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Immunisation Changes –

Immunisation Changes –. Pediacel - D TaP / IPV / Hib – Prim. Imm Repevax – D TaP / IPV …. for pre-school d TaP / IPV …. for pre-school Revaxis – dT / IPV ……… for teenager. Further information. www.immunisation.nhs.uk Email: dh@prolog.uk.com Tel 08701 555455.

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Immunisation Changes –

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  1. Immunisation Changes – Pediacel - D TaP / IPV / Hib – Prim. Imm Repevax – D TaP / IPV …. for pre-school d TaP / IPV …. for pre-school Revaxis – dT / IPV ……… for teenager

  2. Further information • www.immunisation.nhs.uk • Email: dh@prolog.uk.com • Tel 08701 555455

  3. Changes including Inactivated Polio – WHY? Acellular Pertusis – WHY? What is it? No Thiomersal – What is it?

  4. Changes to Immunisation Programme • Introduction of a new vaccine for Pneumococcal infection • Pneumococcal vaccination catch up programme • Amending the Men.C vaccination • Hib vaccine booster dose in 2nd year

  5. New Vaccination Schedule • 2 months DTaP / IPV / Hib + Pneumococcal +Rota virus • 3 months DTaP / IPV / Hib + Men.C + Rota virus • 4 months DTaP / IPV / Hib + Pneumococcal • 12 months Hib / Men.C • 13 months 1st MMR + Pneumococcal vaccine • 4-5 years 2nd MMR + dTaP / IPV • 12-13 years: (Girls) HPV in 3 doses with in 6 months • 15 years Td / IPV + Men. C

  6. Changes to BCG Programme • Targeted Neonate and At Risk • All infants living in area where incidence of T.B is 40/100,000 or more • All infants whose parents born in a country with T.B is 40/100,000 or more • Previously unvaccinated new immigrants from high prevalance country with TB • School programme to be replaced by screening for Risk factors, tested and vaccinated as appropriate • Mantoux test replacing Heaf test

  7. Issues related to Contraindication • No child should be denied Imm. Without serious thought (Emma Thompson case) • Acute illness – Postpone Imm. until recovery • In minor infection without fever or systemic upset are not reason to postpone Imm. • Special risk groups (Immunisation as priority): • Asthma • Chronic lung disease • Cong. Heart disease • Preterm baby & S.F.D • Down’s syndrome

  8. Not Contraindication • F.H of any adverse reaction following Imm. • F.H of convulsion • Previous history of pertussis, measles, rubella or mumps • Stable neurological condition such as CP • Contact with infections diseases • Asthma, eczema, hay fever • Rx. With Antibiotics or locally acting Seteroid (topical or inhaled) • History of NN jaundice • Under a certain weight • Recent or imminent surgery • Over the age recommended in Imm. Schedule

  9. Severe Immunisation Reaction • Fever = or > 39.5°C within 48 hours of vaccine • Anaphylaxis, general collapse, bronchospasm, laryngeal oedema • Prolonged unresponsiveness • Prolonged inconsolable or high pitch screaming for >4 hours • Convulsions or encephalopathy within 72 H

  10. Special risk groups related to LIVE VACCINESParalytic Polio & Disseminated infection with BCG if Live Vaccine given to patients • Malignant disease or within 6 months of terminating such Rx. • Organ transplant, Bone marrow transplant, Immunosuppressive Rx. • Prednisolone (or it’s equivalent) of 2 mg/kg/d for a week or > • (postpone immunisation for 3 months). • Topical or intra-articular steroid are NOT immunosuppressive. • ? Aerosols.

  11. NO Casual link between Immunisation to: • Guillain-Barre syndrome • Aseptic Meningitis • Learning disability • Neuropathy • Haemolytic anaemia or ITP • ADHD, Infantile Spasm • Reyes syndrome, Cot death • Autism, Inflammatory bowel disease

  12. MMR • Measles can kill! → 126 deaths in England (1980-1989) • Complications → Pneumonia, Feb. Convulsion, Encephalitis, SSPE • Since the MMR uptake↓, Notification of Measles↑ (Worldwide) • MMR is victim of it’s own success • M.R campaign (1994) averted huge epidemic (200,000→150 cases) • 2nd MMR introduced (1996) • Mumps → Deafness, Viral Meningitis, Pancriatitis,…. • Rubella → Congenital Rubella Syndrome,….

  13. MMR (cont.) • MMR introduced in 1988 with 90-95% efficacy • If there is history of personal or F.H of febrile convulsion / Epilepsy it is safe to immunise + control fever. (explain to parents) • MMR & the egg allergy: MMR is contraindicated ONLY if there is history of ANAPHYLACTIC REACTION. • 1200 cases with + ve skin test: Given MMR → 2 cases ? Anaphylaxis • 284 cases with history of egg allergy (confirmed by oral challenge) → immunised safely with NO adverse reaction • If there is genuine concern → Immunise under controlled condition (Hospital)

  14. MMR & the issues of: AUTISM and CROHNS • Issues raised by Dr Wakfield (Royal Free Hospital) → 12 cases study • Theory: MMR → intestinal symptoms leading to over absorption of protein parts (peptides) → disruption of Brain development • Public confidence↓ → ↓ MMR uptake → ↑ Notification of all diseases all over the World (outbreak of Measles in Netherlands & Ireland) • “The evidence favour rejection of casual relationship between MMR and ASD & Crohns disease” • By American Academy of Paediatrics • US Institute of Medicine Safety Review • All Party Parliamentary Group on Primary Care Public Health • Scottish & Irish Parliaments Health Committee

  15. MMR: Combined OR Separate Vaccines? • Combined Vaccines MMR is strongly recommended! • Separate Vaccines: NOT recommended. WHY? • Means more injections (6 instead of 2) • Means longer interval required between the injections (↑ risk) • NO ↓ in the number of ASD among children given separate V!! • Private……Quality & Standard issues • Not sure on what strain of vaccine they are given (Mumps) • Rubini strain (No protection) • Urabe strain (Aseptic Meningitis) • Jerry Lynn strain is highly effective (lasting immunity)

  16. COMPARISION: Disease & MMR “Problems” CONDITIONSDISEASE MMR • Convulsions 1 in 200 1 in 1000 • Men./Encephalitis 1 in 200-5000 < 1 in 1000,000 • Blood disorder (↓ plat.) 1 in 3000 1 in 22,000 • SSPE 1 in 8000 0 • Death 1 in 2500-5000 0

  17. MENINGOCOCCAL VACCINES • Meningitis: many serotypes → Group A, B, C, W135, Y • No effective vaccine yet available for type B – commonest in UK – • 10% carrier (of population) • 40% of Meningitis → Group C • Plain Polysaccharide A & C vaccine: 1- Safe but not effective in <18 months of age 2 – Last for 3-5 years 3 – In UK used for outbreak of Men. C and for traveller • Plain Polysaccharide (ACW135Y) Vaccine for Hajj & Umrha • Conjugate Men.C vaccine

  18. ? Futrure Routine Vaccine • Hepatitis B – currently selective vaccine • Meningitis B Vaccine • Chicken Pox Vaccine • Rota Virus Vaccine • ?? R.S.V Vaccine • Replacement of BCG Vaccine by DNA antigen

  19. Be immunised → Be safe!!

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