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JSNAA

Childhood Immunisations (JSNAA)

 

  • Immunisation is the process in which a person becomes immune or resistant to an infectious disease, usually by administering a vaccine. It is one of the most cost-effective public health interventions, protecting children and vulnerable adults from serious illness and death.
  • Coordinated international programmes have eradicated some infectious diseases such as smallpox, and reduced death and disability from many others e.g. polio.
  • Immunisation programmes have clearly defined target groups; they can be delivered effectively through outreach activities; and vaccination does not require any major lifestyle change.
  • Vaccination is different from giving medicine to an unwell child to make them better. The idea is that a child won't become ill with measles or end up in intensive care with meningitis. Deciding not to vaccinate a child can put them at risk of catching a range of potentially serious, even fatal, diseases.
  • Having a vaccination is much safer than not having one. They're not 100% effective in every child, but they're the best defence against the epidemics that used to kill or permanently disable millions of children and adults.

Key issues

  • The childhood immunisation programme in South Tyneside has some of the highest take-up rates in England.
  • While performance is satisfactory teenage immunisation programmes for Flu and Meningitis ACWY could have a higher take-up rate.

High level priorities

  • When a vaccination programme against a disease begins, the number of people catching the disease goes down. As the threat decreases, it's important to keep vaccinating; otherwise the disease can start to spread again.
  • If enough people in a community are vaccinated, it's harder for a disease to pass between people who have not been vaccinated. This is called herd immunity.
  • Herd immunity is particularly important for protecting people who can't get vaccinated because they're too ill or because they're having treatment that damages their immune system.
  • An infographic explaining herd immunity can be found on Figure 1 of the supporting appendices Child Immunisation Appendices1.11MB

Those at risk

  • Vaccination coverage is the best indicator of the level of protection a population will have against vaccine preventable communicable diseases.
  • Coverage is closely correlated with levels of disease. Monitoring coverage identifies possible drops in immunity before levels of disease rise.
  • Those at most risk are children under 2 years-old, those with auto-immune deficiencies, and over-65s.

Level of need

Childhood vaccines timeline

6-in-one vaccine

Protects against: diphtheria, tetanus, whooping cough, polio, Hib (Haemophilus influenzae type b) and hepatitis B.

Given at: 8, 12 and 16 weeks of age to all babies born on or after 1 August 2017.

  • The combined DTaP/IPV/Hib is the first in a course of vaccines offered to babies to protect them against diphtheria, pertussis (whooping cough), tetanus, Haemophilus influenzae type b (an important cause of childhood meningitis and pneumonia) and polio (IPV is inactivated polio vaccine).
  • The combined DTaP/IPV/Hib is the first in a course of vaccines offered to babies to protect them against these five diseases. The vaccine is offered when babies are two, three and four months old.
  • There is an expectation that 95% of children receive the 6-in-1 vaccination.
  • In 2016/17 93.4% of children were vaccinates in England.
  • South Tyneside was significantly higher than both the benchmark and England, with 97.8% of the borough's children vaccinated.
  • For local and national trends see figure 2 of the supporting appendices Child Immunisation Appendices1.11MB

Pneumococcal or pneumo jab (PCV)

Protects against: some types of pneumococcal infection

Given at: 8 weeks, 16 weeks and one year of age

  • The PCV vaccination has a benchmark of 95%.  In 2016/17 93.5% of eligible children across England were vaccinated.
  • South Tyneside was significantly higher than both the benchmark and England, with 97.9% of the borough's children vaccinated.
  • For local and national trends see figure 3 & 4 of the supporting appendices Child Immunisation Appendices1.11MB

Rotavirus vaccine

Protects against: rotavirus infection, a common cause of childhood diarrhoea and sickness

Given at: 8 and 12 weeks of age

  • The average monthly rotavirus vaccine coverage for children who had reached 25 weeks (February 2014 and July 2016) show South Tyneside has identical coverage to England for the first dose, with 93.4% coverage.
  • Second dose coverage with Rotarix is higher in South Tyneside where the average monthly rate was 96.9% compared with 88.6% across England.

Men B vaccine

Protects against: meningitis (caused by meningococcal type B bacteria)

Given at: 8 weeks, 16 weeks and one year of age

  • The MenB vaccination was introduced from 1 September 2015 for infants due to receive their primary immunisations starting at two months of age on or after 1 September 2015 (i.e. those babies born on or after 1 July 2015)
  • Between August 2017 and March 2018 98% of eligible children in South Tyneside received one dose of the MenB vaccine, compared to 95.9% across England.
  • During the same period two dose coverage was at 94.3% in South Tyneside, significantly higher than the coverage across England which was 88.2%.

Hib/Men C vaccine

Protects against: Haemophilus influenzae type b (Hib) and meningitis caused by meningococcal group C bacteria

Given at: one year of age

  • Population coverage for the MenC vaccine by age 1 was 98.6% in 2015/16.
  • Vaccine coverage for the age 2 booster was at 96.4%, significantly higher than England's 91.5%
  • 5 year booster coverage was 98.4%, significantly higher than England's 92.6%.
  • Coverage at all ages is significantly higher than the 95% benchmark.
  • For local and national trends see figures 5, 6, & 7 of the supporting appendices Child Immunisation Appendices1.11MB

MMR vaccine

Protects against:measles, mumps and rubella

Given at: one year and at three years and four months of age

  • South Tyneside has continually achieved 95% of children or more receive the first dose of the measles mumps, and rubella vaccine by both 2 and 5 years old.
  • In recent years vaccination coverage for both doses by age 5 has increased significantly, from 87.6% in 2010/11 to 96.2% in 2016/17.
  • For local and national trends see figures 8, 9, & 10 of the supporting appendices Child Immunisation Appendices1.11MB

Children's flu vaccine

Protects against: flu

Given at: annually as a nasal spray in Sept/Oct for all children aged two to eight years on 31 August.

  • In 2013-14, a new childhood influenza vaccine programme was started to vaccinated all children aged 2 and 3 and then extending to 4 year olds in 2014/15.
  • Key changes to the programme in the 2017/18 flu season were that reception year (children aged 4-5 years) were offered flu vaccination in their reception class, rather than through general practice
  • Children in School Year 4 (children aged 8-9 years) are included in the programme this year as part of the phased roll-out of the children's programme
  • South Tyneside was included as part of a pilot programme aiming at extending coverage of the flu vaccination.  This meant all primary school aged children in the borough were offered the vaccine.
  • It is hoped that in extending the childhood influenza vaccination programme to healthy children will reduce transmission of flu to at-risk and elderly patients.
  • For local and national trends see figure 11 of the supporting appendices Child Immunisation Appendices1.11MB

 

  • To exceed the national benchmark 65% of eligible children are eligible are expected to be vaccinated annually.
  • Vaccinations among 2-4 year-olds were 44%, higher than regional and national results.  While this classed as performing to expectation it does not exceed the benchmark.
  • 56% of primary school aged children were vaccinated as part of the 2017/18 programme.  60% of reception aged children were vaccinated, however this declined as children aged, with 53% of year 6 pupils being immunised against flu.
  • For local and national trends see Table 1 of the supporting appendices Child Immunisation Appendices1.11MB

HPV vaccine (girls only)

Protects against: cervical cancer

Given at: 12-13 years as two injections at least six months apart

  • The human papilloma virus (HPV) is the name given to a very common group of viruses.
  • There are many types of HPV, some of which are called "high risk" because they're linked to the development of cancers, such as cervical cancer. Other types can cause conditions like warts or verrucas.
  • Nearly all cervical cancers (99.7%) are caused by infection with a high-risk type of HPV. HPV infections don't usually cause any symptoms, and most people won't know they're infected.
  • In England, girls aged 12 to 13 years are routinely offered the first HPV vaccination when they're in school year 8.
  • The second dose is normally offered 6 to 12 months after the first (in school year 8 or year 9).
  • In 2016/17 93.5% of females aged 12-13 were covered with both doses of the HPV vaccine.  This was significantly higher than the England rate of 87.2%
  • For local and national trends see figures 12 & 13 of the supporting appendices Child Immunisation Appendices1.11MB

 

  • While not currently offering coverage to teenage boys as part of the childhood immunisation programme national HPV vaccination programme for men that have sex with men (MSM), who will not receive the benefit of herd immunity from the current HPV scheme, began on 1 April 2018.
  • The purpose of the HPV for MSM programme is to opportunistically offer the vaccine to MSM up to and including 45 years of age through Specialist Sexual Health Services (SSHS) and/or HIV clinics.

MenACWY vaccine

Protects against: meningitis (caused by meningococcal types A, C, W and Y bacteria)

Given at: 14 years and new university students aged 19-25

  • The objective of the MenACWY immunisation programme is to immunise all adolescents in school years 9 to 13 before they complete academic year 13.
  • This is being met through replacing the routine adolescent MenC booster given in school years 9 or 10 with the MenACWY vaccine since September 2015.
  • During 2016/17 South Tyneside had comparable coverage to England, with 80% of year 9-12 children vaccinated.
  • The MenACWY vaccine is new to the timeline, there will be a mop-up programme locally to increase take-up to eligible children.
  • For local and national trends see Table 2 of the supporting appendices Child Immunisation Appendices1.11MB

Unmet needs

  • Uptake of most immunisations exceeds 95%, with high levels of uptake of all childhood immunisations both compared to uptake across England and uptake within other local areas.
  • Herd immunity has been achieved for all immunisations up to 24 months consistently over the past four years.
  • Child Flu vaccination coverage could be improved.  The primary purpose of the programme is to protect those with autoimmune deficiencies and older people as they are of higher risk of severe harm or death from flu.

Projected Need and Demand

  • The child immunisation programme is population wide, changes to demand will occur due to population change.
  • The 0-19 population in South Tyneside was 32,800 in 2016.  Current projections suggest there will be a small decline in the 0-19 population by 2036, reducing by around 500 young people to 32,300.
  • It is likely that there will be additional vaccinations delivered as part of the programme in years to come, this could increase demand on resources.
  • To retain herd immunity which can help prevent outbreaks it is important to ensure vaccinations are up-to-date for those who migrate into the borough.  New housing developments could increase internal migration, which will mean there is an increase in the number of children who would need to be immunised.

Community assets and services

  • Pre-school age immunisations are typically delivered in a GP Practice by a Practice Nurse.  There are currently 25 practices across the borough,
  • Commissioned NHS Foundation Trust nursing staff deliver immunisations to older children in a school setting.

Evidence for interventions

  • From birth and in early infancy and childhood, humans are exposed to countless numbers of foreign antigens and infectious agents in the everyday environment.  Responding to these stimuli helps the immune system to develop and mature. Compared with exposure in the natural environment, vaccines provide specific stimulation to a small number of antigens. Responding to these specific antigens uses only a tiny proportion of the capacity of an infant's immune system (Offit et al., 2002).
  • Evidence does not suggest that an infant's immune system could be exhausted by multiple vaccines.  If this was the case it would be expected that vaccinated children would have a higher risk of serious infections.
  • Studies to investigate whether vaccines increase susceptibility to serious infections have shown no evidence of such an effect, with infection rates generally being lower in vaccinated children (Hviid et al., 2005, Miller et al., 2003).
  • Nice guidelines (PH21) suggests authorities consider using pharmacies, retail outlets, libraries and local community venues to promote and disseminate accurate, up-to-date information on childhood immunisation.

HPV Vaccination in teenage boys

  • Since the roll-out of the HPV vaccination there have been increasing calls to extend the programme to include teenage boys.  The human papillomavirus (HPV) has been linked to several cancers, including cervix, vulva, vagina, penis, or anus.  HPV infection can also cause cancer in the back of the throat, including the base of the tongue and tonsils.
  • A Norwegian study to investing the effectiveness of offering the vaccination to boys found the expected tender price of the vaccination a barrier, and increasing coverage in girls was uniformly more effective and cost-effective than expanding vaccination coverage to boys. (Burger et al., 2014)
  • There is evidence that offering the vaccination to men who have sex with men (MSM) could be effective in preventing the spread of HPV and conditions linked to it.   Unlike heterosexual men, MSM cannot count on the herd immunity provided by the vaccination of girls.
  • One Canadian summary of evidence found that given the current cost of the vaccine, the cost/utility ratio of pre-adolescent boy vaccination would exceed commonly accepted threshold Quality Adjusted Life Years (QALY), even with a 2-dose schedule.
  • However, it acknowledged that a free vaccination program for pre-adolescent boys may still be justified by political considerations or the desire for equity, to provide boys and especially MSM with direct protection.  (Sauvageaua and Dufour-Turbisb, 2015)

 

  • Update 18th July 2018 - After an inquiry into the cost-effectiveness of broadening the HPV jab programme, the Joint Committee on Vaccination and Immunisation (JCVI) backed a "gender neutral" scheme.
  • Update 24th July 2018 - The government has announced that adolescent boys aged between 12 and 13 in England will be given a vaccine to protect them against HPV-related cancers.  

Additional Needs Assessments Required

  • Adult Immunisations

Key contacts and references

References:

  • Hviid A, Wohlfahrt J, Stellfeld M and Melbye M (2005) Childhood vaccination and non-targeted infectious disease hospitalization. JAMA 294(6): 699-705.
  • Miller E, Andrews N, Waight P and Taylor B (2003) Bacterial infections, immune overload, and MMR vaccine. Measles, mumps, and rubella. Arch Dis Child 88(3): 222-3.
  • Offit PA, Quarlest J, Gerber MA et al. (2002) Addressing parents' concerns: Do multiple vaccines overwhelm or weaken the infant's immune system? Pediatr 109(1): 124-9.
  • NICE Public health guideline [PH21] (2009) Immunisations: reducing differences in uptake in under 19s
  • Emily A. Burger , Stephen Sy, Mari Nyg√•rd, Ivar S. Kristiansen, Jane J. Kim (2014) Prevention of HPV-Related Cancers in Norway: Cost-Effectiveness of Expanding the HPV Vaccination Program to Include Pre-Adolescent Boys

National Strategies and Plans:

https://www.gov.uk/government/collections/immunisation#childhood-immunisation-schedules/

Additional Resources:

http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD009069.pub3/full

Key contact

Caroline Hall

E-mail

Public Health Practitioner

Job Title

Caroline.Hall@SouthTyneside.gov.uk

Phone Number

0191 - 424 6510

Last Updated: May 2018

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  • Joint Strategic Needs and Assets Assessment (JSNAA)
  • South Shields Town Hall
    Westoe Road
    South Shields
    Tyne & Wear
    United Kingdom
    NE33 2RL

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