Amendments to the childhood immunisation schedule for Hib/MenC are highlighted by Sandra Wolper and David Green


The UK childhood immunisation schedule summarises the vaccines to be administered for the childhood programme and is available on the NHS immunisation website (www.immunisation.nhs.uk) and in the Green Book from the Department of Health (DH) website (www.dh.gov.uk).1 However the current variations in the vaccination programme introduced to phase in amendments to the schedule are not clearly highlighted. It is therefore necessary to dig deeper to establish current DH requirements.

Hib immunisation

We are currently in a catch-up phase of Hib immunisation. Children born between 13 March 2003 and 3 September 2005 were not offered the Hib booster dose, being too young to receive it as part of the 2003 Hib catch-up campaign and too old to receive the Hib/MenC booster scheduled at 12 months. The Joint Committee on Vaccination and Immunisation recommended that these children should be offered a Hib booster to protect them further through childhood in line with the protection offered to older and younger children. To minimise disruption it was proposed that these children should receive the Hib booster with the preschool booster. This campaign started on 10 September 2007 and will continue until March 2009.2

This information is not highlighted on the NHS immunisation website. The letter PL/CMO2007/5 of 23 July 2007 informing professionals about the campaign can however be found at www.immunisation.nhs.uk/Professional_Information/CMO_letters.2

At the introduction of the campaign, Infanrix-IPV+Hib®, a newly licensed combination vaccine, was made available as first choice to enable children to receive their preschool booster of diphtheria, pertussis, tetanus, polio with Hib as a single injection. Pediacel® was suggested as an alternative. These children also receive a second injection of the measles, mumps, and rubella vaccine at the same time.

However, due to pressure on the supply chain the DH issued further advice, dated 16 May 2008, which changed the actual vaccines to be given, requiring two injections instead of one.3 This advised that if local supplies of Infanrix-IPV+Hib were exhausted, practices should use two injections, combining the usual preschool booster (Repevax® or Infanrix-IPV), with an additional injection of Menitorix® (Hib/MenC) for the Hib component. Pediacel, the vaccine used for primary immunisation, was still an alternative but this has now put pressure on stocks of this vaccine. Consequently the DH has restricted supplies of all these vaccines and is allocating supplies to each practice based on historic usage.4

Keeping up to date

The DH produces a monthly electronic newsletter, Vaccine Update, which all general practices should be receiving. It includes up-to-date information on vaccine supply, immunisation policy, information resources, and vaccine ordering. To subscribe, email vaccine.supply@dh.gsi.gov.uk. Previous copies are also available on the NHS immunisation website at www.immunisation.nhs.uk/Professional_Information/Vaccine_Update.

This sequence of events illustrates the difficulties in keeping abreast of changes to the standard schedules as published on the immunisation website. All staff involved in immunisation must have good access to the latest information and support from local networks, which should include the local Immunisation Co-ordinator, the Health Protection Agency contact and PCT pharmacist responsible for community health services.

Patient group directions

One reason for including the key pharmacist is the growing use of patient group directions (PGDs) in the immunisation programme. This is another area where ensuring the availability of up-to-date information is a challenge. The PGDs must be adapted to reflect the types of changes already mentioned. Throughout these changes it is important that all practices supplying and administering vaccines for the childhood programme are working within the law and maintaining good professional practice. If practice nurses are working with PGDs, these directions should be written to allow the practice nurses to work flexibly within their competencies using their skills and knowledge to select appropriate vaccines to immunise the practice population.

The PGD website has examples of good practice (www.portal.nelm.nhs.uk/PGD/default.aspx), and there are also answers to frequently asked questions on various aspects of PGDs including, for example, ‘can supply or administration be delegated to another practitioner under a PGD?’ and on using PGDs in the private sector. These questions and associated governance issues, are currently very important as we move to practice-based commissioning, commissioner/provider splits, and with new providers evolving, including independent and charitable organisations.

Conclusion

The key messages from this are that immunisation issues are frequently being reviewed and changes implemented. Even recognised websites may not be totally dependable sources of information unless you know how to navigate around them. Use local leads to ensure that your needs are being addressed and ensure that you have access to pharmacist expertise. This is, after all, a legal requirement for PGDs.

 

  1. Department of Health. Immunisation against infectious disease—The ‘Green Book’.http://www.dh.gov.uk/en/Publichealth/Healthprotection/Immunisation/Greenbook/DH_4097254. Last modified 26 June 2008.
  2. Department of Health. Haemophilus influenzae type B (Hib) vaccine for young children—catch-up programme. London, DH: 2007.www.immunisation.nhs.uk/Professional_Information/CMO_letters/
  3. Department of Health. Vaccine supply for primary immunisation. Letter G9934, 16 May. London: DH, 2008.
  4. Department of Health. Vaccine Update. Issue 148, June 2008. London: DH, 2008.G