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

2. 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!!

3. 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?

4. 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

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

6. CI: purpose
Non-routine?
Hepatitis B
Tuberculosis

7. 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!

8. 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)

9. 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

10. 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)

11. 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 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)* micrograms IM (0.30ml) micrograms IM (0.5ml)(300 micrograms IM if patient is small or prepubertal) * A suitable syringe for small volumes should be used.

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

13. 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?

14. 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

15. 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

16. 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!!

17. References
1. Green Book: sset/dh_ pdf 2. Summary Table (colour) dh_digitalassets/documents/digitalasset/dh_ pdf 3. Oxford Handbook of General Practice

18. 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