The New Primary Childhood Immunisation Schedule
The National Immunisation Advisory Committee (NIAC), an expert Committee of the Royal College of Physicians in Ireland has recommended the introduction of vaccines to protect against Meningococcal B (MenB) and rotavirus diseases so the HSE Primary Childhood Immunisation Schedule will change significantly for all babies born on or after 1st October 2016. The introduction of these two new vaccines means there will be a change in the vaccines given at each of the five visits in the childhood vaccination schedule. Payment for the new schedule is currently under negotiation.
Children born before 1st October 2016 should receive the old schedule regardless of when they present for vaccination. This means that the 2 schedules will be in place for at least 12 months and the child’s date of birth should be checked to determine which schedule to give.
What are the changes?
The table below summarises the changes to the immunisation schedule for babies born on or after 1st October 2016.
- MenB vaccine (Bexsero GSK) at 2, 4 and 12 months to protect against meningococcal B disease.
Rotavirus oral vaccine (Rotarix GSK) at 2 and 4 months to protect babies against rotaviral gastrointestinal disease.
To allow for earlier protection of meningococcal B infection.
- MenC vaccine changes from 4 and 13 months to 6 and 13 months
- PCV schedule changes from 2, 6 and 12 months to 2, 6 and 13 months.
To minimise the number of injections given at 13 months
- HiB/MenC combination vaccine (Menitorix GSK) will be used instead of separate vaccines
Why are the new vaccines recommended?
Ireland has the highest rate of invasive meningococcal disease in Europe. Since the successful introduction of the meningococcal C (MenC) vaccine in 2000, meningococcal group B disease is now the predominant cause of invasive meningococcal disease. The highest rates of disease are seen in infancy, then early childhood, with a smaller peak in infections seen in adolescence. Meningococcal B disease is a much feared infection amongst parents and health care professional staff alike, owing to its rapid onset and the severe illness and death which can be associated with the infection. This disease is now vaccine preventable.
Rotavirus disease is very infectious and the most common cause of gastroenteritis in children in Ireland under the age of 5 years. Whilst most babies and children will recover at home, almost 1000 children per year will become significantly dehydrated and require hospitalisation with an average length of stay of 5 days. This is a significant burden of disease to young families and one that is now vaccine preventable.
How are the new vaccines given?
The MenB vaccine is an injected vaccine which should be given to babies in their LEFT anterolateral thigh.
The rotavirus vaccine is an oral vaccine. This comes as a sugary solution, prepared in an oral applicator. This vaccine should be given first to babies, whilst they are more settled and it helps act as a pain reliever for the injected vaccines. The applicator should be placed in the baby’s mouth and aimed down one side and towards the back of the baby’s mouth. All the applicator contents should be given.
Are the new vaccines safe and effective?
Yes, all vaccines undergo rigorous safety checks before they are licensed for use and are continually monitored after licensure.
Both MenB and rotavirus vaccines are widely used internationally and have proven to be very safe and effective. The vaccine was first licensed in Europe, Australia and Canada in 2013 and has been shown to be very safe and well tolerated. Rotavirus vaccines are used routinely in 12 EU countries, the US and Australia and has been shown to be very safe and well tolerated by the majority of babies.
What’s new about the vaccines?
The MenB vaccine when given with other vaccines can increase the risk of fever in babies under 12 months of age. All babies should be given 3 doses of 2.5 mls (60 mg) liquid infant paracetamol at or just after their 2 and 4 month vaccines and 4-6 hours later, respectively, for the second and third doses.
This will reduce the severity of any fever and the risk of a baby developing a fever by approximately 50%.
Experience from the UK has shown that parents are happy to give their baby paracetamol and that they are unlikely to seek medical help if they are informed
that a fever is likely over the first 24 hours after vaccination. Prophylactic paracetamol is not recommended when MenB vaccine is given at 12 months as the rate of fever is the same as for the other childhood vaccines.
Rotavirus vaccine cannot be given on or after 8 months and 0 days of age as the risk of intussusception (intestinal prolapse leading to obstruction) is greater in older childrenIn Ireland, approximately 1 in 1500 babies will develop this condition naturally, most commonly between the ages of 5 months and 1 year.
Intussusception can occur at any time after rotavirus vaccine. It is estimated that for every 100,000 first doses of rotavirus vaccine given, there may be 1-2 extra cases of intussusception i.e. up to 2 cases per year in Ireland.
Babies with intussusception have pain similar to a severe colic, accompanied with bouts of crying. However, they generally become very pale during episodes, rather than flushed as they might with colic, and they may draw their legs up. The episodes become more frequent over a few hours and are associated with vomiting or blood in their stools. If this occurs then the baby needs to be urgently referred to hospital for investigation. The sooner a baby is identified and referred to hospital, the less likely they are to need an operative intervention. As the risk of intussusception increases with age, babies should not be given rotavirus vaccine at 8 months and 0 days or older.
Further information
Further details on these vaccines, are provided in the new immunisation information materials for parents and for healthcare providers, and on the www.immunisation.ie website. Your local immunisation office, local public health departments and the National Immunisation Office are available to assist with any questions that you may have.
The new childhood immunisation schedule will provide protection to infants and young children against serious diseases when they are most vulnerable.
Elyce McGovern is a Specialist Registrar in Public Health Medicine currently working at the National Immunisation Office. She is a vocationally trained GP who previously worked as a GP in Dublin and Wicklow.
