Vaccine preventable diseases and changes to UK vaccines 2004

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Vaccine preventable diseasesand changes to UK
vaccines 2004

• Dr Kyle Knox
• CCDC

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Diseases

• Diphtheria, Tetanus, Pertussis, Polio, Hib
• Epidemiology Worldwide
• UK
• Local
• Changes to vaccines in UK

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Diphtheria
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Diphtheria cases reported to WHO 1997
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Diphtheria epidemic in the old Soviet Union
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Oxfordshire cases

• Two cases over past 2 years
• Both imported
• Both non-toxigenic

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Continued outbreaks

• Disease Outbreak Reported
• As of 9 August 2003, WHO reported 50 cases,
  including 3 deaths ( case fatality rate, 6),
  during 12 June and 2 August 2003 in a
  resettlement camp for internally displaced
  persons in Kandahar. Preliminary epidemiological
  data indicate that 74 of the cases were aged 5
  to 14. Samples received by the Central Laboratory
  in Kabul confirm C.diptheriae. Further laboratory
  investigations are ongoing in Islamabad,
  Pakistan.
• A mass vaccination campaign targeting the entire
  population of the camp (c. 40,000) was launched
  on 2 August 2003. As of 7 August 2003, 7,544
  individuals had received vaccine.
• WHO, UNHCR, UNICEF, Médecins sans
  Frontières-Holland, International Committee of
  the Red Cross, International Federation of Red
  Cross and Red Crescent Societies and Inter-SOS
  are assisting the Ministry of Health in the
  implementation of control activities and in the
  provision of drugs, antitoxin, and vaccine
  supplies as well as technical and logistic
  support. Ongoing activities include heightened
  surveillance , case and contact tracing.

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Tetanus
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UK Tetanus 1985 -2002
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Cases of tetanus in IDU January 2003-04
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Geographical distribution
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Description of cases

• 10 cases last case 6/1/2004
• 6 females 4 males
• 1 death

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Description of cases 2

• Injection method available on 5
• -all skin poppers
• Tetanus status available on 7
• -only 1 immunised in past 10 years
• -4 probably never immunised
• -none had received 5 doses

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Oxfordshire

• Last case 1998
• Elderly woman
• Likely source was a fungating breast malignancy

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Pertussis
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Lab confirmed Pertussis by quarter 2003
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Notifications of Pertussis in Oxfordshire
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Poliomyelitis
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Worldwide polio 1988
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Worldwide polio 2003
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Weekly Epidemiological RecordJuly 2004

• August 2003 Polio immunisation halted in
  Northern Nigeria due to vaccine safety concerns
• July 2004 259 children paralysed due to polio
  (76 of the worldwide cases)
• Cases of paralytic polio linked to Northern
  Nigeria have occurred in 10 African
  countries
• August 2004 Nigerian Health Minister apologies
  to neighbouring countries and re-institutes
  programme

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Hib
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Invasive Hib infections by age group, 1990-2002
England and Wales, combined PHLS HRU/CDSC data
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Invasive Hib infections by age group, 1994-2002
England and Wales, combined PHLS HRU/CDSC data
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Incidence of Hib and proportion of cases fully
vaccinated, (per 100,000 children under five)
85
85
76
69
53
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Changes to UK vaccines
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Why change?

• OPV-VAPP
• wP-more reactogenic than aP
• Thiomersal

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JCVI Advice Switch from OPV to IPV

• Oral Polio Vaccine
• Good individual protection
• Some protection of contacts
• but.VAPP

• Inactivated Polio Vaccine
• Good individual protection
• No protection of contacts
• No VAPP

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UK paralytic polio 1985 2003
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JCVI Advice Switch from wP to good quality aP

• Good quality aP giving at least the level of
  protection given by current wP
• aP tends to be less reactogenic than wP
• wP vaccines becoming more difficult to source

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JCVI Advice thiomersal-free vaccines where
possible

• Precautionary advice based on the general aim to
  reduce avoidable exposure to mercury.
• In line with CSM advice

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Diphtheria

• Objective
• Minimum of 5 doses of diphtheria containing
  vaccine

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Diphtheria

• Two strengths
• D 30 iu
• -primary immunisation up to 10 years
  (DTaP/IPV/Hib)
• d 2 iu
• -primary immunisation gt10 years (Td/IPV)

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Boosting

• Preschool (and up to 10 years if required)
• either -DTaP/IPV
• -dTaP/IPV
• Over 10 years -Td/IPV
• Second (school leaving) booster
• -Td/IPV

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Hib - Objective

• Primary
• Minimum of 3 doses of a Hib-containing vaccine
  for infants lt1 year (DTaP/IPV/Hib)
• (nb. use DTaP/IPV/Hib up to 10 years for all
  primary immunisation )

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• Booster
• Not currently recommended

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Pertussis - Objective

• Primary
• Minimum of 4 doses of pertussis containing
  vaccine for children up to 10 years
  (DTaP/IPV/Hib)
• (Not recommended for children aged 10 years and
  over and adults)

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• Booster
• in children lt10 years, either
• -DTaP/IPV
• or
• -dTaP/IPV

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nb.

• DTaP/IPV/Hib can be used to complete a primary
  course started with whole cell or another
  acellular pertussis vaccine
• Both DTaP/IPV and dTaP/IPV can boost a primary
  course of whole cell or acellular pertussis
  vaccine

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Poliomyelitis

• Objective
• Minimum of five doses of polio-containing vaccine

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PrimaryThree doses of IPV-containing product.
1 month intervalUnder 10 yrs of age
DTaP/IPV/HibOver 10 yrs of age Td/IPV
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BoosterFirst booster 3 years after completion
of the primary courseUnder 10 years DTaP/IPV
or dTaP/IPVOver 10 years if last dose of polio
vaccine at least 5 years ago, should have IPV
combined with TdThe 2nd booster dose of Td/IPV
10 yrs after 1st booster dose
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Tetanus

• Objective
• Minimum of 5 doses of tetanus-containing vaccine

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Primary

• 3 doses of tetanus-containing product with
  interval of one month between each dose
• Under 10 yearsDTaP/IPV/Hib
• Over 10 years Td/IPV

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Booster 1st boosterUnder 10 years 3 years
after completion of primary course-dTaP/IPV or
DTaP/IPVOver 10 years if last dose of Tetanus
vaccine at least 5 years ago Td/IPV
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• 2nd booster
• Td/IPV 10 years after 1st booster

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Current schedule
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• Primary Immunisations
• Previous DTwP-Hib OPV MenC
• Current DTaP/IPV/Hib MenC
• DTaP/IPV/Hib - Pediacel made by Aventis

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• Pre - School Booster
• Previous DTaP OPV MMR
• Current dTaP/IPV MMR
• (or DTaP/IPV MMR)
• dTaP/IPV - Repevax made by Aventis
• DTaP/IPV - Infanrix-IPV made by GSK

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• School leaving
• Previous Td and OPV
• Current Td/IPV
• Revaxis made by Aventis

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What is the timescale of the changes?

• First supplies week commencing 27th September.
• All GP surgeries and pharmacies will have one
  months stock by 8th October

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Current schedule
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Upcoming issues ?

• MMR booster ?
• Hib booster ?
• BCG ?
• Pertussis ?
• Pneumococcal conjugate ?
• Men C ????

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Effectiveness of meningococcal serogroup C
conjugate vaccine 4 years after introduction
Caroline L Trotter, Nick J Andrews, Edward B
Kaczmarski, Elizabeth Miller, Mary E Ramsay
Lancet 2004 364 365-67