Meningitis B and Chicken Pox vaccines

[GillianHG]

Sorry - just seen the massive recent thread on this!! Reading with interest...

[klh]

In case anyone else has booked a meningitis B vaccination at Your Travel Clinic in the Akerman Medical Practice, I had booked our son in for today over a week ago having been assured that they had supplies and I paid a deposit. I even called back last week to double check they definitely had supplies and to offer to pay the full amount in advance and was told his wasn't necessary. I have just been called, an hour before his appointment, to be told they have now run out. Obviously, I'm very upset to have been told there was a dose earmarked for our son but now it appears it has been sold to someone else.

[bodsier]

Saffron, can you tell he why it is necessary for children to have a chicken pox vaccine? I always thought it was something most kids go through, granted bacterial complications can occur, but they are extremely rare, and it really only poses a problem for people with immune problems. even then isn't it highly unlikely to be problematic? My son has immune problems, and breathing difficulties, he also had chicken pox. Please enlighten me.....

[Saffron]

I'm not sure I entirely understand your question. Are you asking about varicella immunisation in general? I couldn't comment on you son's specific case, as I don't know the details. Suffice it to sat that if your son has already had CP infection (varicella virus), then he would not receive the CP vaccine. However, in years to come, it may be suggested that he receives the shingles vaccine, to prevent the re-emergence of the varicella virus from its dormant state in the body, where it remains after infection.

Also, I'm not sure what you mean by referring to CP as "something most kids go through"? The fact that an infection is (a) common or (b) generally occurs during childhood, is in not necessarily directly related to the type or extent of clinical symptoms being mild in children. Prior to the advent of vaccinations and antibiotics, many common childhood diseases were devastating, despite the fact that most children suffered through them.

Immunising against CP means that children are significantly protected from contracting varicella virus. If they do contract the virus, their symptoms are likely to be shorter and less severe than children who were not immunised. Although the individual level of efficacy is very good for the CP vaccine, the risk of transmission can be further reduced by increasing the total number of individuals vaccinated (known as herd immunity). The knock-on effect of this is better protection for individuals who cannot be immunized due to age or other health complications. This is especially true for infants, in who varicella infection can result in death. Typically when unvaccinated vulnerable individuals are exposed to CP, they are now treated with immunoglobulin (IG) therapy, which reduces mobidity and mortality in CP infection. Nevertheless people with active CP infection should not mix with the general public or any vulnerable individuals, to avoid infecting such people. Unfortunately, CP is most contageous before symptoms appear, meaning that vulnerable individuals can be exposed to an infectious person without being aware.

Even in healthy children CP infection can lead to severe symptoms/complications, and it's not universally true that the course of infection is more mild in younger children. It's also not universally true that you only contract CP once. Depending on the population studied, re-infection rates for CP are something like 1:400 to 1:200. Following infection, the virus becomes dormant in the nervous system and can reemerge as shingles in adults, leading to painful long-lasting symptoms in some patients (though early intervtion with modern anti-viral drugs can greatly improve this.)

In addition to fever, scarring, and time off work/school, even healthy children can develop complications, at a rate of ~20-40%. Severe complications occur in ~1% of paediatric cases (including previsouly healthy children, with no underlying medical conditions). These complications can include encephalitis, cerebellar ataxia, osteomyelitis, pyogenic arthritis, necrotizing fasciitis, endocarditis, pneumonia, sepsis, and death. Although individual risk is very low for severe complications, taken together admittance for CP complications account for a significant proportion peadiatric hospitalisations (~20%) in studies of unvaccinated populations. Therefore they represent a notalbe economic burden for healthcare systems.

Hope that helps. All this information is easily searchable on Google, Google Scholar, PubMed, and various institutional websites for further details. xx

[Saffron]

klh Wrote:

-------------------------------------------------------

> In case anyone else has booked a meningitis B

> vaccination at Your Travel Clinic in the Akerman

> Medical Practice, I had booked our son in for

> today over a week ago having been assured that

> they had supplies and I paid a deposit. I even

> called back last week to double check they

> definitely had supplies and to offer to pay the

> full amount in advance and was told his wasn't

> necessary. I have just been called, an hour before

> his appointment, to be told they have now run out.

> Obviously, I'm very upset to have been told there

> was a dose earmarked for our son but now it

> appears it has been sold to someone else.

That is super frustrating. I hope they're going to give you a discount, considering their oversight! xx

[Melihoople]

Saffron That is my take on CP vaccine too. Its been part of the general childhood programmes for the last 25 yrs in the US, Canada, Japan amongst others. Is very well studied.

I'm also old enough to remember a time when you had to purchase the mumps vaccine privately & the discussions that were had then. :)

[klh]

Thanks Saffron. Having spoken to them again it seems that they took my booking without realising they wouldn't be able to get further private patient supplies to fulfil it. Still upsetting and very annoying but I suppose nothing much they or I can now do about now except wait for new supplies.

[devsdev]

As always, articulated really well Saffron. I have been very grateful that my two girls have been vaccinated against chickenpox (just the one injection so far for various reasons, but I will get them the booster within a year). They have been exposed a couple of times already and so far are fine. I had chickenpox as a kid (10 yr old) and remember being miserable, so I am grateful I can minimise their risk of infection.

[devsdev]

For those who may not have signed the petition, here is the government response to the petition:

MenB vaccine is offered to infants, free on the NHS, at 2 months with further doses at 4 and 12 months. The programme, as advised by independent experts, offers protection to those at highest risk.

As the UK, we are proud to have been the first? and to date the only - country in the world to introduce a national, publicly-funded MenB immunisation programme for infants using the Bexsero vaccine. We are leading the world in offering children protection from this devastating disease.

National immunisation programmes are introduced on the advice of the Joint Committee on Vaccination and Immunisation (JCVI), the independent expert body that advises the Government on all immunisation matters. https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation

JCVI reviewed all available evidence before it advised on eligibility for the Bexsero vaccine. It recommended that MenB immunisation should be routinely offered to the group of children at the highest risk - infants at two months of age with a further dose at four months and a booster at 12 months, provided that the vaccine could be procured at a cost-effective price. There is a duty on the Secretary of State for Health to ensure, so far as is reasonably practicable, that the recommendations of the JCVI, are implemented.

The programme started on 1st September 2015 for those babies due to receive their primary immunisations starting at 2 months of age on or after 1 September 2015 (i.e. those born on or after 1 July 2015). A one off catch-up programme was recommended by JCVI for infants born from 1 May 2015 to 30 June 2015 (aged 3 or 4 months of age when the programme launched) when they attended for their primary immunisation appointments. This ensured that those infants were offered the vaccine before the winter peak of the disease. By May 2017, all children under the age of two years will have been offered the vaccine. The vaccine is also available for a small number of older children and adults who are at increased risk of infection, such as those with no spleen. Early indications are that the vaccine has been very well accepted by parents and coverage is likely to be high.

With this programme, our priority is to protect those children most at risk of MenB, in line with JCVI?s recommendation. The NHS budget is a finite resource. It is therefore essential that JCVI?s recommendations are underpinned by evidence of cost-effectiveness. Offering the vaccine outside of JCVI?s advice would not be cost effective, and would not therefore represent a good use of NHS resources which should be used to benefit the health and care of the most people possible.

When any new immunisation programme is introduced, there has to be a cut-off date to determine eligibility. While this is extremely difficult for parents whose children aren?t eligible there is no other way of establishing new programmes to target those at highest risk without introducing inequalities. This approach is supported by the best evidence and by independent recommendations. JCVI considered older age groups (1-4 year olds) but did not advise a catch-up programme in view of the marginal cost-effectiveness of even the infant programme. JCVI considered that the priority should be the implementation of the primary immunisation programme for infants. They also considered a programme for adolescents but advised that further research was needed Preparatory research has been commissioned and is underway.

There are many bacterial, viral and other causes of meningitis (inflammation of the lining of the brain and surrounding tissues) and septicaemia (blood poisoning). Successful vaccination programmes have already reduced the risk of these serious diseases. Current rates of group B meningococcal disease are low. In the early 2000s there were more than 1,600 cases in England, compared to around 400 cases in 2014.

The vaccine should provide direct protection against MenB for infants and those who are at increased risk of meningococcal disease. However, not all strains of the group B meningococcal bacteria are covered by this vaccine and cases can still occur in vaccinated infants and children. There are also other strains of meningococcal disease for which there is currently no vaccine. It therefore remains important for parents to be alert to the symptoms of meningococcal disease such as fever, blotchy skin, refusal to feed, irritability, cold hands and feet, rash, muscle pain, and a stiff body with jerky movements or else floppy and lifeless. They should trust their instincts and seek urgent medical attention if they have concerns.

Department of Health

[devsdev]

Oops - sorry, wrong thread. But still relevant!