Key learning points:
– Immunisation programmes have a beneficial impact on the health of infants and young children
– Health visitors have a key role in promoting these programmes
– Immunisation programmes are subject to change and being aware of how to access accurate resources supports practice
Immunisation programmes are a highly cost effective public health intervention that save lives and promote health in infants and children.1 In 2015, children born in the United Kingdom (UK) are offered immunisation against 12 vaccine preventable diseases during the first five years of their life.
The success of these immunisation programmes rely on high proportions of the population being vaccinated (high uptake), parental confidence in the vaccines/programme and health care professionals who are skilled in promoting and delivering immunisations.2-6 Health visitors and community staff have a key role in promoting vaccines.
The importance of immunisation programmes
Immunisations directly protect individuals against vaccine preventable diseases. The immune system is primed to mount a rapid, disease specific response in the event of exposure to infection. Vaccination of infants and children in the UK has significantly reduced the burden of vaccine preventable disease.
While most infants and children can be safely immunised, a small minority can’t, due to medical conditions or treatment and may be vulnerable to vaccine preventable disease. These children and other vulnerable members of the population can indirectly benefit from an immunisation programme if the uptake of vaccines are high enough to prevent diseases from circulating.
The spread of infectious diseases in a population can be stopped when a certain proportion are vaccinated; a concept known as herd immunity. Some parents may consider that herd immunity alone will protect their child. But herd immunity cannot be relied upon, as children don’t spend their childhood in isolation and move between different groups/areas.
The epidemiology of infectious diseases is ever changing and carefully monitored. Immunisation programmes may need to be modified or new programmes introduced to ensure the population is optimally protected. Surveillance of vaccine preventable disease and immunisation programmes is undertaken by Public Health England (PHE). This surveillance informs the work of the Joint Committee on Vaccination and Immunisation (JCVI), a statutory committee that advises the UK health departments on immunisation programmes.
The UK routine childhood programme
The routine programme aims to protect infants and children against vaccine preventable diseases at an age when they may otherwise be vulnerable to infection.7 The scheduling of vaccines takes into account; the age at which infants and children are most at risk of the disease, complications associated with the disease, side effects of vaccination and how well the immune system will respond to the vaccine.
Some vaccines require a series of doses in order to provide immunity and many require a booster dose in the second or subsequent years of life to provide continued protection throughout childhood. The schedule, if followed will maximise protection for each infant and child. Migrant infants and children should be caught up to the UK schedule.
Public confidence in immunisation programmes and the vaccines used is critical to their success. Any decline in uptake leaves a population susceptible to disease, which was evidenced when a large measles outbreak occurred in 2013 with 1,413 confirmed cases of measles recorded in England.8
Health visitors have a key role in working with parents and carers to explain and promote immunisation programmes and to support those who are hesitant about these decisions.
Parents are known to require clear, consistent, factual information.9
Route of administration
All the vaccines that will be explained are administered by intramuscular (IM) injection with the exceptions being; rotavirus (oral) and the live attenuated influenza vaccine (LAIV), which is a nasal spray.
IM injections target the systemic immune system. The oral and nasal vaccines additionally target the mucosal immune system, providing immunity where the influenza virus or rotavirus enters the body (nose and gut respectively).10
Routine vaccine schedule: birth to five years of age
Rotavirus vaccine: given at two and three months of age
Rotavirus infection causes gastroenteritis. An infant vaccination programme began in July 2013. A 71% reduction in laboratory confirmed cases of rotavirus was reported in 2014. An indirect impact was also seen with a reduction in rotavirus disease incidence in two to five year olds and adults.11
Pertussis (whooping cough): given at two, three and four months of age (5-in-1 vaccine), booster at three years four months (4-in-1 vaccine)
Bacterial infection causing prolonged coughing bouts. For babies and young children, whooping cough can be a very serious illness, often leading to hospitalisation. An outbreak of pertussis began in England in 2012 with over 9,000 confirmed cases. To reduce the rates a programme to vaccinate pregnant women was introduced. The trans-placental transfer of antibodies from mother to foetus affords infants passive (given) immunity, before they receive their own infant vaccines. Uptake of the maternal programme is around 60%. In 2014, seven infants died due to pertussis. It continues to circulate, particularly in those aged 15 years and above.12
Tetanus: given at two, three and four months of age (5-in-1 vaccine), booster at three years four months (4-in-1 vaccine)
Infection with tetanus spores is characterised by stiffness and muscle spasms. In 2014 seven cases were reported in England.13
Diphtheria: given at two, three and four months of age (5-in-1 vaccine), booster at three years four months (4-in-1 vaccine)
A bacterial infection most commonly affecting the throat, 5-10% people die from complications. Currently less than 10 cases a year are reported.14
Polio: given at two, three and four months of age (5-in-1 vaccine), booster at three years four months (4-in-1 vaccine)
A virus that causes a range of illnesses; varies from asymptomatic infections to paralysis. Europe has been declared polio free since 200315 but polio continues to cause disease in parts of Middle East, South Asia and Africa.16
Haemophilus influenzae type b (Hib): given at two, three and four months of age (5-in-1 vaccine) booster at 12 months (Hib/menC vaccine)
Hib bacteria can cause serious illness in infants and children, including invasive disease such as meningitis, pneumonia and epiglottitis. Vaccination protects immunised individuals from infection and reduces carriage.
Between 2012 and 2014 there were less than 20 confirmed cases/year of Hib in England.17
Pneumococcal conjugate vaccine: (PCV13) given at two and four months of age, booster at 12 months
There are more than 90 subtypes of streptococcus pneumoniae and these bacteria’s cause a range of infections, from middle ear infections to septicaemia and meningitis. PCV13 contains 13 common subtypes. Vaccination protects immunised individuals from infection and reduces carriage. In the wider population a reduction in vaccine preventable disease subtypes is reported.18
Men C: given at three months of age (Men C vaccine), booster at 12 months (Hib/menC vaccine)
Meningococcal group C bacteria cause meningitis and septicaemia. This vaccine protects individuals from infection and reduces carriage.
Prior to the programme there were 1500 cases/year with 150 deaths and 150 children left with disabilities. During 2013/14 meningococcal group C infections accounted for 4% (27) of all confirmed cases in England.
MenB vaccine: recommended to be given at two and four months of age, with a booster at 12 months (Men B vaccine) (Set to begin 1 September 2015)
Meningococcal group B is the predominant cause of invasive meningococcal disease in infants and children in England.19 The JCVI has recommended that a meningococcal group B vaccine should be introduced into the routine infant schedule.20
The menB vaccine is estimated to protect against 88% of meningococcal B strains in the UK. Confirmation and start dates are awaited.
Introduction pending: Measles: (MMR vaccine) at 12 months and three years four months
Measles virus is highly infectious, causes widespread infection and is associated with significant complications. Without a measles vaccination programme most children would suffer from measles before the age of 15, and more than 100 people would be expected to die in the UK each year from measles.
The most common complications are otitis media (7 to 9% of cases), pneumonia (1 to 6%), diarrhoea (8%) and convulsions (one-in-200). If 95% of a population are immune, measles cannot circulate.
Mumps: (MMR vaccine) at 12 months and three years four months
It is a viral infection, commonly presenting as swelling to one or both sides of the face and under the ears. Complications include meningitis and inflammation of the testicles or ovaries. Vaccination protects individuals and the community around them. Disease incidence is low in early childhood but rises in young adults aged 15-30 years.
There were 2,224 laboratory confirmed cases of mumps recorded in England in 2014.8
Rubella: (MMR vaccine) at 12 months and three years four months
Mild viral illness with fever and rash. Rubella infection in pregnancy may lead to the loss of the foetus or congenital rubella syndrome. Risk of harm is highest if infection occurs during the first trimester of pregnancy. Vaccination protects individuals but also reduces the risk of children infecting pregnant women. While rubella is reported infrequently congenital rubella syndrome does still occur.21
Influenza: in 2015/16 flu season all children aged two to seven years, single dose of Live Attenuated Intranasal Vaccine (LAIV)
A highly infectious viral respiratory illness, symptoms include fever, chills and myalgia. Complications include pneumonia. This programme aims to reduce the incidence of disease in children and also in the wider population through the reduction in transmission by children.
The long term aim is to vaccinate annually all children aged two to 17. Additionally each year the cohorts being vaccinated is extended until the aim is achieved.
No child should suffer from a vaccine preventable disease when immunity can be safely achieved from highly effective vaccines. The continued success relies on high levels of uptake, parental confidence and well-informed health care professionals. Any healthcare professional promoting vaccines should be up to date with current programmes and have appropriate training.
1. World Health Organisation. Immunisation. www.who.int/topics/immunization/en/ (accessed 7 June 2015)
2. Herzog R, Álvarez-Pasquin MJ, Díaz C, Del Barrio JL, Estrada JM. & Gil Á. (2013) Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? a systematic review. BMC Public Health. 2013;13(1): 1-17.
3. Desmond N, Grant C, Goodyear-Smith F, Turner N, Petousis-Harris, H. Nurses make a difference in immunisation service delivery. Australian Journal of Advanced Nursing 2011;28(4): 28-35.
4. Uskun E, Uskun SB, Uysalgenc M, Yagiz M. Effectiveness of a training intervention on immunization to increase knowledge of primary healthcare workers and vaccination coverage rates. Public Health, 2008;122(9): 949-958.
5. Petousis-Harris H, Goodyear-Smith F, Turner N, Soe B. Family practice nurse views on barriers to immunising children. Vaccine 2005;23(21): 2725-2730.
6. Peckham C, Bedford H, Senturia Y. The Peckham report :National immunisation study : factors influencing immunisation uptake in childhood. Institute of Child Health, London: Horsham : Action research for the crippled child. 1989
7. Public Health England. Chapter 11: The UK immunisation schedule. In: Salisbury D, Ramsay M (eds.) Immunisation against infectious disease; 2015. www.gov.uk/government/uploads/system/uploads/attachment_data/file/400554... (accessed 7 June 2015)
8. Health Protection Report. Laboratory confirmed cases of measles, mumps and rubella, England: October to December 2014. Public Health England. Report no. 9(7) 2015. www.gov.uk/government/uploads/system/uploads/attachment_data/file/408159... (accessed 7 June 2015)
9. Yarwood J, Noakes K, Kennedy D, Campbell H, Salisbury A. Tracking mothers attitudes to childhood immunisation 1991-2001. Vaccine. 2005;23: 5670 -5687.
10. van Ginkel FW, Nguyen HH, McGhee JR. Attenuated Viral Vaccines for Mucosal Immunity to Combat Emerging Infectious Diseases. Emerging Infectious Diseases. 2000;6(2): 123-32.
11. Health Protection Report. Impact of first infant vaccination programme in England for rotavirus confirmed. Public Health England. Report no 8(37) 2014. www.gov.uk/government/publications/health-protection-report-volume-8-201... (accessed 7 June 2015)
12. Health Protection Report. Laboratory confirmed cases of pertussis reported to the enhanced pertussis surveillance programme in England: annual report for 2014. Public Health England. Report no. 9(18). 2015. www.gov.uk/government/uploads/system/uploads/attachment_data/file/429674.... (accessed 7 June 2015)
13. Health Protection Report. Tetanus in England and Wales:2014. Public Health England. Report no 9(18). 2015. www.gov.uk/government/uploads/system/uploads/attachment_data/file/429677... (accessed 7 June 15)
14.Public Health England. Public health control and management of diphtheria (in England and Wales). Diphtheria Guidelines Working Group Public Health England. www.gov.uk/government/uploads/system/uploads/attachment_data/file/416108.... (accessed 7 June 2015)
15. World Health Organisation. Poliomyelitis. www.euro.who.int/en/health-topics/communicable-diseases/poliomyelitis (accessed 7 June 15)
16. World Health Organisation. Polio global eradication initiative: data and monitoring. www.polioeradication.org/Dataandmonitoring/Poliothisweek/Poliocasesworld.... (accessed 7 June 15)
17. Public Health England. Laboratory reports of Haemophilus influenzae infection by serotype and year: England, 1990 to 2014. www.gov.uk/government/uploads/system/uploads/attachment_data/file/407090.... (accessed 7 June 2015)
18. Public Health England. Pneumococcal disease: guidance, data and analysis. www.gov.uk/government/collections/pneumococcal-disease-guidance-data-and.... (accessed 7 June 2015)19.
19. Health Protection Report. Invasive meningococcal disease (laboratory reports in England): 2013/2014 annual data by epidemiological year. Public Health England. Report no. 9(3). 2015. www.gov.uk/government/uploads/system/uploads/attachment_data/file/397913.... (accessed 7 June 2015)
20. Joint Committee on Vaccination and Immunisation. Minutes of the meeting of 11/12 February 2014. Public Health England. 2014. www.app.box.com/s/iddfb4ppwkmtjusir2tc/1/2199012147/18992168807/1. (accessed 7 June 15)
21. Health Protection Report. Laboratory confirmed cases of measles, mumps and rubella, England. January to March 2015. Public Health England. Report no. 9 (18). 2015 www.gov.uk/government/uploads/system/uploads/attachment_data/file/430451...
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