Immunisation

Question 1

Immunisation

Answer 1

In the new born–

• BCG is given to infants at high risk of infection

At 2, 3 and 4 months of age –

• the ‘5 in 1’ vaccine is given, against diphtheria, tetanus, pertussis, H. influenzae type b (Hib) and polio.
• The oral, live polio vaccine has been replaced by killed-vaccine given by injection, owing to the risk of vaccine-associated polio in unvaccinated family members or immune-deficient people following contact with gastrointestinal excretions of vaccine recipients

At 2, 4 and 13 months,

• the pneumococcal conjugate vaccine (PCV13) is given

At 3 and 4 months,

• the conjugate vaccine against group C meningococcus (MenC) is given by separate injection

At 12–13 months,

• a booster Hib vaccine is given, MenC and MMR (measles, mumps, rubella) is given

At 12–13 years of age,

• the human papillomavirus (HPV) vaccine is given to girls. The rubella vaccine is no longer given to adolescent girls.

BCG is no longer given to adolescents

Question 2

Immunisation

Rationale behind the immunisation programme(1)

Answer 2

Diphtheria – infection causes local disease with membrane formation affecting the nose, pharynx or larynx or systemic disease with myocarditis and neurological manifestations. Immunisation has eradicated the disease in the UK

Pertussis – Huge decline in incidence with immunisation, but epidemics recur when immunisation rates fall

Haemophilus influenzae type b – causes invasive disease in young children The number of reports of infection dropped dramatically after the introduction of Hib vaccination

Poliovirus infection – Although most infected children are asymptomatic or have a mild illness, some develop aseptic meningitis and <1% develop paralytic polio

Meningococcal C – The marked fall in the number of reports in all age groups is shown in

Question 3

Immunisation

Rationale behind the immunisation programme(2)

Answer 3

Pneumococcal vaccination –

• introduced into the immunisation programme in 2006. Prior to this, about 530 children under 2 years of age developed invasive pneumococcal disease in England and Wales each year

Human papillomavirus (HPV) vaccine –

• introduced in 2008. Provides protection against the two strains (HPV16 and 18) that cause 70% of cervical cancer.
• Three doses of vaccine are given over a 6-month period to all girls aged 12–13 years of age

BCG immunisation –

• although the number of notifications of TB is rising, it remains uncommon and mainly confined to high-risk populations
• BCG immunisation in the neonatal period is therefore targeted to those at increased risk

Hepatitis B and varicella vaccination –

• included in the immunisation programme in the USA and many other countries.
• in the UK, but may be given to the siblings of ‘at-risk’ children (e.g. those undergoing chemotherapy)

Question 4

Immunisation

Complications and contraindications

Answer 4

• The MMR vaccine is only contraindicated in children with proven non-HIV-related immunodeficiency and those who are allergic to neomycin or kanamycin, which may be present in small quantities in the vaccine
• Children with a history of anaphylaxis to egg (the virus is grown in fibroblast cultures generated from chick embryos) should be immunised with MMR under medical supervision
• There is a 10% vaccine failure rate from primary vaccination with MMR at 12–13 months of age, but the proportion of susceptible school-age children in the UK has been reduced by the introduction of a preschool booster of MMR.