Immunisation a public health issue

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Immunisation - a public health issue

• Judith Moreton
• Programme Manager

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Aims objectives of immunisation

• prevention of serious diseases and their
  complications
• protection of individuals and communities
• containment of outbreaks
• elimination of certain diseases, e.g. tetanus
• eradication of diseases, e.g. smallpox (1980)
  polio (target date 2005)

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World situation

• World Health Organization (WHO) - Expanded
  Programme on Immunization (EPI) 1974
• six target diseases diphtheria, tetanus,
  pertussis, polio, measles tuberculosis
• inequity to vaccination programmes RD
  funding of new existing vaccinesimmunisation
  safetyState of the Worlds Vaccines and
  Immunization, WHO, 2002

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Decisions to introduce a vaccine

• is the disease important enough?
• can a safe and effective vaccine be produced?
• is it acceptable to recipients, their parents or
  carers?
• is it cost effective?
• can enough people in the target group be
  immunised to make the programme effective?

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Different types of vaccines

• Inactivated vaccineskilled whole organisms e.g.
  pertussisinactivated bacterial toxins, e.g.
  diphtheria tetanusacellular vaccine e.g.
  pertussis
• Polysaccharide vaccinesplain polysaccharide
  e.g. pneumococcal for over 2spolysaccharide
  conjugate e.g. Hib, MenC
• Live attenuated e.g. MMR, polio BCG
• Combination vaccines e.g. DTP-Hib, MMR

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Development of safe, effective vaccines

• Pre-clinical trials
• volunteers and protocols
• clinical trialsPhase I studiesPhase II
  studiesPhase III studies
• licensure
• immunisation policy

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Monitoring vaccine safety

• routine testing before release
• Phase lV studies - Post-Licensing Evaluation
• Yellow card system
• studies of vaccine safety cohort
  studies case-control studies record linkage

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Contraindications precautions

• Contraindications severe local or systemic
  reactions to preceding doseslive vaccines
  because of disease temporary contraindications
  live vaccines in the immunosuppressed due to
  treatment - chemotherapy, radiotherapy, high dose
  corticosteroids, organ transplantation with
  concurrent immunosuppressive treatment
• Precautionsincreased risk of reaction or
  compromised immunity

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Adverse events

• all medicines, including vaccines can cause
  adverse events
• three general categorieslocalsystemicallergic
• real v myth

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Benefits and risks

• the benefit of the vaccination outweighs the risk
  of the disease and associated morbidity and
  mortality
• the risk of adverse events to an immunisation
  outweighs the risk of the disease and associated
  morbidity and mortality

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Successful immunisation

• production of a safe and effective vaccine
• maintaining cold chain from point of manufacture
  to administration
• ordering and storage
• consent
• injection into correct site using the correct
  technique
• ? Immune response in individual

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Public professional knowledge

• Bi-annual tracking of mothersknowledge about
  immunisationattitudes towards immunisationexperi
  ence of immunisation servicesresponse to
  advertising using key indicators
• annual health professional surveyimpact of
  publicityawareness evaluation of
  materialsassessing the needs of GPs, practice
  nurses health visitors

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Information

• Resourcesleaflets, factsheets, FAQs, websites,
  green book, posters, videosprofessional mailings
  - CMO letters/updates
• Advertising TV radio, parent and professional
  journals, newspapers
• press public relations

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Professional responsibility

• responsibility of being reliably informed
• responsibility of not just simply providing the
  facts, but of our own informed opinion and
  support for immunisation
• responsibility for promoting immunisation as the
  most important of all medical interventions

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It is every childs right to be protected against
infectious disease. No child should be denied
immunisation without serious thought as to the
consequences, both for the individual child and
for the community