Immunisation - a public health issue

Judith Moreton Programme Manager

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)

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: R&D &
funding of new & existing vaccines immunisation safety
State of the Worlds Vaccines and Immunization, WHO, 2002

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?

Inactivated vaccines: killed whole organisms e.g. pertussis inactivated bacterial toxins, e.g. diphtheria & tetanus acellular vaccine e.g. pertussis Polysaccharide vaccines plain polysaccharide e.g. pneumococcal for over 2s polysaccharide conjugate e.g. Hib, MenC Live attenuated e.g. MMR, polio & BCG Combination vaccines e.g. DTP-Hib, MMR

Different types of vaccines

Development of safe, effective vaccines

Pre-clinical trials volunteers and protocols clinical trials Phase I studies Phase II studies Phase III studies licensure immunisation policy

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

Contraindications & precautions

Contraindications: severe local or systemic reactions to preceding doses live 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 Precautions: increased risk of reaction or compromised immunity

Adverse events
all medicines, including vaccines can cause adverse events three general categories: local systemic allergic real v myth

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

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

Public & professional knowledge

Bi-annual tracking of mothers:
knowledge about immunisation attitudes towards immunisation experience of immunisation services response to advertising using key indicators

annual health professional survey: impact of publicity awareness & evaluation of materials assessing the needs of GPs, practice nurses & health visitors

Information
Resources: leaflets, factsheets, FAQs, websites, green book, posters, videos
professional mailings - CMO letters/updates

Advertising: TV & radio, parent and professional journals, newspapers press & public relations

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

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