Childhood Immunisations

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About the vaccines

DTaP (Diphtheria, Tetanus and Pertussis) (2, 3, 4 and 40-60 months)

  • Diphtheria is a toxoid vaccine, as is the tetanus component
  • Pertussis vaccine is made from highly purified selected (antigenic) components of the Bordatella pertussis organism
  • The vaccine is produced by treating with formaldehyde, to fix, and an adjuvant (e.g. aluminium phosphate or aluminium hydroxide) to increase its antigenicity
  • NB This vaccination does not prevent the transmission of the organisms concerned
  • There is a very small increased risk of febrile seizure after the DTaP BUT NO INCREASED RISK OF EPILEPSY
    • If a patient has a full blown seizure after the first/second vaccination, it is a reasonable contraindication for further DTaP vaccinations

IPV (inactivated polio vaccine) (3, 4 and 40-60 months)

  • Also called the Salk vaccine
  • Contains inactivated strains of polioviruses 1-3.
    • The inactivated vaccine carries no risk of causing vaccine associated paralytic polio (of which there is a tiny risk using the oral polio vaccine)
      • However, it doesn’t effectively induce immune sensitisation in the gut, and so is less effective at protecting against wild-type polio which can be introduced in the GI tract
  • NB The OPV is more effective and more widely used in outbreaks/epidemics of polio (this includes vaccination of contacts of polio).  However, the OPV should not be given to immunodeficient patients at risk of the disease.
  • NB This vaccine does not prevent transmission of the virus

Hib (Haemophilus influenzae type B) (2, 3, 4 and 12-13 months)

  • Composed of capsular polysaccharide from cultured H Influenzae type B bacteria, conjugated to protein.
  • The efficacy is around 94-100% and the vaccine also reduces nasopharyngeal carriage and therefore confers herd immunity.

Pneumococcal Conjugate Vaccine (PCV) (2, 4 and 12-13 months)

  • Composed of purified capsular polysaccharide from 13 types of pneumococcus conjugated to an antigenic protein combined again with adjuvant
  • NB This is not the same as the adult pneumococcal vaccine, which contains polysaccharide from 23 strains, but does not have them bound to protein (and thus, in young children <2, it does not induce an immune response)
  • Occasionally children may feel a bit unwell for a day or two after the vaccination.  This should settle and advice is for antipyretics, fluids and rest as required

Rotavirus vaccine (2 and 3 months)

  • Attenuated live vaccine against rotavirus
  • Small risk of intussusception (look out for unwell, tummy ache, vomiting, and abnormal ‘redcurrent jelly’ stools:- emergency)
    • More commonly children feel a bit unwell, and occasionally diarrhoea

Meningitis C vaccine (3, 12-13 months and 12-18 years)

  • Comes as part of the Hib/MenC conjugate vaccination- inactivated vaccine
  • Very effective (95%)
  • Can cause fever and vomiting in a minority (again, supportive care until this resolves)
    • Very rarely, the MenC vaccine can be associated with fainting, seizures and numbness/hypotonia

Mumps, Measles and Rubella vaccine (12-13 months and 40-60 months)

  • Attenuated live vaccine containing all three viruses.  It does not contain any thiomersal or other preservatives.
  • Very effective against rubella (95%); effective in measles (~90%) and mumps (80-90%)
  • It is not uncommon for the child to feel unwell, mild fever, vomiting/diarrhoea a week or so after the vaccination (local reaction is also common as with other vaccinations)
    • It is rare to cause anything else (occasionally febrile seizures)
      • Although there is a technical risk of meningitis given the vaccine is live, this has only been shown to occur in several cases traced to one strain in Finland- never in UK)
  • NB Whilst the MMR contains traces of egg, it has not been shown to be significant to cause reactions in children who are allergic (i.e. safe)

A note about MMR and autism.  After much research, no significant evidence has been produced that supports a link between MMR and autism.  It is ultimately the parents’ decision as to whether their child receives a vaccination.  As a doctor, you may present them with the information they need to make an informed decision, and you should respect their wishes.

HPV (12-13 years in girls)

  • Contain virus-like particles for HPV virus strains
    • Note that the vaccine offered in the UK contains VLPs for HPV types 16 and 18, which cause over 70% of all cervical cancers
      • There is also a quadrivalent vaccine which covers types 6 and 11 also
  • There is no risk of catching warts/cancer from the vaccine, and side effects (other than local reactions) are rare.
    • The vaccine is very effective (99% at preventing lesions)
  • Initially, there was some controversy over the age at which girls were being offered this vaccine (some parents felt that, because this was essentially a sexually transmitted disease, this was too young).
    • It is important to reassure parents that girls should be vaccinated before sexual activity- and that the option of later vaccination is possible should this be requested.

Counselling parents about vaccinations

  • In general, most parents will be happy for their child to receive vaccinations and will have questions about what to expect after (and any potential side effects)
  • If a parent has specific concerns:
    • Listen to the concern in full; it is a good idea to wait to the end of this and explain the vaccination in full afterwards, paying attention to the concerns, before answering any questions at the end (avoids repeating/confusing)
    • It is a good idea to explain that vaccines are continually being monitored for safety; do explain the local and common side effect with all vaccines
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