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Dr Simon Nadel Consultant Paediatric Intensivist Department of Paediatrics St Mary's Hospital Praed Street London W2 1NY Rt. Hon. Jeremy Hunt MP Secretary of State for Health Department of Health Richmond House 79 Whitehall LONDON SW1A 2NS 9 January 2014 Dear Secretary of State, Meningitis and meningococcal disease are not only a parent’s greatest fear, but also a clinician’s. This is due to the difficulty in diagnosis, the speed with which the disease strikes and its severity. The three meningitis vaccinations already in the Childhood Immunisation Programme (Hib, meningococcal C and pneumococcal) have been successful in addressing what used to be major causes of meningitis and septicaemia in the UK. Even before these vaccines were introduced, the leading cause of bacterial meningitis was meningococcal group B (MenB) infection, which affects on average over 1000 people a year, primarily children. A MenB vaccine is now licensed. While data regarding efficacy and effectiveness are not yet available due to the fact that it has not been introduced widely, the vaccine is estimated to cover 88% of MenB disease in the UK (JCVI minutes 02 October 2013). We read with interest the Joint Committee on Vaccination & Immunisation (JCVI)’s interim position statement in July regarding the licensed MenB vaccine, in which there was a call for further submissions from stakeholders. It is vital the JCVI’s interim conclusions are re-evaluated because of the following: The health burden associated with MenB disease is far reaching and has not been adequately reflected in the cost effectiveness analysis (CEA) considered by the JCVI. The proportion of survivors with after effects was underestimated. Quality of life impact on carers was not included, although it is legitimate to consider this within NICE Cost Effectiveness Analysis guidelines. The method used to measure quality of life impact cannot identify impacts in young children who represent the majority of MenB cases. Discounting health benefits of the vaccine at 3.5% dramatically reduces health benefits that extend into the future. Other public health interventions, including CEA for previous vaccines have been discounted at 1.5% to compensate for this. The costs of MenB disease to the NHS have been underestimated. The analysis did not take into account the millions of pounds paid out every year by the NHS Litigation Authority in legal costs for clinical negligence claims relating to meningitis. The extensive costs of ongoing treatment for some serious after effects were also not included. There has been no consideration of the wider benefits beyond the scope of the CEA. For example many survivors of meningitis and septicaemia will need ongoing educational and financial support as a result of this disease, resulting in a burden to other government departments beyond the NHS. We urge that the JCVI employs a flexible approach, and still considers the vaccine if it exceeds the cost effectiveness threshold through the application of “special circumstances” (Rawlins M, Barnett D, Stevens A. Pharmacoeconomics: NICE’s approach to decision making. British Journal of Clinical Pharmacology 2009; 70(3): 346349), if there are sufficient justifications. The issue of cost-effectiveness must be fully and properly understood so that a viable basis for the pricing and purchase of the vaccine can be established. We are aware that the JCVI met on 2 October to consider stakeholder responses. We welcome their subsequent statement that new and recently-published evidence received in these submissions will be considered and analysed. We support the need for more data on this new vaccine regarding its effectiveness, duration of protection and impact on meningococcal carriage and transmission. It is a cause for concern to us that after years of research, a vaccine which could prevent a significant proportion of cases of this dreadful disease might simply be shelved. It is hard to see how this could do anything other than discourage further research into other novel vaccines. If the UK does not take the lead and give a clear message that it genuinely supports innovative vaccine development, the negative impact on both disease prevention and future vaccine research could have very wide and unwanted implications. The UK has amongst the worst child health outcomes in Western Europe (Wolfe et al: Health services for children in Western Europe. Lancet 2013; 381: 1224–34), and you have the opportunity to make an immediate and positive impact on this through the introduction of this new vaccine. As Secretary of State for Health, we urge you to make the right decision for children in the UK. We encourage you to: 1. Ensure that the further deliberations of the JCVI are concluded as swiftly as possible. 2. Introduce this MenB vaccine for infants and adolescents outright, or at least in a UK wide population-based evaluation, as soon as possible. In the initial JCVI interim position statement, it is suggested that a population-based evaluation could be the way forward. This will not only save lives and prevent disability, but will enable the collection of important data and allow continued investment in vaccine development, if appropriate. 3. Ensure that the Section 7a discussions between NHS England and the Department of Health to make arrangements for the introduction of the new vaccine are concluded quickly to avoid any delay to subsequent availability. We look forward to hearing from you. Yours sincerely, Dr Simon Nadel, Consultant in Paediatric Intensive Care, St Mary’s Hospital, London 2 Professor Dlawer Ala'Aldeen, Professor of Clinical Microbiology, University of Nottingham Dr Tom Allport, Senior Paediatrician, North Bristol NHS Trust Dr Lorraine Als, Research Associate, Imperial College London Dr Ed Bache, Consultant Orthopaedic Surgeon, Birmingham Children's Hospital Dr Paul Baines, PICU Consultant, Alder Hey Children's Hospital Dr Nick Beeching, Senior Lecturer in Infectious Diseases and Clinical Director, Liverpool School of Tropical Medicine Dr Sumit Bokhandi, Consultant Paediatrician and Specialty Tutor in Paediatrics, Poole Hospital NHS Foundation Trust Dr Jennie Borg, Research Psychologist, University College London Dr Emma Bould, Consultant Paediatric Intensivist, Royal London Hospital Professor Philip Butcher, Professor of Molecular Medical Microbiology, St George's University of London Professor Enitan Carrol, Chair in Paediatric Infection, University of Liverpool Dr Paul Carter, Retired Consultant Paediatrician, Walsall Community Trust Dr Bambos Charalambous, Senior Lecturer in Clinical Microbiology, Royal Free & University College Medical School Dr Beth Cheesebrough, Research Fellow in Paediatric Infectious Diseases, Imperial College London Dr Deborah Christie, Consultant Clinical Psychologist, University College London Hospitals NHS Foundation Trust Dr Stuart Clarke, Reader in Infectious Disease Epidemiology, University of Southampton Professor Jonathan Cohen, Emeritus Professor, Brighton and Sussex Medical School Dr Mehrengise Cooper, Consultant Paediatric Intensivist and Paediatric Tutor, Imperial College London Dr Sian Cooper, Consultant Paediatric Intensivist, Leeds General Infirmary Dr Aubrey Cunningham, Senior Lecturer in Paediatric Infectious Diseases, Imperial College London Dr Andrew Curran, Consultant Paediatric Neurologist, Alder Hey Children's Hospital Dr Ffion Davies, Consultant in Emergency Medicine, Leicester Royal Infirmary Dr Patrick Davies, Clinical Lead, Paediatric Intensive Care Unit, Nottingham Children's Hospital Dr Naomi Davis, Consultant in Paediatric Orthopaedic Surgery, Royal Manchester Children’s Hospital Dr Mathew Diggle, Clinical Lead for Molecular Diagnostics, Nottingham University Hospitals NHS Trust Dr Garth Dixon, Consultant Paediatric Microbiologist, Great Ormond Street Hospital Dr Liam Dorris, Paediatric Neuropsychologist, Royal Hospital for Sick Children (Yorkhill) Dr Nicholas Embleton, Consultant Neonatal Paediatrician, Newcastle Hospitals NHS Foundation Trust Ms Sian Falder, Consultant Plastic Surgeon, Alder Hey Children's Hospital 3 Dr Helen Fardy, Consultant Paediatrician, University Hospital of Wales Professor Saul Faust, Honorary Consultant Paediatrician and Director, NIHR Wellcome Trust Clinical Research Facility, University of Southampton Dr Eva Galiza, Research Fellow, Paediatric Infectious Diseases, St Georges University of London Professor Elena Garralda, Emeritus Professor of Child and Adolescent Psychiatry, Imperial College London Dr Stephen Granier, General Practitioner, Whiteladies Medical Group Bristol Dr Jim Gray, Consultant Microbiologist, Birmingham Children's Hospital Dr Martin Gray, Director PICU, St George's Hospital London Professor George Griffin, Professor of Infectious Diseases and Medicine / Honorary Consultant Physician, St George's University of London/ St George's Hospital Dr Scott Hackett, Consultant in Paediatric Infectious Diseases and Immunology, Birmingham Heartlands Hospital Dr Rosie Hague, Consultant in Paediatric Infectious Diseases and Immunology, NHS Greater Glasgow and Clyde Ms Caroline Haines, Consultant Nurse PICU/HDU, Bristol Royal Hospital for Children Dr Steven Hancock, Lead Consultant (Paediatrics), Embrace Yorkshire & Humber Infant & Children's Transport Service Mr Andrew Harvey, Research Nurse, Bristol Royal Infirmary Professor Paul Heath, Professor in Paediatric Infectious Diseases /Honorary Consultant in Paediatric Infectious Diseases, St George's University of London/ St George's Hospital Dr Jethro Herberg, Senior Lecturer in Paediatric Infectious Diseases, Imperial College London Dr Lee Hudson, Consultant Paediatrician, Great Ormond Street Hospital Dr Mike Hudson, Honorary Senior Lecturer in the Department of Paediatrics, Imperial College London Dr Warren Hyer, Consultant Paediatrician and Consultant Paediatric Gastroenterologist, St Mark’s Hospital and Chelsea and Westminster Hospital, London Dr David Inwald, Consultant in Paediatric Critical Care Medicine, St Mary's Hospital Dr Hannah Jones, Post Doctoral Researcher, Institute of Child Health, University College London Dr Laura Jones, Consultant in Paediatric Diseases, Royal Hospital for Sick Children Edinburgh Professor Beate Kampmann, Professor of Paediatric Infection & Immunity, Imperial College London Dr George Kassianos, Immunisation Lead, Royal College of General Practitioners Dr Dominic Kelly, Consultant in Paediatrics and Paediatric Infectious Disease, Oxford University Hospitals NHS Trust Dr Julia Kenny, Senior Clinical Research Fellow, Institute of Child Health, University College London Dr Steve Kerr, Consultant in Paediatric Intensive Care Medicine, Alder Hey Children's Hospital 4 Professor Nigel Klein, Consultant in Paediatric Infectious Diseases and Immunology, Great Ormond Street Hospital Professor Simon Kroll, Professor of Paediatrics and Infectious Diseases, Imperial College London Professor Jai Kulkarni, Consultant in Rehabilitation Medicine, University Hospital of South Manchester Professor Harold Lambert, Emeritus Professor of Microbial Diseases, St George's Hospital London Dr Nick Lessof, Consultant Paediatrician, Great Ormond Street Hospital Dr Paula Lister, Paediatric and Neonatal Intensivist, Great Ormond Street Hospital Dr Hermione Lyall, Consultant in Paediatric Infectious Diseases, Imperial College London Dr Nathalie MacDermott, Paediatric Speciality Trainee, Cwm Taf NHS Trust and Honorary Clinical Research Fellow at Imperial College London Dr Roderick MacFaul, Consultant Paediatrician, Pinderfields General Hospital Dr Iain MacIntosh, Consultant Paediatric Intensivist & Director PICU, Southampton General Hospital Mrs Chris Mackerness, Senior Sister, PICU, Great North Children's Hospital Newcastle Dr Ian Maconochie, Lead Consultant in Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust Dr Robin Marlow, Research Fellow, University of Bristol Dr Nuria Martinez-Alier, Paediatric Consultant in Infectious Diseases and Immunology, Evelina London Children’s Hospital Dr Georgios Mavrogeorgos, Paediatric SHO, St George's Hospital London Dr Antoinette McAulay, Consultant Paediatrician, Poole Hospital NHS Foundation Trust Dr Jillian McFadzean, Clinical Lead for PICU, Royal Hospital for Sick Children, Edinburgh Dr Fiona McGill, Clinical Research Fellow, University of Liverpool Dr Michael McIntyre, Consultant Microbiologist, Wexham Park Hospital Dr Alison McKendrick, Consultant in Rehabilitation Medicine, University Hospital of South Manchester Ms Sheila McQueen, Head of Health, Community and Education Department, Northumbria University Dr Esse Menson, Consultant in Paediatric Infectious Diseases and Immunology, Evelina London Children’s Hospital Dr Benedict Michael, NIHR Doctoral Research Fellow, University of Liverpool Dr Siraj Misbah, Consultant Clinical Immunologist, Oxford Radcliffe Hospitals NHS Trust Dr Fergal Monsell, Consultant Paediatric Orthopaedic Surgeon, Bristol Royal Hospital for Children Professor Richard Moxon, Emeritus Professor Paediatrics, University of Oxford Dr Linda Murdoch, Consultant in Paediatric Intensive Care, St George's Hospital London Dr Fiona Neely, Consultant in Health Protection/Public Health Dr Nelly Ninis, Consultant Paediatrician, St Mary’s Hospital, London 5 Dr Vas Novelli, Consultant in Paediatric Infectious Diseases, Great Ormond Street Hospital Dr Ifeanyichukwu Okike, Clinical Research Fellow, St George’s University of London Professor Mark Pallen, Head of the Division of Microbiology and Infection, Warwick Medical School Dr Kamal Patel, Consultant Paediatrician in Critical & Emergency Care, Royal Alexandra Children's Hospital Brighton Dr Nazima Pathan, University Lecturer and Consultant in Paediatric Intensive Care, University of Cambridge and Addenbrooke’s Hospital Dr Mark Peters, Consultant Paediatric Intensivist, Great Ormond Street Hospital Dr Stephen Playfor, Consultant Paediatric Intensivist, Royal Manchester Children’s Hospital Dr Jane Ratcliffe, Consultant in Paediatric Intensive Care, Alder Hey Children’s Hospital Dr Martin Richardson, Consultant Paediatrician, Peterborough Hospital Dr Anna Riddell, Paediatric Service Director, Royal London Hospital Dr Christine Rollier, Post Doctoral Research Associate, University of Oxford Ms Gael Rolls, Senior Charge Nurse/Critical Care Co-ordinator, Yorkhill Hospital Dr Robert Ross-Russell, Consultant Paediatrician, Addenbrooke’s Hospital Dr Manish Sadarangani, Clinical Lecturer in Paediatric Infectious Diseases and Immunology, University of Oxford Dr Tina Sajjanhar, Consultant in Paediatric Emergency Medicine, University Hospital Lewisham Dr Julian Sandell, Consultant in Paediatric Emergency Medicine, Poole Hospital NHS Foundation Trust Dr Martin Schweiger, Trustee, Thackray Medical Research Trust Dr Andrew Seaton, Consultant in Infectious Diseases, NHS Greater Glasgow and Clyde Dr Tim Sell, Clinical Research Fellow, Oxford Vaccine Group Professor Michael Shields, Professor of Child Health & Consultant Paediatrician, Queen's University of Belfast & Royal Belfast Hospital for Sick Children Dr Delaine Shingadia, Consultant in Paediatric Infectious Diseases, Great Ormond Street Hospital Dr Matthew Snape, Consultant in General Paediatrics and Vaccinology, Oxford University Hospitals NHS Trust Dr Yogi Thakker, Consultant Paediatrician, Milton Keynes Community Health Services Dr Alistair Thomson, Consultant Paediatrician, Leighton Hospital Dr Kent Thorburn, Consultant in Paediatric Intensive Care Medicine, Alder Hey Children’s Hospital Dr Guy Thwaites, Clinical Reader in Infectious Diseases, King's College London Dr Mark Tighe, Consultant Paediatrician, Poole Hospital NHS Foundation Trust Dr David Turner, Clinical Associate Professor and Honorary Consultant Microbiologist, University of Nottingham and Nottingham University Hospitals NHS Trust Dr Sam Walters, Consultant in Paediatric Infectious Diseases, Imperial College London 6 Dr Gabriel Whitlingum, Consultant Paediatrician - Neurodisability, Royal Hampshire County Hospital Dr Tim Whittington, Consultant Paediatric Intensivist, John Radcliffe Hospital Dr Ed Wilkins, Clinical Director of Infectious Diseases, North Manchester General Hospital Dr Andrew Winrow, Consultant Paediatrician, Kingston Hospital Dr Katie Yallop, Paediatric Registrar, Winchester Hospital Dr Robert Yates, Consultant in Paediatric Intensive Care, Royal Manchester Children's Hospital Additional names since 13 January 2014 Dr Rachel Agbeko, Consultant Paediatric Intensivist, Newcastle Hospitals NHS Foundation Trust Dr John Alexander, Consultant in Paediatric Intensive Care, University Hospital of North Staffordshire Dr Tariq Ali, Director Paediatric Critical Care, John Radcliffe Hospital, Oxford Dr Rim Al-Samsam, Consultant Paediatric Intensive Care, Cardiff and Vale University Health Board Dr Jacky Anderson, GP, Camberley, Surrey Professor Peter Andrew, Professor of Microbial Pathogenesis, University of Leicester Professor Jonathan Austyn, Professor of Immunobiology, John Radcliffe Hospital Oxford Ms Helen Avila, Senior Sister PICU, St Mary's Hospital Dr Jay Bannerjee, Consultant in Emergency Medicine & Associate Medical Director for Clinical Quality & Improvement, University Hospitals of Leicester NHS Trust Dr Chris Bayliss, Lecturer in Bacterial Genetics, University of Leicester Dr Jane Bayreuther, Consultant in Paediatrics and Paediatric Emergency Medicine, Lewisham and Greenwich NHS Trust Dr Colin Begg, Consultant Paediatric Intensivist, Royal Hospital for Sick Children Yorkhill Ms Toni Berry- Brown, Sister, PICU, Royal Manchester Children’s Hospital Professor Mitch Blair, Officer for Health Promotion, RCPCH Ms Nicola Booth, RGN, Northern Lincolnshire and Goole Hospital's NHS Foundation Trust Ms Daniella Boyle, Student Paediatric Nurse, Darent Valley Hospital Dr Charlotte Briar, Fellow in Extracorporeal Membrane Oxygenation, Great Ormond Street Hospital Dr Penelope Brock, Consultant Oncologist, Great Ormond Street Hospital Ms Jayne Brown, Specialist Community Public Health Nurse, Norfolk and Norwich University Hospital Trust Dr Angela Brueggemann, University Research Lecturer and Wellcome Trust Career Development Fellow, University of Oxford Mr David Burford, Advanced Nurse Practitioner, PICU, Birmingham Children's Hospital 7 Dr Margarita Burmester, Consultant and Honorary Senior Lecturer/Clinical Lead Paediatric Intensive Care/ Director SPRinT Programme, Royal Brompton Hospital Dr Fiona Burton, Consultant in Emergency Medicine, Hairmyres Hospital Ms Emma Bushell, Senior Sister PICU, St Mary's Hospital Professor Gary Butler, Professor and Consultant in Paediatric & Adolescent Medicine and Endocrinology, University College London Hospital & UCL Institute of Child Health Ms Tracy Caiger, ENA Emergency Nurse Assistant, Winey Minor Injury Unit, Oxfordshire Ms Cheryl Chainey, Advance Nurse Practitioner in Paediatric Emergency Care, Royal Bournemouth Hospital Ms Lesley Chandler, Health Protection Nurse, Wessex Centre Dr Emily Chesshyre, Registrar in Paediatric Infectious Diseases, Bristol Children's Hospital Dr Myron Christodoulides, Chairman of Scientific and Medical Advisory Panel, MenNow and University of Southampton Dr Matthew Christopherson, Consultant Paediatric Intensivist, Bristol Royal Hospital for Children Dr Angela Clayton, Lead Biomedical Scientist Neuropathology Dept., Royal Preston Hospital Ms Nicola Clissold, Staff Nurse, Paediatric Intensive Care Unit, Birmingham Children's Hospital Dr Jane Connell, Consultant Paediatrician, Stepping Hill Hospital, Stockport NHS Foundation Trust Ms Joanne Connolly, Matron for Children and Young People, Furness General Hospital Ms Lisa Cooke, Senior Staff Nurse, PICU, Great Ormond Street Hospital Ms Wendy Dadson, Senior Sister PICU, St Mary's Hospital, London Ms Linda Daniel, Programme Manager Clinical Strategy (South Yorkshire and Bassetlaw), NHS England Dr Jonathan Davis, Consultant in Neonatal Medicine and NICU Infection Lead, St Michaels Hospital Dr Peter Davis, Consultant Paediatric Intensivist, Bristol Royal Hospital for Children Ms Leigh De Souza, Advanced Nurse Practitioner, Orchard Practice, Chessington, Surrey Dr Winnie Dhaliwal, Teaching Fellow in Infectious Diseases, University of St Andrews Dr Nigel Dickson, GP, St Denys Surgery, Southampton Professor David Dockrell, Consultant in Communicable Diseases, Royal Hallamshire Hospital, Sheffield Professor Gordon Dougan, Head of Microbial Pathogenesis Group, Wellcome Trust Sanger Institute, Cambridge Dr Pam D'Silva, PICU Consultant, King's College Hospital Dr Heather Duncan, Consultant in Paediatric Intensive Care, Birmingham Children's Hospital Ms Janet Edmunds, Lead Nurse Looked After Children Hywel DDa Health Board, Glangwili Hospital, Carmarthen Ms Sam Ellis, Lecturer Practitioner PICU, Alder Hey NHS Foundation Trust 8 Dr Marieke Emonts, Consultant in Paediatric Infectious Diseases and Immunology, Royal Victoria Infirmary, Newcastle upon Tyne Dr Peter M B English, Consultant in Public Health/ Health Protection Professor Tom Evans, Professor of Molecular Microbiology, University of Glasgow Ms Margaret Farley, Lead Nurse Extracorporeal Life Support, PICU, Birmingham Children's Hospital NHS Foundation Trust Dr Mark Farrington, Honorary Consultant Microbiologist, Cambridge University Hospitals Ms Calandra Feather, Staff Nurse PICU, St Mary's Hospital Dr Michael Fernando, Consultant Paediatrician, Yeovil District Hospital Dr Katy Fidler, Consultant in Paediatric Infectious Diseases, Royal Alexandra Children's Hospital, Brighton Dr Caroline Finlayson, Consultant Histopathologist, St George's Hospital Professor Peter Fleming, Consultant Paediatrician, University Hospitals Bristol Dr Peter-Marc Fortune, Consultant Paediatric Intensivist / Associate Clinical Head, Royal Manchester Children’s Hospital Dr James Fraser, Consultant in Paediatric Intensive Care, Bristol Royal Hospital for Children Ms Hannah Frederick, PICU Staff Nurse, Alder Hey Children's Hospital Professor Neil French, Chair of Infectious Diseases & Global Health & Hon Consultant Infectious Diseases, Royal Liverpool & Broadgreen University Hospital Trust & University of Liverpool Dr Malcolm Gajraj, Consultant Paediatric Intensivist, University Hospital of Wales, Cardiff Dr Sandra Gala-Peralta, Royal Brompton Hospital Dr Darren Gates, Paediatric Registrar, Alder Hey Children's Hospital Dr Judith Gilchrist, Consultant Paediatric Emergency Medicine, Sheffield Children's NHS Foundation Trust Dr Diane Gindner, Consultant Paediatrician, Milton Keynes Community Health Services Dr Ardiana Gjini, Consultant in Public Health, University of Bristol Dr Effrossyni Gkrania-Klotsas, Consultant in Infectious Diseases, Addenbrooke’s Hospital, Cambridge Dr Mo Gnanalingham, Consultant in Paediatric Intensive Care, Royal Manchester Children's Hospital Dr Lucy Grain, Consultant Paediatrician, Great Western Hospital, Swindon Miss Joanne Greaves, Practice Nurse, St Mary's Surgery, Cambridgeshire Mr Steve Grimbleby, Paediatric Nurse, Heatherwood and Wexham Park NHS Foundation Trust Dr Anil Gupta, Consultant Paediatrician, North Tees and Hartlepool NHS Foundation Trust Dr Rajeev Gupta, Consultant Paediatrician & Hon Senior Clinical Lecturer, Barnsley Foundation Hospital & University of Sheffield Ms Juliette Hall, Staff Nurse, Emergency Department, Lister Hospital Stevenage Ms Rachel Hancock, Junior Sister PICU, Birmingham Children’s Hospital Miss Rosie Hanna, Senior Staff Nurse, Northern Ireland Children's Hospice 9 Dr Sara Hanna, Clinical Director and Consultant in Intensive Care, Evelina London Children's Hospital Dr Tim Haywood, Lead Clinician Paediatric ICU, Leeds General infirmary Professor Andrew Heath, Chair of Cellular Immunology, University of Sheffield Medical School Dr Paul Heaton, Consultant Paediatrician, Yeovil District Hospital Mrs Janet Herald, Practice Nurse, Woodlands Surgery, Banbury Ms Yvonne Heward, Lead Nurse for Education and Workforce Development, PICU, Birmingham Children's Hospital Professor Adrian Hill, Director, The Jenner Institute, University of Oxford Dr Sara-Louise Hulme, Consultant Paediatric Intensivist, Bristol Royal Hospital for Children Ms Amelia Jackson, Birmingham Children's Hospital Ms Sue Jarvis, Consultant Pharmacist (PICU), Bristol Royal Hospital for Children Dr Ashok Jethwa, Victoria Park Health Centre, Leicester, GP Dr Jolly John, Senior Clinical Medical Officer, The David Lewis Centre, Warford, Cheshire Mr Gareth Jones, Consultant in Paediatric Intensive Care, Southampton General Hospital Dr Hilary Jones, GP, Patron Meningitis Research Foundation, Health Editor ITV Breakfast, & BMI Health Care, The Hampshire Clinic Basingstoke Miss Carly Joyce, Staff nurse PICU, Birmingham Children's Hospital Dr Angray Kang, Reader Molecular Cell Biology, Barts & The London School of Medicine and Dentistry Dr Jason Kendall, Consultant in Emergency Medicine, North Bristol NHS Trust Ms Carol Kennelly, Matron, PICU & Paediatrics, St George's Hospital Dr Daniel Khew, GP principal, Derrygonnelly Surgery, Co Fermanagh, N. Ireland Ms Emma King, Senior Staff Nurse PICU, St Mary's Hospital Dr Naga Kishore Puppala, Paediatric Intensive Care Trainee, Alder Hey Children's Hospital Dr Rachel Kneen, Consultant Paediatric Neurologist, Alder Hey Children's NHS Foundation Trust Dr Dinakantha Kumararatne, Consultant Immunologist, Addenbrooke's Hospital, Cambridge Professor Monica Lakhanpaul, Professor of Integrated Community Child Health, University College London Professor Paul Langford, Professor of Paediatric Infectious Diseases, Imperial College London Dr Martin Laqué, Locum Consultant Paediatric A&E, St Thomas' Hospital, London Dr Paul Leonard, Consultant in Emergency Medicine and Paediatric Emergency Medicine, Royal Hospital for Sick Children Edinburgh Professor David Lewis, Professor of Clinical Vaccine Immunology, University of Surrey Ms Nikki Lloyd, Sister NICU Dr Joanna Longstaffe, Private GP, The Independent General Practice, Cardiff Dr Jo Lumsden, Paediatric Intensive Care Consultant, Leeds General Infirmary 10 Dr Karen Luyt, Consultant Senior Lecturer in Neonatal Medicine, St Michael’s Hospital, Bristol Dr Jenny MacLennan, Clinical Researcher, University of Oxford Dr Nick Makwana, Consultant Paediatrician, Sandwell and West Birmingham Hospitals NHS Trust Dr Cliff Mann, President of the College of Emergency Medicine and Consultant in Accident and Emergency Medicine, Musgrove Park Hospital Dr Will Marriage, Consultant in Paediatric Intensive Care, University Hospitals Bristol NHS Foundation Trust Ms Debbie Martin, Community Nurse, East Lothian Dementia Team Dr Natalie Martin, Clinical Research Fellow, Oxford Vaccine Group Dr Rosamund Marvin, ST4 in Palliative Care, Bedford Hospital Ms Corinna Mason, Clinical Nurse Specialist, PICU, Birmingham Children’s Hospital Ms Jane Maund, Senior Specialist Nurse, Wessex Centre Ms Emmeline McArdle, RGN, Advantage Healthcare Ms Juliette McArdle, Community Mental Health Nurse, Early Intervention Team, Southeast Kent Professor Johnjoe McFadden, Professor of Molecular Genetics, University of Surrey Mr Nicholas Mills, Charge Nurse, Paediatric Critical Care Unit, Sheffield Children's NHS Foundation Trust Hospital Dr Henry Mintz, GP, Lisson Grove Health Centre Dr James Moir, Reader, Dept of Biology, University of York Dr Quen Mok, Consultant Paediatric and Neonatal Intensivist, Great Ormond Street Hospital Dr Mary Montgomery, Clinical Lead, Kids Intensive Care and Decision Support, Birmingham Children's Hospital Dr Kevin Morris, Consultant in Paediatric Intensive Care, Birmingham Children's Hospital Ms Rachael Morrison Advanced Nurse Practitioner, Paediatric Intensive Care, Birmingham Children's Hospital Dr Richard Neal, Consultant Paediatric Intensivist, Birmingham Children’s Hospital Ms Clare Nelson, Family Nurse, Ealing Family Nurse Partnership Dr Jane Newcombe, Research Fellow, University of Surrey Ms Lucy Nicholson, Registered Children's Nurse and Student Health Visitor, East London NHS Foundation Trust Dr Tamsyn Nicole, Designated Doctor for Child Death for Somerset, Local Safeguarding Children Board Ms Sue Novakovic, Junior Sister PICU, Birmingham Children’s Hospital Dr Katherine Oakley, Consultant in Palliative Medicine, St Helena Hospice, Colchester Dr Deirdre O'Donnell, Paediatric Emergency Medicine Consultant, Sheffield Children's Hospital NHS Foundation Trust Dr Roddy O'Donnell, Consultant in Paediatric Intensive Care, Addenbrooke’s Hospital, Cambridge 11 Professor Gerard O'Donoghue, Consultant ENT Surgeon, Queens Medical Centre, Nottingham Dr Benedicta Ogeah, Consultant Community Paediatrician, Epsom and St Helier University Teaching Hospital Dr Neil Oldfield, Senior Research Fellow, University of Nottingham Dr Deirdre O'Shea, Specialist Registrar Paediatric Intensive Care, Great Ormond Street Hospital Mr Tim Overton, Consultant in Fetal Medicine and Obstetrics, St Michaels Hospital Dr John Pappachan, Consultant and Honorary Senior Lecturer in Paediatric Intensive Care Medicine, Southampton General Hospital Dr Kate Parkins, Lead Consultant, North West and North Wales Paediatric Transport Service Dr Stéphane Paulus, Consultant in Infectious Diseases, Alder Hey Children's NHS Foundation Trust Dr Lesley Peers, Consultant General Paediatrician, Sheffield Children's NHS Foundation Trust Dr Barbara Phillips, Retired Emergency Paediatric Consultant, Alder Hey Children's Hospital, Liverpool Dr Germaine Pierre, Paediatric Metabolic Consultant, Bristol Royal Hospital for Children Dr Colin Powell, Honorary Consultant Paediatrician, Children's Hospital for Wales Dr Umesh Prabhu, Medical Director, Wrightington, Wigan and Leigh NHS Foundation Trust Dr Katherine Price, Consultant Paediatrician, Sheffield Children's Hospital Mr Edicen Quintos, Staff Nurse, Critical Care Unit, UHCW NHS Trust Dr Padmanabhan Ramnarayan, Consultant in Paediatric Intensive Care and Retrieval, Great Ormond Street Hospital Dr Samiran Ray, Locum Consultant, Children's Acute Transport Service London Ms Nicola Reilly, Senior Clinical Pharmacist, Intensive Care, Alder Hey Children’s NHS Foundation Trust Ms Sharon Rice, Registered Adult Nurse, Kettering General Hospital, Northamptonshire Dr Julie Richardson, Consultant Paediatric Intensivist, Royal Belfast Hospital for Sick Children Dr Shelley Riphagen, PICU & STRS Consultant, Evelina London Children’s Hospital Professor Ian Roberts, Professor of Molecular Microbiology, University of Manchester Dr Simon Robinson, Paediatric Intensivist & ECMO Consultant, Glenfield and Leicester Royal Infirmary Hospitals Dr Susan Robinson, Clinical Director of the Emergency Department (ED), Addenbrooke’s Hospital, Cambridge Dr Joan Robson, Retired Consultant in Emergency Care, Alder Hey Children's Hospital Dr Marion Roderick, Specialist Registrar Paediatrics, Bristol Royal Hospital for Children Ms Meg Rodgers, Treatment Room Locality Sister, Northern Trust, Northern Ireland Dr Helen Rowlands, Paediatric Intensivist, University Hospital Southampton 12 Dr David Rowney, Consultant Anaesthesia and Intensive Care (Retrieval), Royal Hospital for Sick Children, Edinburgh Dr Penny Salt, Consultant Paediatrician, University College London Hospitals Ms Gerri Sefton, Advanced Nurse Practitioner PICU, Alder Hey Children’s NHS Foundation Trust Ms Aileen Sharp, Neonatal Transport Nurse, West Midlands Neonatal Transfer Service Miss Jessica Sherratt, Student Nurse, University of Greenwich Dr Victoria Sheward, PICU Senior Registrar, Evelina London Children's Hospital Ms Lynn Shields, Advanced Nurse Practitioner, Children's Acute Transport Service, London Dr Dorothea Sidaras, Associate Specialist in PICU, Alder Hey Hospital, Liverpool Professor Mervyn Singer, Professor of Intensive Care Medicine, University College London Ms Laura Snow, Sister PICU, Evelina London Children's Hospital Ms Linda Somner, Staff Nurse, Appleby Court Nursing Home (ex Burns Unit Royal Manchester Children’s Hospital) Professor David Southall, Honorary Medical Director, Maternal and Child Health Advocacy International (MCAI) Dr Charles Stack, Consultant Paediatric Anaesthetist and Intensivist, Sheffield Children's NHS Foundation Trust Ms Andrea Stanley, Paediatric Sister, Broomfield Hospital Chelmsford Essex Ms Holly Starling-Cass, Specialist Community Public Health Nurse (Health Visiting), Beechwood House, Whitfield Ms Alexis Stevens, Health Protection Nurse, Wessex Centre Dr David Stewart, Consultant Paediatric Intensivist, Royal Manchester Children's Hospital Dr Shoeb Suryani, General Practitioner Principal, Suryani Surgery, Bilston Ms Alison Taberner-Stokes, PICU Nursing Sister, Great Ormond Street Hospital Dr Brent Taylor, Emeritus Professor of Community Child Health, University College London Dr Matthew Taylor, Consultant Intensivist/Anaesthetist, Sheffield Children's Hospital Dr Prakash Thiagarajan, Consultant General & Neonatal Paediatrician, Noble's Hospital Dr Yamuna Thiru, Consultant Paediatric Intensivist, Newcastle Upon Tyne Hospitals NHS Trust Dr Matthew Thompson, Reader in Primary Care, University of Oxford Department of Primary Care Health Sciences Ms Amanda Tomlinson, Paediatric Nurse, Isabel Healthcare Dr Jeremy Tong, Specialist Trainee in Paediatric Intensive Care Medicine, Birmingham Children's Hospital Dr Lance Turtle, NIHR Clinical Lecturer in Infectious Diseases, University of Liverpool Dr Mamta Vaidya, Consultant, Barts Health NHS Trust Dr Nadja van Ginneken, Research Fellow, London School of Hygiene and Tropical Medicine Dr Tushar Vince, Consultant Paediatric Intensivist, Kings College Hospital Dr Stephen Wadams, Consultant Paediatrician, Poole Hospital NHS Foundation Trust 13 Ms Julia Waddon, Advanced Nurse Practitioner, PICU, Alder Hey Children’s Hospital Ms Nicola Walmsley, Clinical Supervisor, Yorkshire Ambulance Service Dr Allan Wardhaugh, Consultant Paediatric Intensivist & Clinical Director, Child Health, University Hospital of Wales Dr Steven Welch, Consultant in Paediatric Infectious Diseases, Heartlands Hospital, Birmingham Ms Wendy Wells, Health Visitor, Stafford and Stoke on Trent Partnership Trust Ms Debbie White, Clinical Research Nurse, PICU, Addenbrooke’s Hospital, Cambridge Mr Stephen-Andrew Whyte, Lead Clinical Pharmacist, The Portland Hospital for Women & Children Professor Peter Williams, Emeritus Professor of Microbiology, University of Leicester Dr Grace Williamson, Consultant Paediatric Intensivist, Great North Children's Hospital Dr Karl Wooldridge, Associate Professor of Microbiology, University of Nottingham Dr Victoria Wright, Senior Research Fellow, Paediatric Infectious Diseases, Imperial College London Dr Paul Younge, Consultant in Emergency Medicine, North Bristol NHS Trust Dr Deborah Zeitlin, PICU Registrar, Evelina London Children's Hospital 14