Hib vaccine for younger children – booster campaign

2007 to 2009Adapted, with permission, for use in Scotland from materials produced by the Department of Healthhttp://www.immunisation.nhs.uk/files/hib_presentation_handouts.pdf .

Haemophilus influenzae type b • Bacterial infection of young children• 60% of invasive cases have meningitis +/- bacteraemia

– 5% case fatality rate– 15-30% neurological complications

• 10% septicaemia• Pneumonia, septic arthritis, osteomyelitis, pericarditis,

cellullitis, epiglotitis

Immunisation & epidemiology

• 1992: Hib vaccine introduced → dramatic fall in cases

• 1999 start of low level increase in cases → need for booster campaign

• 2003: booster campaign for children 6 months to 4 years

• September 2006: Introduction of routine booster at 12 months (Hib/MenC)

Cohort being targeted

• Children born 4 April 2003 to 3 September 2005

• Children born on or after 4 April 2003 – as they are too young to have had a booster in the 2003 booster campaign

• Children born on or before 3 September 2005- as they are too old to have received the new Hib/MenC booster at 12 months

Rationale

• Children being targeted will have lower levels of Hib immunity

• Their risk is greater in relative terms than older or younger children who have received a booster

• Absolute risk for this cohort is 30 cases across UK

• JCVI recommendation

JCVI Feb 2007

• Reviewed incidence of Hib disease in 3-4 year olds and older

• More than expected

• Fall in children targeted in 2003 booster campaign

• But no strong herd effect

Summary of campaign• Starts 5 November 2007; ends 3 March 2009

• For most of the cohort, PSB vaccine will change to product containing Hib

• Children who have already had PSB – recall for Hib/MenC

• Bring forward timing of routine PSB to 3 years after primary course completed

Rationale for schedule

• Adding Hib to PSB avoids extra injections & ensures higher coverage

• All children should be offered PSB at age recommended in Green Book because:– It’s best practice– Otherwise youngest children in cohort

wouldn’t receive Hib booster until 2010– The only alternative to delay would be a

separate catch-up campaign

A locally phased campaign

• Lowering the age for PSB will be phased in – By local agreement as there is variation in

the age at which PSB is currently given

• Temporary increase in clinic capacity will be needed

Routine

• By the end of the campaign it will become routine to call children for PSB at 3 yrs 4 months – 3yrs 6 months

• Children who finish primary imms late should have PSB a min of 1 year later

Vaccines to be used:

• Hib/MenC for children who have already received PSB

• Infanrix-IPV+Hib for the main body of children due their PSB

• Pediacel if absolutely necessary

Use of Infanrix-IPV+Hib

• Use of Infanrix-IPV+Hib strongly recommended to conserve stocks of Pediacel for primary immunisation

• Infanrix-IPV+Hib should not be used for primary immunisation as it has 3 component aP and doesn’t offer the same protection as the 5 component aP in Pediacel

Re “off-label” use:

• Infanrix-IPV+Hib SPC states upper age of 36 months

• Expert review by JCVI takes precedence

• NB Pediacel is frequently used off-label

Infanrix-IPV+Hib

• Single dose pack

• Pre-filled syringe and vial contained Hib portion as powder

• Green + blue needles included

Vaccine supply issues

• Infanrix-IPV+Hib, Menitorix & Pediacel should be ordered in the usual way

• Local stocks of Repevax and Infanrix IPV should be depleted by 5 November launch

Adverse reactions

• aP vaccines less reactogenic than wP, but, booster doses of aP after priming with aP, associated with an increase in local reactions

• Reaction usually develop within 24 hours and settle within 5 days – can be mistaken for cellulitis

• More of a problem with 5th dose than 4th

• Increased local reaction expected with any aP booster

• First children primed with aP due for PSB in late 2007

Resources

• PGDs – will be updated locally

• Leaflets for parents and a Q&A factsheet

• Updated Health Scotland websitewww.healthscotland.com/immunisation/

Children in cohort who may have already had a dose of Hib-containing vaccine over the age of 12 months

• See Green Book page 132– “…one dose of Hib is effective from one

year of age…”

– Therefore no further Hib booster required