New research on childhood pneumococcal vaccine

24 Nov 2017
New research on childhood pneumococcal vaccine

An expert group, The Joint Committee on Vaccination and Immunisation (JCVI), have recommended a dose of the childhood pneumococcal vaccine be removed from the routine childhood immunisation schedule in infancy. As well as causing pneumonia, pneumococcal bacteria is a leading cause of bacterial meningitis.

The recommendation was presented for the first time by Professor David Goldblatt, Professor of Vaccinology and Immunology, at the Meningitis Research Foundation conference in London.

The recommendation is based on new data from the Journal Lancet Infectious Disease which suggests that the change is ‘likely to maintain population control of vaccine-type pneumococcal disease’.

UK babies are currently given three separate injections of pneumococcal vaccine: two in infancy (at two and four months of age), with a booster dose at one year of age. This is known as a 2 + 1 schedule. It is now recommended that the schedule be amended to one dose in infancy at three months of age with a booster at one year (known as a 1 + 1 schedule). 

The pneumococcal vaccine protects against 13 strains of pneumococcal bacteria  The findings suggest that, for 9 of the 13 strains, infants receiving two injections of the vaccine get an ‘equivalent or superior’ protective response after both doses to those who received all three injections.

The JCVI are an expert group who make recommendations to government about who should receive routine vaccinations and when, with the aim of providing the best possible protection through the smallest number of vaccines given at the most effective times. Reducing the number of vaccines could reduce appointment times and save the NHS money, but some concerns remain which need to be addressed to ensure protection is maintained:

Vinny Smith, Chief Executive of Meningitis Research Foundation, said: “We appreciate that the evidence highlighted in the JCVI minutes suggests removing one dose of vaccine will not make significant changes to protection but we would like to see some figures. We would like them to publish the modelling they used to reach this conclusion so that we can review it. Any change that increases the number of meningitis cases would be of real concern.

“The JCVI report says there would be a ‘limited effect’ from changing the number of injections. While any move to simplify vaccine schedules for families is welcomed, protection must be maintained and we are pleased that the report says this must be kept under regular review. Public health authorities need to monitor the situation very closely and ensure mechanisms are in place to quickly respond to any changes or new evidence. Before any changes to immunisation are made, we would like them to be clear on when and how the vaccine would be re-introduced if protection wasn’t maintained.

A reduced schedule would also make it more important than ever that people take up vaccines available to them. It is vital that children are immunised with the second dose at one year of age to stop the spread of the disease. In some areas uptake is much too low, so money saved from removing the infant dose should be spent on improving uptake. This might prevent us from seeing localised pockets of disease.” 
 
The JCVI recommendations can be found here: https://app.box.com/s/iddfb4ppwkmtjusir2tc/file/247634612957

The JCVI report suggests that the pneumococcal vaccine has not only successfully reduced cases of disease due to the 13 strains covered by the vaccine, but that it has also dramatically reduced the circulation of these bacteria amongst the wider population. They believe this means the risk of exposure to the strains of disease contained in the vaccine has reduced so much that removing a vaccine dose in infancy would not result in a significant increase in cases. 
 

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