Childhood Immunisations Developmental Milestones Dr Tessa Hicks For GP Small Group Teaching 19 Oct 2011

Learning Objectives List diseases included in standard childhood immunisation programme Give main contraindications to immunisation State immunisation schedule State nature (live/inactivated) of each vaccine Explain key developmental milestones State key causes for concern/referral Practice/Help with AKT questions!!

Starter Quiz! 1. How many diseases vaccinated against in standard immunisation schedule? 2. How many times is child seen for immunisations in standard imm. schedule? When can a child say ‘mama’ and ‘dada’ When can a child use a spoon and fork? At what age should you refer a child who cannot walk?

Childhood Immunisations (CI) Purpose - to protect individual and herd against important infectious diseases: ‘DTaP/IPV/Hib’ Diphtheria Tetanus Pertussis Polio (Inactivated Polio Vaccine) Haemophilus Influenza type b

CI: purpose Pneumococcal disease Meningococcal group C ‘MMR’ Measles Mumps Rubella Human papilloma virus

CI: purpose Non-routine? Hepatitis B Tuberculosis

Pre Immunisation 1. No contraindications 2. Consent 3. Patient/parent understands procedure 4. Patient/parent understands possible adverse reactions and how to treat 5. After - Record/document!

CI: main contraindications - general All vaccines contraindicated if: Previous confirmed anaphylactic reaction to same antigen or another vaccine component Temporary contraindication for live vaccines - immunosuppressed - pregnant (no evidence)

CI: contraindications - specific Egg allergy (influenza, yellow fever) MMR safe if allergy after ingestion of egg, under supervision if confirmed anaphylaxis to egg-containing food Latex In tip cap and/or rubber plunger Avoid if severe anaphylaxis to latex

CI - deferral Fever or systemic upset Evolving neurological condition Recent immunoglobulins (3 weeks/3months) Do NOT defer in premature babies (if born < 28 weeks, need respiratory monitoring in hospital after initial immunisations)

CI: ‘AEFI’ = Adverse events following immunisation Programme related Vaccine induced – common, rare Coincidental Anaphylaxis DD = feint, panic attack Anaphylactic reactions to vaccines are extremely rare but have the potential to be fatal. Between 1997 and 2003, there were 130 reports to the Medicines and Healthcare products Regulatory Agency (MHRA) of anaphylaxis or anaphylactic-type reactions following immunisation (excluding the meningitis C campaign), although no deaths as a result of the reaction were reported. In that time, around 117 million doses of all vaccines were supplied to hospitals and GPs. This rate (approximately one per million vaccine doses) is similar to that reported from other countries (Bohlke et al., 2003; Canadian Medical Association, 2002). Age Under 6 months Over 6 months but under 6 years 6 to 12 years Over 12 years including adults Dose of adrenaline (epinephrine) Volumes stated are 1:1000 adrenaline 150 micrograms IM (0.15ml)* 150 micrograms IM (0.15ml)* 300 micrograms IM (0.30ml) 500 micrograms IM (0.5ml)(300 micrograms IM if patient is small or prepubertal) * A suitable syringe for small volumes should be used.

Developmental Milestones Guide to normal development Variations/Bell curve distribution Points for concern

Starter Quiz! 1. How many diseases vaccinated against in standard immunisation schedule? 2. How many times is child seen for immunisations in standard imm. schedule? When can a child say ‘mama’ and ‘dada’ When can a child use a spoon and fork? At what age should you refer a child who cannot walk?

At what age would the average child acquire the ability to draw a cross? A. 18 months B. 2 years C. 2 ½ years D. 3 years E. 4 years

Each of the following vaccines is given at 3 months except: A. Haem influenza b B. Inactivated polio virus C. Pneumococcal conjugate virus D. Tetanus E. Meningitis C

Learning Objectives List diseases included in standard childhood immunisation programme Give main contraindications to immunisation State immunisation schedule State nature (live/inactivated) of each vaccine Explain key developmental milestones State key causes for concern/referral Practice/Help with AKT questions!!

References 1. Green Book: http://www.dh.gov.uk/prod_consum_dh/groups/ dh_digitalassets/@dh/@en/documents/digitala sset/dh_130279.pdf 2. Summary Table (colour) http://www.dh.gov.uk/prod_consum_dh/groups/ dh_digitalassets/documents/digitalasset/dh_12 2401.pdf 3. Oxford Handbook of General Practice

Starter Quiz! 1. How many diseases vaccinated against in standard immunisation schedule? 11 2. How many times is child seen for immunisations in standard imm. schedule? 7 3. When can a child say ‘mama’ and ‘dada’? 9 m 4. When can a child use a spoon and fork? 3 yr 5. At what age should you refer a child who cannot walk? 18 months