Starting school: Is your child fully vaccinated?

As the new school year starts, with children about to start school for the first time, many parents will have a list of things needed for the big day: haircut, new shoes, school bag, etc. This is an exciting time for families. One important thing for the list is whether their child needs any vaccines. As children starting school will be mixing in larger numbers, the risk of catching infections increases.

Fortunately, although unpleasant, most of these such as cough and colds will be mild even if they are frequent! However, where numbers of unvaccinated children gather, there is also a risk of outbreaks of more serious infections.

Measles is top of the list of potentially serious infections where outbreaks are likely. This is because it is so highly infectious – considered the most infectious – and, to prevent outbreaks, very high uptake (95%) of two doses of measles, mumps, rubella (MMR) vaccine are needed. Unfortunately, this target vaccine uptake has never been met in the UK and current MMR vaccine uptake is the lowest for a decade: 2 in every 10 children in England have not had two doses of vaccine. In London, this figure is as high as ¼ of 5-year-olds entering school, while in some parts of the capital as many as a half of children are not fully vaccinated (NHS Digital 2023).

The situation is such in London that UKHSA has advised that, based on current vaccine uptake, there is the potential for an outbreak of between 40,000 and 160,000 cases (UKHSA 2023). These numbers make it inevitable that there would be many hospital admissions for measles, with complications such as pneumonia and encephalitis as well as deaths. Although large outbreaks are less likely in the country as a whole, there is this possibility where there are pockets of susceptible children, young people and adults.

So, what can be done? Fortunately, we have the means to prevent measles outbreaks through MMR vaccination. It is easy to check children’s vaccination status, by either looking at their red book or, if not available, checking with the GP surgery. Where vaccines are missing, they can be caught up at the GP surgery. Even though vaccines may have been missed at younger ages, for most there is no upper age limit, they can be caught up at any age. This does not require starting the course all over again – they just need the missing vaccines. Older children and young adults are also recommended to have had two doses of MMR vaccine, particularly those who are starting university in the next few months. This is particularly important as many young people missed out on their vaccines when they were young, and we have seen many cases of measles in recent outbreaks in this age group when disease is often more severe.

Don’t forget to also remind parents about the pre-school-booster vaccine. Usually offered at 3 years 4 months along with the second dose of MMR vaccine. This boosts immunity to diphtheria, tetanus, whooping cough and polio through the early school years and is an important part of the vaccine schedule.

Professor Helen Bedford – Professor of Children’s Health, Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health

References

Also see:

Parent Tips

PT – Childhood Immunisations Part 1: An introduction to childhood immunisations
This Parent Tip provides some useful information on the childhood vaccination programme, explaining how vaccines work, how they are regulated and why it is important to ensure that your baby receives all the recommended immunisations.
PT – Childhood Immunisations Part 2: Frequently asked questions
It is natural to have questions about your baby’s immunisations. This second part of our Parent Tip series on immunisations provides answers to “Frequently Asked Questions” and has been written by leading national experts. It covers FAQs on getting your baby immunised and what to expect, including information on things such as soothing your baby during and after vaccinations, and what to do if they are poorly on the day of their appointment.

Good Practice Points

GPP – Promoting the Uptake of Childhood Immunisations
The immunisation programme in the United Kingdom (UK) is a key component of the Healthy Child Programme. It is important for health visitors to be aware of current research and practice to promote immunisation uptake and know where to go for information.

New NICE quality standard – Flu vaccination: increasing uptake

The National Institute for Health and Care Excellence (NICE) has published a new quality standard on increasing the uptake of flu vaccinations among people who are eligible.

The quality standard discusses the following priority areas for improvement:

To use a range or combination of methods, such as phone, face-to-face, or social media communications, to invite people in eligible groups for flu vaccination. Commissioners are encouraged to review their services to make sure systems are in place to accommodate these different methods.
To include information within invitations to vaccination appointments about people’s individual situation or clinical risk. This will help eligible people understand the benefits of having a flu vaccine and why getting flu could be particularly risky for them.
To ensure health records are timely, accurate and consistent in order to improve the accuracy of uptake figures and reduce unnecessary invitations to those who have already had flu vaccinations.
To ensure employers enable health and social care staff who are in direct contact with vulnerable people to have flu vaccinations, including allowing flexibility during shifts.

Go to NICE Quality Standard - Flu vaccination: increasing uptake

PHE and NHS England urge eligible people to get free flu vaccine

Parents of 2 and 3-year olds are urged to protect their children against flu, which can be a serious and fatal illness.

Those aged 65 and over, children and adults with underlying medical conditions and pregnant women are also urged to get their free vaccine in the next few weeks, before flu begins to circulate widely.

The primary schools-based flu vaccination programme is once again underway. This follows a temporary pause in the ordering of the nasal vaccine, which was caused by delays from the manufacturer.

Primary school clinics will be rescheduled as soon as possible and children in high risk groups should visit their GP if their school session has been delayed, to ensure that they are protected early. GPs have now been advised to call in all eligible children for vaccination by early December.

Boys offered free HPV vaccine for the first time

From September 2019, boys in school year 8 will be offered the free Human Papilloma Virus (HPV) vaccine for the first time.

Worldwide, about 5% of all cancers are linked to the HPV virus. This includes cervical, penile, anal and genital cancers and some cancers of the head and neck – all of which the vaccine helps to protect against. Cervical cancer is currently the most common cancer in women under 35, killing around 850 women each year. HPV is thought to be responsible for over 99% of cervical cancers, as well as 90% of anal, about 70% of vaginal and vulvar cancers and more than 60% of penile cancers.

Modelling produced by the University of Warwick estimates that by 2058 in the UK the HPV vaccine currently being used may have prevented up to 64,138 HPV-related cervical cancers and 49,649 other HPV-related cancers. This would be 50 years after the introduction of the HPV vaccination programme, when people who were vaccinated as teenagers have reached the age groups that they would typically be affected by HPV-related cancers.

Girls have been offered the human papilloma virus (HPV) vaccine free from the NHS since 2008. So far, ten million doses of HPV vaccine have been given to young women in this country meaning over 80% of women aged 15-24 have received the vaccine. Since the introduction of HPV vaccination, infections of some types of HPV (HPV 16/18) in 16-21 year old women have reduced by 86% in England. A Scottish study also showed that the vaccine has reduced pre-cancerous cervical disease in women by up to 71%. Similarly, diagnoses of genital warts have declined by 90% in 15-17 year old girls and 70% in 15-17 year old boys due to the HPV vaccine.

Parents of girls and boys aged 12 and 13 should look out for information from their children’s school about the vaccine and timings for the jab. If they miss out on the vaccination for any reason they should talk to their school nurse/immunisation team about getting the vaccine at a later date.

More information about HPV vaccination for parents and their children is available here (see HPV).

MMR vaccination call following high numbers of measles cases

Public Health England (PHE) is calling for all parents to get their children vaccinated against measles, mumps and rubella (MMR) when the vaccine is offered, or for them to take it up now if they didn’t have it at the scheduled time.

In the first quarter of 2019, there were 231 confirmed cases of measles. This figure is slightly lower compared to the same quarter last year. As measles is highly infectious, anyone who has not received two doses of MMR vaccine is at risk, particularly unvaccinated people travelling to countries where there are currently large outbreaks of measles. The recent measles cases are mainly occurring in under-vaccinated communities, particularly those with links to other countries with ongoing measles outbreaks. There has also been some spread into the wider population, such as those who may have missed out on the MMR vaccine when they were younger.

In the final quarter of 2018 94.9% of eligible children aged five received the first dose of MMR. To achieve herd immunity for measles at least 90-95% of the population need to be fully protected. One dose of the MMR vaccine is about 90-95% effective at preventing measles. After a second dose the level of protection is around 99%. Coverage of the second dose is at 87.4% for children aged five. PHE is therefore urging those who have only had one dose to ensure they are fully vaccinated with two doses.

This quarter, 795 cases of mumps have also been confirmed. No new cases of rubella were reported.

The MMR vaccine is given on the NHS as a single injection to babies as part of their routine vaccination schedule, usually within a month of their first birthday. A second injection of the vaccine is given just before starting school, usually at 3 years and 4 months. The vaccine is also available to all adults and children who are not up to date with their two doses. Anyone who is not sure if they are fully vaccinated should check with their GP and those planning to travel to Europe should check NaTHNaC travel health advice.

PHE – National Childhood flu programme 2017 to 2018

Provides information on the flu vaccination programme 2017 to 2018 for children, the vaccine and how to administer it.

This document on the flu vaccination and vaccination programme includes information on:

what flu is
the flu vaccine
dosage
administering the vaccine
advice on vaccinating children with an egg allergy
further resources

In the 2017/18 flu season, flu vaccine should be offered to all children who are aged two to eight years old (but not nine years or older) on 31 August 2017 and to all primary school-aged children in former primary school pilot areas. It should also be offered to children from six months of age in clinical risk groups.

The key changes to the childhood flu programme in the 2017/18 flu season are that:

Reception Year (children aged 4-5 years) will now be offered flu vaccination in their reception class, rather than through general practice
Children in School Year 4 (children aged 8-9 years) will be included in the programme this year as part of the phased roll-out of the children’s programme

Go to PHE National Childhood Flu Programme 2017/18

PHE Guidance – Unlicensed BCG vaccine: guide for parents and carers

From Public Health England – Documents for parents and carers explaining the use of the unlicensed BCG vaccine.

Since late 2015, there has been a global shortage of the BCG vaccine. To protect those at risk Public Health England has secured a limited supply of BCG vaccine for babies who are eligible.

These documents explain why a brand of BGC vaccine without a UK licence is being used and why it is still recommended.

PHE: Unlicensed BCG vaccine: guide for parents and carers

Statement from UK healthcare professionals on the importance of childhood vaccination

The iHV is one of a group of healthcare professionals to sign a letter, issued to all media, including parenting magazines and websites, stressing the safety of vaccinations and the importance of getting children vaccinated.

Statement from UK healthcare professionals on the importance of childhood vaccination

“As healthcare professionals, we want to send a strong message to parents. Having your child vaccinated is the only effective way of protecting them against many serious and potentially fatal diseases. Routine vaccinations are safe and thoroughly tested long before they are made available to the public. Vaccines strengthen our own immune defences against disease.

“Illnesses such as measles, mumps and rubella are serious and can lead to severe life-long
complications and sometimes death, in children and adults. These diseases can be prevented with vaccines. Although most of us have never seen them in our lifetime, they will return if children are not vaccinated. This would be a tragedy that can and must be prevented.

“Vaccinations are safe, effective, and crucial to safeguarding child health.”

Professor Neena Modi, President, Royal College of Paediatrics and Child Health
Dr Cheryll Adams, CBE, Executive Director, Institute of Health Visiting
Professor Simon Capewell, Vice-President for Policy, Faculty of Public Health
Nicola Close, Chief Executive, Association of Directors of Public Health
Janet Davies, Chief Executive and General Secretary, Royal College of Nursing
Professor Lesley Regan, President, Royal College of Obstetricians and Gynaecologists
Professor Helen Stokes-Lampard, Chair of Council, Royal College of General Practitioners
Cathy Warwick, CBE, Chief Executive, Royal College of Midwives

PHE: Reminder on changes to the meningococcal C (MenC) vaccination schedule from 1 July 2016

Public Health England (PHE) reminds that the infant dose of MenC that is normally given at three months of age has now been removed from the childhood immunisation schedule (from 1 July 2016). All children will continue to be offered a combined Hib/MenC vaccine when they reach one year of age. This, along with the adolescent MenACWY vaccination, will help to provide protection across all age groups including infants and children.

There are almost no cases of MenC disease in infants or young children in the UK. Most cases are seen in over 25s with a history of travel outside of the UK or coming to the UK from abroad. The Joint Committee on Immunisation and Vaccination (JCVI) advised that the removal of the infant MenC dose, alongside the introduction of the MenB vaccine (Bexsero®) into the routine immunisation programme, would not have any significant risk associated with it, providing that community protection could be sustained by the MenACWY programme that was introduced for teenagers in September 2015. The MenB vaccination for infants, introduced in September 2015, may also help prevent some MenC cases.

Please also remain aware that not all meningococcal disease cases are vaccine preventable, and cases can still occur in vaccinated infants and children. There are also other rare types of the disease for which there is no vaccine currently in use. It therefore remains important for public health practitioners to urge parents to be alert to the symptoms and seek urgent medical attention if ever there is concern. This is particularly important as the new meningococcal vaccination programmes become fully established.

Please assure parents that effective control of this disease within our communities will remain. To help with this, a leaflet for parents is available to order from the DH Orderline please use product code 2904568 and also available to download below. Action is being taken to update PHE and NHS literature and this will gradually be reflected in documents that are already in circulation.

Download Meningococcal C (MenC) vaccination: leaflet for parents

Further information can be found in the April edition of Vaccine Update and in the official guidance for professionals