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Vaccination and Immunisation Jane Renton Principal Pharmacist NHS Lothian
<ul><li>“  The two public health interventions that have had the greatest impact on the worlds health are clean water and ...
History of Vaccination <ul><li>1796 -Jenner – cowpox </li></ul><ul><li>1885 - Pasteur – cholera, diphtheria, chickenpox, r...
Terminology! <ul><li>Vaccination: the process of administering a vaccine </li></ul><ul><li>Immunisation: the process of in...
Immunity <ul><li>Active </li></ul><ul><li>An antibody response formed by the body </li></ul><ul><li>Induced by vaccine or ...
Why immunise? <ul><li>To prevent or protect against serious disease </li></ul><ul><li>To eliminate a particular disease fr...
<ul><li>However it is not possible to eradicate all vaccine-preventable diseases: </li></ul><ul><ul><li>Asymptomatic carri...
Population (herd) immunity <ul><li>“ Population immunity is the state achieved when immunisation programmes reach sufficie...
Herd Immunity <ul><li>Protects people unable to be vaccinated i.e too young, have health problems, pregnant. </li></ul><ul...
UK Vaccination Guidance <ul><li>JCVI </li></ul><ul><li>WHO </li></ul><ul><li>DOH & SGHD </li></ul><ul><li>EU </li></ul><ul...
Vaccine preventable diseases (bacterial) <ul><li>Diptheria   </li></ul><ul><li>Haemophilus influenzae B  (Hib)   </li></...
Vaccine preventable diseases (viral) <ul><li>Chickenpox </li></ul><ul><li>‘flu   </li></ul><ul><li>Measles    </li></ul>...
UK Childhood Vaccination  schedule <ul><li>When to immunise  What is given </li></ul><ul><li>2 months old  DTaP/IPV/Hib (P...
SIRS <ul><li>Scottish Immunisation Recall System </li></ul><ul><li>File opened at birth </li></ul><ul><li>Should have comp...
Successes <ul><li>Efficacy of National Childhood Immunisation Programme </li></ul><ul><ul><li>Cases of Measles notified in...
Challenges <ul><li>Breaking down barriers to immunisation uptake. </li></ul><ul><li>Cold chain issues </li></ul><ul><li>Pr...
Barriers to Immunisation Uptake
Barriers to Immunisation Uptake <ul><li>Poor information/ misconceptions/ myths </li></ul><ul><li>Conflicting advice: fami...
Poor information/ misconceptions/ myths <ul><li>Misconceptions have always been around  e.g </li></ul><ul><ul><li>Vaccines...
 
Conflicting advice: family, media etc <ul><li>Provocative media headlines </li></ul><ul><ul><li>e.g   “Autism: new risk in...
 
Inconvenience: e.g time, system inflexibility <ul><li>Working parents have difficulty in attending fixed daytime immunisat...
Vaccine supply issues <ul><li>Can affect uptake of immunisation </li></ul><ul><ul><li>Clinics cancelled – patients forget ...
Vaccine Production <ul><li>Two main stages </li></ul><ul><ul><li>Biological  - antigen preparation </li></ul></ul><ul><ul>...
Cold Chain <ul><li>System of transporting and storing vaccines within the recommended temperature range of  2 – 8 0 C </li...
Why is the cold chain important? <ul><li>Effectiveness of vaccines cannot be guaranteed if exposed to temperature extremes...
Risks associated with incorrect vaccine storage <ul><li>Financial </li></ul><ul><ul><li>Vaccine costs/ disposal costs </li...
Risks associated with incorrect vaccine storage <ul><li>Risk to patient </li></ul><ul><ul><li>Risk of acquiring infection ...
Immunisation administration errors <ul><li>e.g. Administration of the wrong vaccine </li></ul><ul><li>Administration of ex...
Travel Vaccines
Travel Vaccination <ul><li>Increased risk of transmission of infectious disease due to dramatic    in global travel </li>...
Travel Vaccines <ul><li>Cost – is an area of much debate!. </li></ul><ul><li>Some vaccines can be prescribed on a GP10 </l...
And finally…. <ul><li>“  Protection from infectious diseases is one of the greatest benefits that any government can ensur...
References and Resources <ul><li>‘ The Green Book’,  www.dh.gov.uk   </li></ul><ul><li>www.immunisation.nhs.uk </li></ul><...
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Vaccination and immunisation jane renton - principal pharmacist - nhs lothian

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Vaccination and immunisation
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Jane Renton - Principal Pharmacist
NHS Lothian

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Vaccination and immunisation jane renton - principal pharmacist - nhs lothian

  1. 1. Vaccination and Immunisation Jane Renton Principal Pharmacist NHS Lothian
  2. 2. <ul><li>“ The two public health interventions that have had the greatest impact on the worlds health are clean water and vaccines” WHO </li></ul>
  3. 3. History of Vaccination <ul><li>1796 -Jenner – cowpox </li></ul><ul><li>1885 - Pasteur – cholera, diphtheria, chickenpox, rabies </li></ul><ul><li>1911 - first typhoid vaccine </li></ul><ul><li>1927 - first tetanus vaccine </li></ul><ul><li>1931 - Calmette & Guerin – first crude BCG </li></ul><ul><li>1936 - influenza </li></ul><ul><li>Modern era of vaccination </li></ul><ul><li>1940 - diphtheria national programme in UK </li></ul><ul><li>1950’s - polio, pertussis, modern BCG </li></ul><ul><li>1960’s - measles, mumps & rubella, modern tetanus </li></ul><ul><li>1980’s - H. Influenzae B (Hib) </li></ul><ul><li>2000’s - Meningitis C, Human papilloma virus (HPV) </li></ul>
  4. 4. Terminology! <ul><li>Vaccination: the process of administering a vaccine </li></ul><ul><li>Immunisation: the process of inducing immunity to disease </li></ul><ul><li>Immunity is usually acquired naturally, but can be induced by vaccination </li></ul>
  5. 5. Immunity <ul><li>Active </li></ul><ul><li>An antibody response formed by the body </li></ul><ul><li>Induced by vaccine or natural infection </li></ul><ul><li>Passive </li></ul><ul><li>Antibody is donated </li></ul><ul><li>e.g. immunoglobulin or maternal antibody passed to infant </li></ul>
  6. 6. Why immunise? <ul><li>To prevent or protect against serious disease </li></ul><ul><li>To eliminate a particular disease from a defined population </li></ul><ul><li>To eradicate a disease entirely e.g. smallpox </li></ul>
  7. 7. <ul><li>However it is not possible to eradicate all vaccine-preventable diseases: </li></ul><ul><ul><li>Asymptomatic carriage </li></ul></ul><ul><ul><li>Mutating organisms e.g. influenza </li></ul></ul><ul><ul><li>Animal reservoirs e.g. SARS, avian influenza </li></ul></ul><ul><ul><li>Environmental reservoirs e.g. tetanus </li></ul></ul><ul><ul><li>Global travel/mass immigration </li></ul></ul>
  8. 8. Population (herd) immunity <ul><li>“ Population immunity is the state achieved when immunisation programmes reach sufficiently high coverage of the target population to interrupt transmission within the community” </li></ul><ul><li>Depends on: </li></ul><ul><ul><li>Degree to which disease is infectious </li></ul></ul><ul><ul><li>Efficacy of vaccines </li></ul></ul><ul><ul><li>Vulnerability of population </li></ul></ul><ul><ul><li>Environmental factors </li></ul></ul>
  9. 9. Herd Immunity <ul><li>Protects people unable to be vaccinated i.e too young, have health problems, pregnant. </li></ul><ul><li>Thresholds (% of population that needs to be immune) are quite high. </li></ul><ul><ul><li>Polio 80-86% </li></ul></ul><ul><ul><li>Diphtheria 85% </li></ul></ul><ul><ul><li>Measles 95% </li></ul></ul>
  10. 10. UK Vaccination Guidance <ul><li>JCVI </li></ul><ul><li>WHO </li></ul><ul><li>DOH & SGHD </li></ul><ul><li>EU </li></ul><ul><li>HB </li></ul><ul><li>SIRS SUPPLIES </li></ul>
  11. 11. Vaccine preventable diseases (bacterial) <ul><li>Diptheria  </li></ul><ul><li>Haemophilus influenzae B (Hib)  </li></ul><ul><li>Meningococcal (meningitis)  </li></ul><ul><li>Pneumococcal disease  </li></ul><ul><li>Tetanus  </li></ul><ul><li>Tuberculosis  </li></ul><ul><li>Whooping cough (pertussis)  </li></ul>
  12. 12. Vaccine preventable diseases (viral) <ul><li>Chickenpox </li></ul><ul><li>‘flu  </li></ul><ul><li>Measles  </li></ul><ul><li>Mumps  </li></ul><ul><li>Polio  </li></ul><ul><li>Rubella  </li></ul><ul><li>HPV  </li></ul>
  13. 13. UK Childhood Vaccination schedule <ul><li>When to immunise What is given </li></ul><ul><li>2 months old DTaP/IPV/Hib (Pediacel) & PCV (Prevenar 13) </li></ul><ul><li>3 months old DTaP/IPV/Hib (Pediacel) & Men C </li></ul><ul><li>4 months old DTaP/IPV/Hib (Pediacel) & PCV & MenC </li></ul><ul><li>Between 12 and Hib/ Men C & PCV & MMR </li></ul><ul><li>13 months old </li></ul><ul><li>3 years and 4months or dTaP/IPV or DTaP/IPV & </li></ul><ul><li>As soon after. MMR </li></ul><ul><li>13 to 18 years old Td/IPV (Revaxis) </li></ul><ul><li>Girls aged 12-13yrs HPV (Cervarix) </li></ul>
  14. 14. SIRS <ul><li>Scottish Immunisation Recall System </li></ul><ul><li>File opened at birth </li></ul><ul><li>Should have complete immunisation record up to school leaving </li></ul><ul><li>Records immunisations which are scheduled </li></ul><ul><li>Unscheduled attendee form to be completed for all non-recall vaccinations </li></ul>
  15. 15. Successes <ul><li>Efficacy of National Childhood Immunisation Programme </li></ul><ul><ul><li>Cases of Measles notified in under 15’s in Scotland  from over 12,000 in 1976 to 147 in 2007. </li></ul></ul><ul><ul><li>Rubella  from 6,000 cases in 1989 to 131 in 2007. </li></ul></ul><ul><ul><li>Pertussis  from 4,000 cases in 1982 to 62 in 2007. </li></ul></ul><ul><ul><li>Data: ISD </li></ul></ul>
  16. 16. Challenges <ul><li>Breaking down barriers to immunisation uptake. </li></ul><ul><li>Cold chain issues </li></ul><ul><li>Preventing immunisation errors </li></ul>
  17. 17. Barriers to Immunisation Uptake
  18. 18. Barriers to Immunisation Uptake <ul><li>Poor information/ misconceptions/ myths </li></ul><ul><li>Conflicting advice: family, media etc </li></ul><ul><li>Inconvenience: time, transport, lack of flexibility in system </li></ul><ul><li>Vaccine supply issues </li></ul>
  19. 19. Poor information/ misconceptions/ myths <ul><li>Misconceptions have always been around e.g </li></ul><ul><ul><li>Vaccines can give you the infection e.g ‘flu </li></ul></ul><ul><ul><li>Multicomponent vaccines overload the immune system </li></ul></ul><ul><ul><li>Giving vaccines singly is safer </li></ul></ul><ul><ul><li>Risk from vaccine is worse than the infection – no-one dies these days from measles! </li></ul></ul><ul><ul><li>etc.etc.etc………….. </li></ul></ul>
  20. 21. Conflicting advice: family, media etc <ul><li>Provocative media headlines </li></ul><ul><ul><li>e.g “Autism: new risk in NHS vaccine” ( Scotsman 13 March 2004 ) </li></ul></ul><ul><ul><li>Anecdotal parental reports of autism after MMR vaccination </li></ul></ul><ul><li>Emotional impact – creates confusion/ concern in parents </li></ul><ul><li>Once damage done is difficult to rectify despite evidence </li></ul>
  21. 23. Inconvenience: e.g time, system inflexibility <ul><li>Working parents have difficulty in attending fixed daytime immunisation clinics. </li></ul><ul><li>Yellow fever vaccines only available from designated clinics </li></ul><ul><li>Changes being made – ‘flu clinics on Saturdays, Community pharmacies undertaking ‘flu vaccines. </li></ul>
  22. 24. Vaccine supply issues <ul><li>Can affect uptake of immunisation </li></ul><ul><ul><li>Clinics cancelled – patients forget to return for next dose </li></ul></ul><ul><ul><li>Increased number of injections having to be given puts people off! </li></ul></ul>
  23. 25. Vaccine Production <ul><li>Two main stages </li></ul><ul><ul><li>Biological - antigen preparation </li></ul></ul><ul><ul><li>Pharmaceutical - ready to use product </li></ul></ul><ul><li>Production cycles are long </li></ul><ul><ul><li>Tetanus vaccine - 9-10 months </li></ul></ul><ul><ul><li>Diphtheria vaccine - 11 months </li></ul></ul><ul><li>Rigorous QA checks </li></ul>
  24. 26. Cold Chain <ul><li>System of transporting and storing vaccines within the recommended temperature range of 2 – 8 0 C </li></ul>
  25. 27. Why is the cold chain important? <ul><li>Effectiveness of vaccines cannot be guaranteed if exposed to temperature extremes. </li></ul><ul><li>Ensures compliance with manufacturers’ SPC/MA </li></ul><ul><li>Provides assurance/ confidence in potency of the product </li></ul><ul><li>Ensures patient obtains maximum benefit from immunisation </li></ul>
  26. 28. Risks associated with incorrect vaccine storage <ul><li>Financial </li></ul><ul><ul><li>Vaccine costs/ disposal costs </li></ul></ul><ul><ul><ul><li>Repevax £11.98/dose </li></ul></ul></ul><ul><ul><ul><li>Revaxis £7.25/dose </li></ul></ul></ul><ul><ul><ul><li>Pediacel £19.94/dose </li></ul></ul></ul><ul><ul><ul><li>Infanrix IPV £18.88/dose </li></ul></ul></ul><ul><ul><ul><li>Prevenar £34.50/dose </li></ul></ul></ul><ul><ul><ul><li>Cervarix /Gardasil £80.50/dose </li></ul></ul></ul>
  27. 29. Risks associated with incorrect vaccine storage <ul><li>Risk to patient </li></ul><ul><ul><li>Risk of acquiring infection due to ineffective vaccination </li></ul></ul><ul><ul><li>Risks associated with possible re-vaccination </li></ul></ul><ul><li>Risk to NHS/ Healthcare professionals </li></ul><ul><ul><li>Loss of confidence in service </li></ul></ul>
  28. 30. Immunisation administration errors <ul><li>e.g. Administration of the wrong vaccine </li></ul><ul><li>Administration of extra/ unnecessary </li></ul><ul><li>vaccines </li></ul><ul><li>Administration of out of date vaccines </li></ul><ul><li>Most are avoidable! </li></ul><ul><li>All should be reported using medication incident reporting systems </li></ul><ul><li>Reports should be reviewed and analysed </li></ul>
  29. 31. Travel Vaccines
  30. 32. Travel Vaccination <ul><li>Increased risk of transmission of infectious disease due to dramatic  in global travel </li></ul><ul><li>Study revealed 67% of travellers to high/medium risk areas had not taken medical advice </li></ul><ul><li>Need consultation at least 1 month before travel </li></ul><ul><li>Are two compulsory vaccinations – yellow fever/ meningitis </li></ul>
  31. 33. Travel Vaccines <ul><li>Cost – is an area of much debate!. </li></ul><ul><li>Some vaccines can be prescribed on a GP10 </li></ul><ul><ul><li>Td/IPV, MMR, Hep A, typhoid </li></ul></ul><ul><li>Others require private prescription </li></ul><ul><ul><li>Rabies, Japanese encephalitis, tick borne encephalitis, yellow fever </li></ul></ul>
  32. 34. And finally…. <ul><li>“ Protection from infectious diseases is one of the greatest benefits that any government can ensure for each generation” </li></ul><ul><li>KA Annan </li></ul>
  33. 35. References and Resources <ul><li>‘ The Green Book’, www.dh.gov.uk </li></ul><ul><li>www.immunisation.nhs.uk </li></ul><ul><li>www.hps.scot.nhs.uk </li></ul><ul><li>www.immunisationscotland.org.uk </li></ul><ul><li>www.uvig.org (UK Vaccine Industry Group) </li></ul><ul><li>www.hpa.org.uk </li></ul>

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