Immunisation plans do not go far enough, RCGP says

Plans to expand pertussis and meningitis immunisation and launch a shingles vaccination programme do not go far enough, the RCGP believes.

Dr George Kassianos: vaccination plans must go further

DH advisers at the Joint Committee on Vaccination and Immunisation (JCVI) have set out changes to the vaccinations GPs provide to children, adolescents and the elderly. These include giving DTaP/IPV/Hib at six weeks in some cases, meningococcal C boosters for adolescents and shingles jabs for elderly patients.

RCGP immunisation spokesman Dr George Kassianos believes the committee should have gone further in its recommendations around pertussis, meningitis and shingles vaccination.

‘As regards pertussis, the minimum that should happen is what the RCGP has repeatedly called for in the past - add pertussis to the school leavers’ vaccine,’ he said.

Dr Kassianos said that, when GPs were vaccinating adolescents at the age of 15 years, instead of giving a vaccine that protects against diphtheria, tetanus and poliomyelitis, they should be giving a five-valent vaccine, with an acellular pertussis element.

‘That is the minimum we should be doing,’ he said. ‘[The five-valent vaccine] should be introduced without delay, particularly when it is a vaccine we already use in our UK schedule for the preschool booster.’

The JCVI also recommended pertussis vaccination for healthcare workers working with young babies to protect them against the infection and to stop any risk of them passing the infection on to very young patients.

Dr Peter English, a consultant in communicable disease control and a former GP, said this was one of some ‘very reasonable suggestions’ made by the JCVI. Such immunisation could prevent healthcare workers being sued if they had been shown to pass on an infection, he added.

Dr English said that healthcare workers' vaccination against pertussis was already recommended by many national authorities, and implemented with varying degrees of success.

‘The rationale is clear,’ he said. ‘Babies get whooping cough from their parents, their siblings and other household members, and their healthcare workers - in that order.

‘If a baby were to die, and it were to become apparent that the most likely source was a healthcare worker, the parents might be able to sue the healthcare worker or their employer, if the employer didn't have appropriate policies in place.’

With regard to meningitis C, Dr Kassianos said he agreed with the JCVI’s suggestion to give adolescents a booster vaccine. But he added: ‘In a year when we have two conjugate meningitis A, C, W-135 and Y vaccines, and a meningococcal B meningitis vaccine is about to be made available, why not expand the meningococcal immunisation to more strains?’

Dr Kassianos also agrees with the proposal to introduce the shingles vaccine to cover individuals aged 70 to 79 years. But, again, he argues that the committee’s proposals amount to ‘very restricted action’.

‘What the UK desperately needs is to greatly reduce the circulation of the varicella virus in our communities. The introduction of the varicella vaccine for our children is well overdue,’ he said.

He added: ‘Every time I see children going down with chickenpox, I despair.

'How can we, in the UK, allow our children to be infected by a virus that we have a vaccine for? We need to introduce varicella immunisation for our one-year-old children and introduce shingles immunisation for all adults aged 50 years and over without delay.’

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