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Joint
Committee on Vaccination and Immunisation
Attending
Ex-Officio
Invited to attend
Department of Health
Welsh Assembly Government
DHSS Northern Ireland Scottish Executive 1. ANNOUNCEMENT AND WELCOME The Chairman welcomed all those present and introduced 3 new members, Professor Jonathan Friedland (Imperial College London) as the Infectious Diseases member, Dr Paul Jackson (Consultant Paediatrician, Royal Belfast Hospital) as the Northern Ireland representative and Dr Syed Ahmed (Public Health, Greater Glasgow NHS board) as the Scottish representative. The Chairman also welcomed a new observer from the Netherlands Dr Susan Hahne, Medical Epidemiologist from the Dutch Centre for Infectious Disease Control, and Dr Philippe Duclos from the WHO Immunisation team. Apologies had been received from Dr Yvonne Doyle, Professor David Goldblatt, Professor Alan Eamon, and from Dr Arlene King (Canada) and Dr Mair Powell (MHRA). Wing Commander Green was unable to be present but was replaced by Lt Colonel David Ross and Seargent Rachel Pudney from Ministry of Defense. Members were reminded of the need to ensure their declarations of interest
were up-to-date, and to declare their interests relevant to each agenda
item. 2. MINUTES OF THE LAST MEETING HELD ON WEDNESDAY 15 OCTOBER 2005 The Committee was invited to comment on the draft minutes. The following
changes were suggested: 3. MATTERS ARISING The Committee was made aware that the BCG subgroup needed to meet by late March 2006. The draft Green Book chapters are now on the website and are undergoing final amendments. DH plans to publish the Green Book this summer. Members were requested to submit comments to the JCVI secretariat. It was noted that the ACDP had given advice to vaccinate poultry workers against seasonal flu. This reduces the risk of a poultry worker being co-infected with seasonal flu virus and H5N1 avian flu virus, thereby reducing the theoretical risk of reassortment of the avian virus into one that could be transmitted amongst humans. It is estimated that there are around 75,000 poultry workers in the UK. Informal discussions with representatives of the poultry industry have suggested that the industry would prefer that any vaccination strategies be implemented in a complete and careful manner - and achieving this aim may require such a policy being introduced in autumn 2006. Pneumococcal Vaccine The childhood pneumococcal programme was announced on 8 February 2006,
and aims to be starting later this year. A public health link message
was issued to health professionals. 4. SEASONAL INFLUENZA VACCINATION The Committee was provided with an update on the seasonal flu immunisation programme. Epidemiology Activity to date The seasonal flu vaccination commenced as usual in October, but reports of vaccine shortages were received a few weeks after the programme had started. DH contacted GPs to alert them to the vaccine supply situation and made the DH contingency stock available to all GPs. The Secretary of State for Health also announced in Parliament that a review of the supply and distribution of seasonal influenza vaccine would be carried out. Uptake The Committee discussed how health care workers could be encouraged to accept flu vaccination. The Committee was informed that there was little information from other countries. In the US, where vaccinating healthcare workers has been policy for the last 20 years, uptake rates in this group was believed to be about 30%. It was suggested that uptake data on healthcare workers in care homes should be collected routinely in future. Views varied, with some members advising that the provision of the vaccine via occupational health services needed to be improved whereas others suggested that improved awareness of health professionals was needed. The Committee noted the update on the seasonal influenza immunisation programme for 2005/06; supported the review announced by the Secretary of State; and recommended that more needed to be done to increase uptake in healthcare workers. 5. PANDEMIC FLU The Committee was given an oral update on pandemic flu preparation. The stockpile of the antiviral drug Tamiflu is progressing with half of the total stockpile being delivered by the end of March, and the stockpile would be complete by September. The shelf-life of Tamiflu in capsule form is 5 years; extension of the shelf life may be possible. The Department of Health has secured contracts with 2 manufacturers of H5N1 vaccine. Both vaccines are second generation adjuvanted vaccines, with one produced from an egg-based manufacturing process and the other grown on cell culture. One vaccine is adjuvanted to MF59, the other to alum. The stockpile will be complete by late summer 2006. The Committee was grateful for the information, and wished to be updated at the next meeting. 6. ACELLULAR PERTUSSIS VACCINES Dr Stephen Inglis declared a non-personal and non-specific interest for this item. The purpose of this item was to consider whether the protection from 3 component acellular pertussis vaccine was equivalent to the 5 component acellular pertussis vaccine that is used routinely in the UK. The studies available compare different pertussis vaccines, and use different immunisation schedules, making this a difficult issue to evaluate. Studies have shown that Pediacel (containing 5 component acellular pertussis)
provides similar protection to the whole cell pertussis vaccine previously
used in the UK. Evidence from Sweden suggests that 3-component acellular
pertussis vaccines were effective in controlling pertussis in that country.
However it was noted that the Swedish trials were carried out when pertussis
serotype II was dominant, and it is quite possible that the suitability
of vaccines may depend on the circulating strains. Recommendations: In the face of limited evidence, the Committee was not persuaded that a case had been made to demonstrate equivalent protection from the 3-component and 5-component acellular pertussis vaccine in the UK. 7. HIB VACCINES Professor Keith Cartwright and Dr Stephen Inglis declared a non-personal and non-specific in GlaxoSmithKline. The purpose of this paper was to consider the protection against Hib disease by different combination vaccines. The Committee was given an update on the incidence of Hib disease in the UK. The Hib catch up programme carried out in 2003 had reversed the previous increase of Hib cases, and rates were returning to very low levels in young children. A decline in cases in older age groups had also been observed, but cases were still occurring. The addition of the Hib booster vaccine in the second year of life, as previously recommended by JCVI, will provide long-term protection in children. However, with Hib disease still occurring in older children, it is important that the protection of older children who will not have received a booster at 12 months and who were too young to receive an additional dose during the one-off booster campaign in 2003) needs to be considered. The Committee was alerted to the observation that the Hib -response is attenuated when combined with the GSK 3-component acellular pertussis vaccine. This effect is not seen with Hib vaccines combined with 5 component acellular vaccine (e.g. Pediacel). Recommendations: The Committee considered that Pediacel (containing the 5 component acellular pertussis vaccine) should continue to be offered in the routine childhood immunisation programme, rather than the 3 component acellular pertussis vaccine in combination with Hib and IPV. It was agreed that combined vaccine containing a 3-component acellular pertussis vaccine could be offered if there were shortages of the preferred vaccine. It was also noted that some current cases of Hib disease were occurring in children who were too young to be vaccinated as part of the Hib catch up campaign in 2003/2004. The Committee asked for this issue to be looked into as a matter of priority.
JCVI noted the minutes of the UK panel for the Certification of the Elimination of Poliovirus and the Working Party for the Laboratory Containment of Poliovirus. An issue raised in the those minutes was whether screening should be carried out to identify people who persistently excrete poliovirus. Although this is not currently an issue since polio vaccination continues in the UK population, this would need consideration before any decision to stop polio vaccination. Recommendation: The JCVI Secretariat agreed to write to the World Health Organization to establish whether this issue is being considered by them. 9. HPV PARENTAL ATTITUDES Professor Keith Cartwright declared a non-personal, and non-specific interest in GlaxoSmithKline (GSK) and Dr Richard Roberts declared a non-personal non-specific interest in Sanofi and Pneumovax. Results from some preliminary research into parental attitudes to the possible human papillomavirus vaccination were shared with JCVI members. This work is not yet published. Generally parents were very positive about vaccination to prevent cervical cancer; mothers were usually more involved than fathers in the detail of the process. Respondents fell into three categories described as trusting parents, compliant parents and resistant parents. Most parents were aware of cervical cancer but knowledge of HPV was more limited. Some parents had raised concerns about introducing the vaccine in primary school and opinion tended towards offering it in early adolescence at secondary school. The Committee welcomed the findings of this work and recommended that it should be prepared for publication.
Dr Syed Ahmed declared a non-personal and non-specific interest in GlaxoSmithKline. As requested, the Committee was given further information on strategies to reduce the transmission of hepatitis B in infancy. The Committee recalled that a universal hepatitis B vaccination programme was unlikely to be cost effective. This may change if a suitable combined vaccine became available. While the prevalence of Hepatitis B in the UK population is very low, it is recognised that some ethnic minorities, and immigrant and refugee populations have prevalence rates similar to those in their countries of origin. The Committee considered targeted strategies that focus those in the higher risk groups, as such a policy may prove cost effective. The Committee discussed the general issue of targeted immunisation programmes. The BCG programme in the UK is targeted at those at higher risk. It was suggested that those at risk of hepatitis B may be similar to those at risk of tuberculosis, and programme could be targeted on the characteristics of the geographical areas. However it was unclear what the best indicator of risk would be to identify areas. Data from antenatal screening needed to be examined to build up a regional picture. The Committee was informed that in Holland immunisation is given to children whose parents come from countries where hepatitis B is prevalent. This policy had been running for 3 years, which may not be a sufficiently long period to assess its impact. However Dr Hahne agreed to report back at the next meeting Conclusion The Committee requested that the issue of targeted policies for hepatitis B vaccination are considered at future meetings. This paper reported on the uptake of 23 pneumococcal polysaccharide vaccine
(PPV) in people aged 75 years and over. Recent surveillance data has suggested an increase in incidence of pneumococcal infections in all ages in 2004/05. The reason for the increase across all ages remains unclear.
The committee's attention was drawn to the following papers for information.
COVER report July to September 2005 The Committee was very concerned with the reported problems in some parts of the country caused by the introduction of the Connecting for Health programme. The Committee were concerned that it could adversely impact on immunisation programmes in this country. Recommendation: The Chairman agreed to raise this issue on behalf of the Committee with the Department of Health Rotavirus The Committee was informed that this vaccine is currently being considered for licensing in Europe. The Committee agreed that this item needed to be added to the Committee's future work programme.
The Committee was informed that DH's supplies of single Hib vaccine would run out in April as this vaccine is no longer used in the routine childhood immunisation programme. This vaccine is currently offered to asplenic patients. The Committee agreed that the combined Hib/MenC vaccine should be offered to patients with splenic dysfunction, in line with existing recommendations for Hib vaccine. This would boost their protection against Hib infection, and a booster against meningococcal C infection would also benefit such patients.
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