Changes to the immunisation programme in the UK
Since 4 September 2006, protection against meningitis and septicaemia has been broadened by the introduction of a new pneumococcal vaccine for babies. Existing protection against group C meningococcal and Hib meningitis has also been enhanced by the addition of a new booster vaccine.
Pneumococcal Vaccine
Pneumococcal disease refers to a wide range of illnesses caused by pneumococcal bacteria, and includes life-threatening meningitis and septicaemia.
Each year there are over 500 cases of severe pneumococcal disease in children under 2 in England & Wales alone, and up to a third of these are cases of pneumococcal meningitis.1
Pneumococcal meningitis is the second most common type of bacterial meningitis in the UK. Pneumococcal meningitis is more deadly than other major types of meningitis - 15 to 20 of every 100 people affected do not survive 2,3, and up to half of survivors are left with permanent disabilities that can be as severe as brain damage, deafness and cerebral palsy4.
Pneumococcal septicaemia is a serious illness and can leave survivors with permanent organ damage5 and amputations6.
Pneumococcal disease is also one of the main causes of severe pneumonia as well as a great many less serious illnesses including ear and sinus infections and bronchitis.
What has changed?
- A pneumococcal vaccine has been introduced into the routine childhood immunisation schedule and is now offered to babies at 2, 4 and 13 months* of age (* 15 months in Northern Ireland).
- There is also a 'catch-up campaign' so that babies and children up to age two, who have already received their routine vaccines, will be offered the pneumococcal vaccine. All children born between 5 September 2004 and 3 July 2006 should be offered one dose of the vaccine before March 2007. The recommended schedules for the catch-up campaigns can be found on the websites below:
England and Wales
http://www.dh.gov.uk/assetRoot/04/13/71/75/04137175.pdf
Scotland
http://www.show.scot.nhs.uk/sehd/cmo/CMO(2006)09.pdf
Northern Ireland
http://www.dhsspsni.gov.uk/ph_hss(md)_14-2006.pdf
Previously, only 'at risk children' - those with health conditions that put them at particular risk from pneumococcal disease (children with immune deficiencies and other conditions that make the disease more common or more serious) - were offered vaccination. However, many children affected by pneumococcal disease do not have any of these 'risk factors' and even children who do are often not given the vaccine, so universal vaccination is the most effective defence against the disease.
What does this vaccine protect against?
- The vaccine can protect against infection by the seven most common strains of pneumococcal disease, which account for 82% of cases of pneumococcal meningitis and septicaemia in children under five7.
- It will also prevent some cases of pneumonia, especially the more severe cases. However, not all cases of pneumonia are caused by pneumococcal bacteria.
- It will prevent some cases of ear infection and other less severe kinds of pneumococcal disease.
The vaccine
- The vaccine is a conjugate vaccine (see box on right) and is therefore effective in babies as young as two months of age.
- This vaccine was licensed for use in Europe in 2001 and has been offered to 'at-risk' children in the UK since 2002.
- The USA began routine immunisation with this vaccine in 2000, after very large trials which showed it to be safe and effective8 and it has since been given to an estimated 30 million children, further confirming its safety record. By 2003, cases of serious pneumococcal disease in the USA, caused by the seven strains in the vaccine, had fallen by 94% in children under 59. The vaccine has also protected unvaccinated adults through herd immunity (see box below).
- Canada, Australia, Austria, Italy, Greece, Spain, Norway, Luxembourg, Qatar and Switzerland have also introduced the vaccine into their routine immunisation schedules.
Pneumococcal vaccine for older 'at-risk' children and adults
An existing polysaccharide vaccine (see box above) is already recommended in the UK for anyone over the age of two years with a health condition which puts them 'at risk' from pneumococcal disease and for everyone over the age of 65. This vaccine protects older children and adults against the 23 most common strains of pneumococcal disease.
New recommendations
- All babies and children under 2 years are now offered the conjugate vaccine either as part of the routine schedule at 2, 4 and 13 months of age (15 months in Northern Ireland) or in the catch-up campaign. 'At risk' children are also offered polysaccharide vaccine after they reach their second birthday, at least two months after their final dose of the conjugate vaccine
- 'At risk' children aged over two and under five years are offered vaccination as soon as possible after their risk factor has been identified.
Group C meningococcal and Hib disease
What's changed?
- A booster vaccine that protects against Hib and MenC disease, is now offered to children at 12 months of age.
- At present, MenC is given at 2, 3 and 4 months of age. This is shifted later, so that children receive it at 3 & 4 months, with the Hib/MenC booster at 12 months of age.
- At present, Hib vaccine is offered as part of the '5-in-1' diphtheria, tetanus, whooping cough, polio and Hib vaccine at 2, 3 and 4 months of age. This will continue in the new immunisation schedule, but Hib will also be given as a booster with MenC at 12 months of age.
Why?
Meningococcal disease is the most common cause of bacterial meningitis in the UK, and it also causes life-threatening septicaemia. There are several strains, or 'groups', and Group C meningococcal disease can be prevented by the MenC vaccine. MenC vaccine was introduced into the immunisation programme at the end of 1999 and has reduced cases of Group C disease by over 90%, saving hundreds of lives. However, research has shown that in babies immunised before one year of age, immunity to MenC disease begins to decline one year after receiving the vaccine10. In order to ensure longer-lasting protection, it is necessary to 'boost' immunity after the first year of life. A further study that evaluated possible vaccine schedules has found that, partly due to widespread herd immunity (see box), the risk of MenC disease to babies should remain at the same very low levels after the first dose of MenC is moved to 3 months of age11.
Haemophilus influenzae b (Hib) causes a range of diseases including meningitis and septicaemia. It was the most common cause of bacterial meningitis in children under five until the Hib vaccine was introduced in 1992, reducing cases of Hib disease by 98%. After 1998, there was a small, but significant rise in Hib disease in the UK. As a necessary short-term measure to reverse this trend, and to increase protection for babies and young children, there was a Hib booster campaign for children under 4 years of age in 2003. The introduction of the Hib/MenC booster into the routine immunisation programme is a long-term solution that will ensure continued protection against Hib disease.
Hib/MenC Booster
- Boosting immunity against these diseases at 12 months of age results in a stronger immune response that is long lasting.
- This combination vaccine has recently been licensed in the UK, but the ingredients of the vaccine are not new; they are used in other vaccines.
- Trials of this vaccine have shown that it is as safe and effective as other Hib and MenC vaccines that are currently in use12.
The new schedule
| 2 months |
3 months |
4 months |
12 months |
13 months* |
DTaP/IPV/Hib
('5-in-one') |
DTaP/IPV/Hib |
DTaP/IPV/Hib |
|
|
| Pneumococcal |
|
Pneumococcal |
|
Pneumococcal |
|
MenC |
MenC |
|
|
|
|
|
Hib/MenC Booster |
|
|
|
|
|
MMR |
*15 months in Northern Ireland
Further Questions
Are there any children who should not have the vaccines?
- Children who have previously had a confirmed anaphylactic reaction (a severe allergic reaction, not just a sore arm or a mild temperature) to any ingredient of either vaccine should not have the vaccine.
- Vaccination should be temporarily postponed in any child who is ill with a high fever. Vaccination should go ahead once they are well.
Should parents be concerned about adding more vaccines to the programme?
- In order to work, vaccines must bring on a response from the immune system, but everyday mishaps like scraped knees and sore throats place more of a demand on the immune system than any combination of all routine vaccinations for babies.
- The idea that multiple vaccines overload the immune system is a myth. American scientists have calculated that a baby's immune system could respond to 10,000 vaccines at a time13 .
- Routine vaccinations are timed to protect babies when they need it most.
- Vaccines in use now contain fewer elements than before. Even with these changes to the programme, having all the vaccines in the routine immunisation schedule will be less of a demand on the immune system than it would have been two years ago.
How can I get these new vaccines?
You don't need to do anything now. All parents of children in the target age group will be invited to their GP surgery for immunisation.
Vaccines cannot protect against all forms of meningitis.
Not all forms of meningitis and septicaemia are vaccine preventable so it is still important to be aware of the symptoms of these diseases, and to seek medical help immediately if you suspect someone has meningitis or septicaemia.
Freefone 24 hour helpline 080 8800 3344
Meningitis Research Foundation's helpline staff respond to calls at any hour of the day or night from people who want to know more about meningitis or septicaemia, including vaccines to prevent the diseases, or who are worried about someone who is ill.
References
- Department of Health. Professional Letter. Gateway Ref. 6126. Planned changes to the routine Childhood Immunisation Programme. February 2006. http://snipurl.com/mc7q
- Laurichesse H, Grimaud O, Waight P Johnson AP, George RC, Miller E. Pneumococcal bacteraemia and meningitis in England and Wales, 1993 to 1995. Communicable Disease and Public Health 1998; 1: 22-27
- Baraff LJ, Lee SI, Schriger DL. Outcomes of bacterial meningitis in children: a meta analysis. Pediatric Infectious Disease Journal 1993; 12: 389-394
- Bedford H, de Louvois J, Halket S, Peckham C, Hurley R, Harvey D. Meningitis in infancy in England and Wales: follow up at age 5 years. BMJ 2001;323: 1-5
- Sundaresan R, Sheagren JN. Current Understanding and Treatment of Sepsis. Infect Med 1995; 12(6): 261-268, 274
- Ohnishi M, Shimizu Y, Iwata K, Ookochi Y, Ooe K. Purpura fulminans complicating pneumococcal sepsis: a case report. Kansenshogaku Zasshi 1994; 68(9): 1117-21
- Melegaro A, Edmunds WJ, Pebody R, Miller E, George R. The current burden of pneumococcal disease in England and Wales. Journal of Infection 2005; 52: 37-48
- Black S et al. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Pediatric Infectious Disease Journal 2000;19(3):187-195
- Morbidity and Mortality Weekly Report. Direct and Indirect Effects of Routine Vaccination of Children with 7-Valent Pneumococcal Conjugate Vaccine on Incidence of Invasive Pneumococcal Disease - United States, 1998-2003. September 2005; 54 (36).
- Trotter CL, Andrews NJ, Kaczmarski EB, Miller E, Ramsay ME. Effectiveness of meningococcal serogroup C conjugate vaccine 4 years after introduction. The Lancet 2004; 364: 365-367.
- Department of Health. Joint Committee on Vaccination and Immunisation. Draft minutes of the October 2005 meeting. http://www.advisorybodies.doh.gov.uk/JCVI/childhoodimmunisationoc05.pdf (accessed 21 Feb 2006).
- H.J Schmitt, M Knuf, R Saenger, G Maechler, D Boutriau. Immunogenicity, safety and immune memory of a 3-dose Haemophilus influenzae type b - meningococcal serogroup C conjugate (Hib-MenC) vaccine in healthy children at 2, 3 and 4 months of age. Presentation at 4th World Congress of the World Society of Pediatric Infectious Diseases, Warsaw, Poland, 1-4 September 2005.
- Offit PA, Quarles J, Gerber MA, Hackett CJ, Marcuse EK, Kollman TR, Gellin BG, Landry S. Addressing parents' concerns: Do multiple vaccines overwhelm or weaken the infant's immune system? Pediatrics Jan 2002; 109 (1): 124-129 http://pediatrics.aappublications.org/cgi/content/full/109/1/124 (accessed 9 Feb 2006)
Page last updated 01.02.07