the US routine immunisation schedule in 2000.

It has made a significant impact. Recent data from the USA Vaccine Adverse Event Reporting System have shown it to be a very safe vaccine.

Immunisation schedule

Children aged two months will receive two doses of the vaccine, two months apart, and a third dose at 13 months.

All other children under two years of age will receive the vaccine in a catch-up campaign, with dates corresponding to the start of the programme on 4 September.

Children born between 5/9/04 and 3/8/05 (aged over 13 months and under 2 years) will receive one dose of the PCV-7.

Children born between 4/8/05 and 3/2/06 (aged eight months to 13 months) will receive one dose of the PCV-7 but only when they are 13 months old.

Children born between 4/2/06 and 3/7/06 (aged over two months and under eight months) will receive two doses of the vaccine, two months apart and be given a third dose at 13 months.

Meningitis C disease

The meningococcal group C immunisation programme has been a great success. We have seen well over 90 per cent reductions in cases in all age groups. It has been shown that two doses of MenC vaccine provide the same protection in children as three doses in the first year of life.

A booster at 12 months will extend protection through to early childhood years.

Haemophilus vaccine

Another success in immunisation was the introduction of the Haemophilus influenza (Hib) vaccine in 1992. We saw a huge fall in Hib disease in children (but also older children and adults), particularly in the number of deaths from Hib meningitis. From 1998 onwards, we started noticing a gradual rise in cases of Hib disease. A Hib catch-up campaign in 2003/04 proved very successful in reversing this trend.

In order to stop Hib disease levels rising again we now offer a booster (fourth dose in the combined Hib/MenC vaccine) at the age of 12 months.

Remuneration

Practices will receive £15.02 per child for delivery of the three pneumococcal vaccine doses and the additional combined Hib/MenC booster at 12 months. For each child immunised in the pneumococcal catch-up campaign practices will receive £7.51.

Conclusion

Routine infant pneumococcal vaccination has come not a moment too soon for primary care, but unfortunately too late for the parents of a baby in my practice left disabled from this disease — just one of hundreds of such children lucky enough to survive this infection.

I am confident that primary care will add another success story to its history. 

Dr Kassianos is a GP in Bracknell Forest, Berkshire, the RCGP’s spokesman on immunisation and honorary secretary and spokesman for the British Travel Health Association

The new schedule of childhood immunisation

When to immunise Vaccines to be given  Brand name of vaccine
 2 months 

diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b (first) 

Pediacel

 pneumococcal conjugate vaccine (first)  Prevenar   
 3 monthsdiphtheria, tetanus, pertussis, polio,  Haemophilus influenzae type b (second)   Pediacel
 meningitis C (first)NeisVac C or Meningitec
 4 monthsdiphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b (third)    Pediacel
 pneumococcal conjugate vaccine (second) Prevenar
 meningitis C (second)NeisVac C or Meningitec
 12 monthscombined Haemophilus influenzae type b (fourth)Menitorix
 and meningitis C (third) – booster   
 13 monthsmeasles, mumps, & rubella [MMRs] (first)Priorix or MMR II
 pneumococcal conjugate vaccine (third) Prevenar
 3.5 to 5 years

diphtheria, tetanus, pertussis, polio —  

(first) booster    

Repevax [dTaP/IPV]

Infanrix-IPV [DTaP/IPV] 

 measles, mumps, & rubella [MMR] (second)Priorix or MMR II
 13 to 18 yearstetanus, diphtheria, polio (second) boosterRevaxis
                              

    

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