1. IMMUNISATIONS Janet Anderson

2. Immunisations The immunisation programme in the UK evolves to meet the demand of controlling infection through vaccination Population immunity if high enough enables the unimmunised to be protected (herd immunity) Vaccination enabled smallpox to be eradicated from the world in 1980 WHO is working towards global polio eradication

3. Acquired immunity Acquired immunity is generally specific to a single or a group of closely related organisms. Active immunity can be acquired by natural disease or immunisation which provides immunity without the risk of the disease or is complications. Acquired immunity is either antibody or cell mediated

4. Passive Immunity Passive immunity is the transfer of active humeral immunity in the form of ready made antibody from one individual to another. Passive transfer occurs when antibody passes from mother to child Artificially acquired transfer occurs when antibody or antitoxin from an immune individual (or animal) is given to an individual at risk. Used when there is a high risk of infection where there is insufficient time for the body to produce its own response or where the individual is immunodeficient.

6. MEASLES Viral, droplet spread, incubation 10 days Coryza, conjunctivitis, fever, rash Complications, pneumonia,encephalitis,death Notifiable Catch up programme offered to those with incomplete immunization because of increasing notifications

7. MUMPS Viral,droplet spread, incubation 14-21 days Parotid swelling Complications oophritis,orchitis,pancreatitis,and meningitis Notifiable

9. RUBELLA Viral, droplet spread incubation 14-21 days Mild illness with rash and lymphadenopathy Maternal rubella, 1st trimester 90% foetal damage ( microcephaly, deafness, cataracts, PDA etc) History needs confirmation with saliva or serology

10. Chicken pox vaccine Given routinely elsewhere, not in UK Cost? Possible increase in Herpes Zoster if immunity is not gained by natural infection?? Available for children at risk

12. DIPHTHERIA Corynebacteria diphtheriae Incubation 2-5 days Infectious for four weeks Inflammatory exudate causing grey membrane in resp tract. Potential obstruction Toxin mediated damage to myocardium, nervous system and adrenals

13. TETANUS Toxin mediated from tetanus bacillus Incubation 4-21 days Spore spread Muscular rigidity with spasms ---(lock jaw)

15. POLIO Polio virus Faecal/oral spread, Incubation 3-21 days Virus may be shed for 6 weeks Range of severity--- asymptomatic to paralysis

17. PERTUSSIS Bordetella pertussis Incubation 7-10 days Infectious until 3 weeks after onset of paroxysms Paroxysmal cough can be associated with apnoea and /or vomiting ‘The 6 month cough’ Complications--- SIDS, bronchopneumonia and cerebral hypoxia

19. HAEMOPHILUS INFLUENZAE Type B Hib Meningitis with high incidence of complications +/- bacteraemia Epiglottitis Osteomyelitis

21. MENINGOCOCCAL DISEASE Neisseria meningitidis Type C vaccine, Type B vaccine being developed— (also available Type A for travelers) Incubation 2-3 days Onset can be fulminant Meningitis / septicaemia Fever, vomiting, purpuric rash

22. Routine Immunisation schedule 2 months Diphtheria Pertussis Tetanus Hib Polio and Pneumococcal (PCV) +Rotavirus 3 months Diphtheria Pertussis Tetanus Hib Polio and Men C + Rotavirus 4 months Diphtheria Pertussis Tetanus Hib Polio and Pneumococcal and Men C

23. Routine Immunisation schedule 12 months Men C and Hib 13 months MMR and Pneumococcal 3 to 5 yrs Diphtheria Pertussis Tetanus Polio and MMR 12-13yrs Human papilloma virus vaccine 3 doses ( girls only) 15 yrs Diphtheria Tetanus Polio

24. Active Immunity Live Attenuated Vaccines eg BCG, MMR, yellow fever, oral polio, oral Rotavirus, nasal inflenza (from September 2013) Inactivated Vaccines eg influenza Extracts of or Detoxified Endotoxins eg tetanus

25. Passive Immunity Normal Immunoglobulin eg for replacement therapy of agammaglobulinaemia Specific Immunoglobulin eg tetanus, VZV rabies, HepB and palivizumab for RSV protection

26. Contraindications To Vaccination General – Febrile illness Anaphylaxis to previous dose or to components of vaccine Severe local reaction Inconsolable unexplained crying >3 hrs within 72hrs Encephalopathic illness (hypotonic-hyporesponsive episode (HHE)) within 72 hours Intramuscular route should not be used for children with bleeding disorders—use s.c. route Live Vaccines – Immunosuppressed, e.g. prednisolone therapy, chemotherapy, HIV (note MMR can be if not severely imunocompromised), BMT within 6 months. Pregnancy

27. DTaP/IPV/Hib and MenC Diptheria, Tetanus, acellular pertussis, Inactivated polio, Haemophilus influenzae and Meningitis C Recent changes are inactivated polio (im) and acellular pertussis Well tolerated, minimal side effects For children over 10 years adsorbed diphtheria (low dose),Tetanus and inactivated polio vaccine only if have received primary immunisations

28. MMR Measles, Mumps and Rubella Serious illnesses associated with significant mortality Fever common 6 to 10 days post vaccination 1:1000 febrile convulsion Can be given to egg allergic children NOT associated with Autism and IBD

31. Current measles prevelence First 6 months 2011------497 cases in UK First 6 months 2012------964 Significant increase in South Wales 2013 Most in the 10-12 age group

32. BCG Administered to at risk babies in neonatal period ( where incidence is greater than 40 per 100,000) Given intradermally Since 2006 risk-based programme for other children as well Local Side effects common--- ulceration or abscess Do not give to HIV + or immunocompromised Mantoux induration > 6mm Previous BCG or past/ present TB.

33. PNEUMOCOCCAL VACCINES Prevenar < 2yrs previously 7 now 13-valent polysaccharide Since 2010 13-valent available—against the most invasive serotypes of pneumococcal bacteria. Part of the routine schedule. Pneumovax > 2years 23- valent polysaccharide Indications for Pneumovax--- those not previously immunised ---asplenia, SS disease, Chronic lung or heart disease

34. Rotavirus Vaccine Rotavirus is responsible for 1 in 10 hospital admissions in children Immunisation in UK introduced September 2012, to be routine from July 2013 Live attenuated oral vaccine Two doses four weeks apart Effective after 6 weeks of age To be offered at 2 and 3 months in the vaccination Schedule

35. Influenza vaccine Current vaccine trivalent inactivated influenza vaccine(TIV) licenced form 6 months of age. Live attenuated influenza vaccine given as a nasal spray (LAIV), licenced in Europe for 2- 17s now available. LAIV contains 3 strains. Not licenced for <2s 2 doses one month apart, unless previously immunised when one is sufficient. To be piloted this year, role out to <5s next and all children 2015

36. OTHERS RSV - passive immunisation—Palivizumab- (Synargis) –given during RSV season to high risk groups. Monoclonal antibody given monthly. HepBV – at risk groups (at present) HPV – Human Papilloma Virus vaccine -3 doses Given to 12-13 year olds –due to increase coverage to 17-18 year olds in September 2008 Cervarix—effective against Type 16 &18 HPV Protects against 75% of cervical cancers Gardasil introduced Sept 2012—effective against Type 6,11, 16 &18 –hence against 90% genital warts as well

37. Others (cont) Chicken pox routine in USA at 12-15 months/top up at 5/6years. Available but not routine in UK. Meningococcal B vaccine available from January 2013, but not in immunisation schedule yet. Pertussis vaccine now advised for every pregnant woman between 28 and 38 weeks ( new recommendation)

38. Vaccine ANAPHYLAXIS ABC Adrenaline 10 mcg/Kg (0.01ml/Kg 1:1000) Hydrocortisone 4mg/Kg Chlorphenamine Beware neomycin and gelatin anaphylaxis – omit MMR