UK's Immunisation Programme Research Articles

Bivalent human papillomavirus vaccine and the risk of fatigue syndromes in girls in the UK

IntroductionOver 70% of cervical cancers are related to human papillomavirus types 16 and 18. In 2008, the vaccine Cervarix, protecting against these two strains, was introduced into the routine UK immunisation programme for girls aged 12–13 years, with a catch-up in girls aged up to 18 years. As part of the risk management planning for this new campaign, the Medicines and Healthcare products Regulatory Agency (MHRA) anticipated a range of conditions, including chronic fatigue syndrome, which might be reported as adverse events in temporal association with the vaccine. MethodsNear-real time ‘observed vs. expected’ analyses were conducted comparing the number of reports of fatigue syndromes submitted via the MHRA's Yellow Card passive surveillance scheme to the expected number, using background rates calculated from the Clinical Practice Research Datalink (CPRD) and estimates of vaccination coverage. Subsequently, an ecological analysis and a self-controlled case series (SCCS), both using CPRD, compared the incidence rate of fatigue syndromes in girls before and after the start of the vaccination campaign and the risk in the year post-vaccination compared to other periods. ResultsThe number of spontaneous reports of chronic fatigue following Cervarix vaccination was consistent with estimated background rates even assuming low reporting. Ecological analyses suggested that there had been no change in the incidence of fatigue syndromes in girls aged 12–20 years after the introduction of the vaccination despite high uptake (IRR: 0.94, 95% CI: 0.78–1.14). The SCCS, including 187 girls, also showed no evidence of an increased risk of fatigue syndromes in the year post first vaccination (IRR: 1.07, 95% CI: 0.57–2.00, p=0.84). DiscussionThe successful implementation of an enhanced pharmacovigilance plan provided immediate reassuring evidence that there was no association between vaccination with Cervarix and an increased risk of chronic fatigue syndromes. This has now also been further demonstrated in more comprehensive epidemiological studies.

New vaccines added to UK immunisation programme

New vaccines added to UK immunisation programme

Vaccination in children: the UK immunisation programme

AbstractOur series Prescribing in children gives practical advice for the management of childhood problems in general practice. Here, the authors describe the UK immunisation programme for children and the potential contraindications and adverse effects. Copyright © 2010 Wiley Interface Ltd

Cervical cancer immunisation: 1 year on

The World Health Organization (2009a) has acknowledged the importance of cervical cancer and other HPV-related diseases as global health problems, and recommended national immunisation programmes to combat these. In September, 2008 the UK Government set out to immunise school girls against cervical cancer. This article examines the UK's immunisation programme one year after its inauguration, including an overview of the choice of vaccine, suspected adverse reactions, uptake rates across the UK, and potential barriers.

Cervical vaccine chosen for UK immunisation programme

Cervical vaccine chosen for UK immunisation programme

Cervical vaccine chosen for UK immunisation programme

Cervical vaccine chosen for UK immunisation programme

Introduction of a conjugate meningococcal type C vaccine programme in the UK.

The purpose of the UK initiative was to accelerate the development and introduction of new conjugate meningococcal C vaccine into the routine immunisation programme, and to implement a catch-up campaign based on the disease epidemiology. Collaboration between Government supported institutions and the vaccine industry lead to a collaborative programme of research designed to answer policy specific questions and to accelerate the availability of new vaccines. Three new conjugate meningococcal C vaccines were developed and licensed for use in the UK after satisfactory data on safety and immunogenicity had been generated. A nationwide campaign was designed to offer vaccine to all infants at the same time as their three doses of primary immunisations, two doses were offered to children over 4 months and under 1 year old; all those over 1 and under 18 years old were offered a single dose of vaccine. The programme was on course for completion within approximately twelve months, with around 15 million immunisations being offered. The programme was implemented simultaneously through school and primary care services. A safe and effective new vaccine, against group C meningococcal disease, has been introduced into the UK immunisation programme after just a 5 year development to implementation process. Early indications point to high coverage and impacts on disease are already apparent in the groups that have been immunised. These vaccines may play an equally important role in other countries where there is a significant burden from Group C meningococcal disease.

Benefits, safety, and risks of immunisation programmes

Immunisation is potentially the most effective and efficient of all preventive medical activities. It is also unique among interventions in that it protects both the individual and the community. The UK's immunisation programme has been highly successful in controlling a number of life threatening infectious diseases, and consequently public concern has shifted from the diseases to vaccine safety. In recent years a series of vaccine myths and vaccine safety scares have affected the UK and other industrialised countries. Although an effective vaccine without any risk is probably unachievable, the vaccines in use in the UK are very safe. Serious adverse outcomes truly attributable to vaccination are extremely rare, always far rarer than adverse outcomes among individuals acquiring the vaccines' target infections. Vaccine safety may be called into question, however, on the basis of spurious coincidental associations between vaccination and adverse events. An inadequate public health response in the 1970s to a scare over whooping cough vaccine allowed substantial losses of professional and public confidence to take place. Vaccine coverage halved and much preventable morbidity and mortality resulted. Plausible vaccine associations must be investigated thoroughly, and the UK has become a world leader in developing techniques for rapid investigations. The public health response to scares over MMR (measles, mumps, and rubella) vaccine safety has been faster and firmer than for whooping cough and no link has been found between MMR vaccine and inflammatory bowel disease or autism. Consequently the impact on immunisation coverage has been small, though the cumulative threat of measles, mumps, and rubella epidemics is growing. Recently an international investigation excluded a possible association of intussusception with oral polio vaccine before it could become a vaccine scare. A clearer chain of communication in responding to vaccine myths and scares is needed. This must provide rapid information and, if appropriate, reassurance to professionals and the public. Considerably more training is needed for professionals in providing information to the public and supporting parents in making difficult decisions over vaccination. Though there is no place for complacency, and improvements are needed, the UK's ability to monitor vaccine effectiveness, safety, and risks is strong. As a consequence it has a vaccination programme that is very safe and very effective.

Benefits, safety, and risks of immunisation programmes

Immunisation is potentially the most effective and efficient of all preventive medical activities. It is also unique among interventions in that it protects both the individual and the community. The UK's immunisation programme has been highly successful in controlling a number of life threatening infectious diseases, and consequently public concern has shifted from the diseases to vaccine safety. In recent years a series of vaccine myths and vaccine safety scares have affected the UK and other industrialised countries. Although an effective vaccine without any risk is probably unachievable, the vaccines in use in the UK are very safe. Serious adverse outcomes truly attributable to vaccination are extremely rare, always far rarer than adverse outcomes among individuals acquiring the vaccines' target infections. Vaccine safety may be called into question, however, on the basis of spurious coincidental associations between vaccination and adverse events. An inadequate public health response in the 1970s to a scare over whooping cough vaccine allowed substantial losses of professional and public confidence to take place. Vaccine coverage halved and much preventable morbidity and mortality resulted. Plausible vaccine associations must be investigated thoroughly, and the UK has become a world leader in developing techniques for rapid investigations. The public health response to scares over MMR (measles, mumps, and rubella) vaccine safety has been faster and firmer than for whooping cough and no link has been found between MMR vaccine and inflammatory bowel disease or autism. Consequently the impact on immunisation coverage has been small, though the cumulative threat of measles, mumps, and rubella epidemics is growing. Recently an international investigation excluded a possible association of intussusception with oral polio vaccine before it could become a vaccine scare. A clearer chain of communication in responding to vaccine myths and scares is needed. This must provide rapid information and, if appropriate, reassurance to professionals and the public. Considerably more training is needed for professionals in providing information to the public and supporting parents in making difficult decisions over vaccination. Though there is no place for complacency, and improvements are needed, the UK's ability to monitor vaccine effectiveness, safety, and risks is strong. As a consequence it has a vaccination programme that is very safe and very effective.