Download Vaccine Preventable disease (Topic 3)

Vaccine Preventable
Diseases
(VPD)
By the end of this session you will be able to:
• For each disease:
• Describe the main signs and symptoms, mode of transmission and
period of infectivity of each different vaccine preventable disease
in the U.K
• Describe the historical impact of vaccination on the epidemiology
of the disease
• Explain the current incidence of each disease in the UK
• Describe the nature and frequency of acute symptoms and
potential long term complications
• Know where to access further information about each disease
January 2016
Diphtheria
• Bacterial respiratory infection caused by toxigenic strains of
Corynebacterium diphtheria or Corynebacterium ulcerans
• Airborne transmission via droplets
• Incubation period 2-7 days
• Affects all ages but moist serious in very old and very young
January 2016
Features
• Early signs: mild fever, swollen neck glands, anorexia, malaise, cough
• 2-3 days: membrane of dead cells forms in throat, tonsils, larynx or nose
which may narrow or occlude the airway leading to respiratory distress
• Toxins may travel through bloodstream = extensive organ damage,
neurological & cardiac complications
• Death occurs in 5-10% cases
January 2016
Cases & deaths 1914-2009, England & Wales
January 2016
Diphtheria issues
• Before vaccination introduced it was a leading cause of death
in children
• Cases in the UK are very low with most being attributed to
recent travel to endemic countries
• Vaccination uptake is vital – epidemic in Soviet Union
between 1990-1998 resulted in 157,000 cases and 5,000
deaths
January 2016
Vaccination schedule Sept 2015 (up to 18 years)
Age
Diseases protected against
2
months
Diphtheria, tetanus, whooping cough, polio, Hib, Pneumococcal,
Rotavirus, and Meningococcal group B (Men B)
3
months
Diphtheria, tetanus, whooping cough, polio, Hib, Meningococcal
group C (Men C) and Rotavirus
4
months
Diphtheria, tetanus, whooping cough, polio, Hib, Pneumococcal
and Men B
12-13
months
Hib/Men C
Pneumococcal, Measles, mumps & rubella (MMR) and Men B
2-6yrs
3yrs 4m
Children’s flu vaccine (live vaccine)
Diphtheria, tetanus, whooping cough, polio
MMR (pre-school immunisations)
1213yrs
1318yrs
Low dose
Diphtheria “d”
not “D”
HPV (cervical cancer) girls only 2 x doses 6 months apart
Diphtheria, tetanus, polio (school leavers immunisations)
Men ACWY
7
Tetanus
• Caused by Clostridium tetani – a bacterium
• Non- communicable (no herd immunity)
• Bacteria form spores that can survive in the environment for years
• Tetanus may occur if a wound or cut is infected by soil or manure
• Incubation period 4-21 days
• Affects people of all ages
• People who recover from tetanus do not
have natural immunity therefore need to be immunised
January 2016
Features
• Initially: muscle stiffness of the jaw (“Lockjaw”) 50% cases
• Followed by: neck stiffness, difficulty swallowing, stiffness of stomach
muscles, muscle spasms, sweating and fever
• Complications Include;
• Fractures
• Hypertension
• Laryngospasm
• Pulmonary embolism
• Aspiration
• Death
January 2016
Neonatal tetanus
• More frequent in developing countries
• Infant born without protective passive immunity
• Infection of the umbilical Cord Stump
• High fatality rate without treatment
https://alicespringstomind.wordpress.com/2013/09/21/development-projects-abound/
January 2016
Cases & deaths, England & Wales 1969-2008
total notified cases
30
25
20
15
10
5
0
1969
1972
1975
1978
1981
1984
1987
1990
1993
1996
1999
2002
2005
2008
years
45 plus years
15 to 44 years
under 15 years
January 2016
More recent data (England)
• January to December 2014:
• 7 cases
• 1 death
• 80+ female
• Immunisation
status unknown
• Cases aged 15-87
• 2 born after 1961 so eligible
for vaccination (and were
vaccinated appropriately)
• 5 born before 1961 (so
immunisation status varied)
• 5 cases occurred during June
& July
• all involved lacerations
sustained in either:
home/garden/woodland/sta
ble/street
• No cases among people who
inject drugs
January 2016
Vaccination schedule Sept 2015 (up to 18 years)
Age
Diseases protected against
2
months
Diphtheria, tetanus, whooping cough, polio, Hib, Pneumococcal,
Rotavirus, and Meningococcal group B (Men B)
3
months
Diphtheria, tetanus, whooping cough, polio, Hib, Meningococcal
group C (Men C) and Rotavirus
4
months
Diphtheria, tetanus, whooping cough, polio, Hib, Pneumococcal
and Men B
12-13
months
Hib/Men C
Pneumococcal, Measles, mumps & rubella (MMR) and Men B
2-6yrs
3yrs 4m
Children’s flu vaccine (live vaccine)
Diphtheria, tetanus, whooping cough, polio
MMR (pre-school immunisations)
1213yrs
HPV (cervical cancer) girls only 2 x doses 6 months apart
1318yrs
Diphtheria, tetanus, polio (school leavers immunisations)
Men ACWY
13
Tetanus issues
• 5 doses of tetanus at appropriate intervals
• Early treatment with tetanus immunoglobulin for heavily
contaminated wounds
• Early recognition of potential tetanus wounds
• Continued vigilance for early signs and symptoms of tetanus
in IDUs
January 2016
Pertussis (whooping cough)
• Respiratory infections caused by bacterium Bordatella pertussis
• Spread easily from person-to-person in droplets produced by
coughing or sneezing
• Most dangerous in children under 1 year, most severe in young
infants
• Incubation period 6-20 days with a range of 4 - 21 days
• Infectious from 6 days after exposure to 3 weeks after onset of
cough
• Duration of illness can be 2-3 months
January 2016
Features
• Initial cold like symptoms
• Gradually worsening cough developing into paroxysms of coughing which are
characterised by whoop
Complications:
• Respiratory – the majority of cases involve some degree of collapsed lung and/or
pneumonia
•
Neurological – lack of oxygen leading to altered consciousness, convulsions,
permanent brain damage, death
•
Severe weight loss and dehydration due to vomiting
•
Sudden death - babies may stop breathing, apnoeic attacks
•
Despite low levels of disease, pertussis remains a significant cause of death in infants
<6m
January 2016
Vaccination schedule Sept 2015 (up to 18 years)
Age
Diseases protected against
2
months
Diphtheria, tetanus, whooping cough, polio, Hib, Pneumococcal,
Rotavirus, and Meningococcal group B (Men B)
3
months
Diphtheria, tetanus, whooping cough, polio, Hib, Meningococcal
group C (Men C) and Rotavirus
4
months
Diphtheria, tetanus, whooping cough, polio, Hib, Pneumococcal
and Men B
12-13
months
Hib/Men C
Pneumococcal, Measles, mumps & rubella (MMR) and Men B
Offered to all
pregnant women
with each
pregnancy
2-6yrs
3yrs 4m
Children’s flu vaccine (live vaccine)
Diphtheria, tetanus, whooping cough, polio
MMR (pre-school immunisations)
1213yrs
HPV (cervical cancer) girls only 2 x doses 6 months apart
1318yrs
Diphtheria, tetanus, polio (school leavers immunisations)
Men ACWY
17
100
80
150,000
60
100,000
40
50,000
20
2005
2000
1995
1990
1985
1980
1975
1970
1965
1960
1955
1950
0
1945
0
vaccine coverage
200,000
1940
notifications of pertussis
Whooping cough notifications and vaccine
coverage: England and Wales, 1940-2009
years
notifications
coverage
January 2016
January 2016
Uptake rates
Apr-Aug 2014
55.6%
Change to
acellular
Current issues
• Incidence in infants – accelerated schedule
• Passive protection via maternal vaccination – recently
extended
• Uptake in infants close to 95% WHO recommendations
• Vaccine highly effective but protection wanes over time
• Adolescent booster under consideration
Poliomyelitis
• Viral infection with three types – I, II & III
• Virus enters via the mouth after contact with faeces or
pharyngeal secretions
• Replicates in pharynx and GI tract
• Invades local lymph tissue
• Enters blood stream and may infect cells of central nervous
system causing aseptic meningitis
• More rarely replicates in and destroys the motor neurones
which activate the muscles (~1:100 infections)
January 2016
Features
• Often asymptomatic (>95% cases)
• May have mild influenza type symptoms
Paralytic polio
• In >1% cases
• The use of one or both arms or legs may be lost and
breathing may not be possible without help of a respirator.
• The degree of recovery varies from person to person
January 2016
Change to IPV
from OPV
Vaccination
• Before vaccine introduced in
1950s there were up to 750
deaths per year
• No cases of naturally
contracted polio in the UK
since 1984
• Now only endemic in
Nigeria, Afghanistan and
Pakistan (WHO, 2015)
• Eradication by 2018 is a
WHO resolution
January 2016
January 2016
Haemophilus influenzae type b - Hib
• Caused by infection with Haemophilus influenzae bacteria
• 6 (a-f) capsular serotypes cause disease in man
• Transmission occurs from coughing, sneezing, close contact
with infected person.
• Healthy individuals can carry Hib bacteria in their nose and
throat without symptoms
January 2016
Features of Hib disease
• Most common presentation of invasive Hib is meningitis,
frequently accompanied by bacteraemia (60%)
• 15% of cases present with epiglottitis
• Bacteraemia without any other concomitant infection,
occurs in 10% of cases
• Remainder made up of cases of septic arthritis,
osteomyelitis, cellulitis, pneumonia, and pericarditis
January 2016
Complications of Hib meningitis
• Deafness
• Convulsions
• Intellectual impairment
• Case fatality rate 2-5% in spite of effective antimicrobial therapy
In England & Wales before 1992:
• 1 child in 600 developed some form of Hib disease by 5th birthday
• Hib meningitis caused 30 deaths each year
• Approximately 80 children a year were left with deafness or permanent
brain damage
January 2016
Invasive Hib infections by age group
1990-2008 England and Wales
January 2016
Vaccination schedule Sept 2015 (up to 18 years)
Age
Diseases protected against
2
months
Diphtheria, tetanus, whooping cough, polio, Hib, Pneumococcal,
Rotavirus, and Meningococcal group B (Men B)
3
months
Diphtheria, tetanus, whooping cough, polio, Hib, Meningococcal
group C (Men C) and Rotavirus
4
months
Diphtheria, tetanus, whooping cough, polio, Hib, Pneumococcal
and Men B
12-13
months
Hib/Men C
Pneumococcal, Measles, mumps & rubella (MMR) and Men B
2-6yrs
3yrs 4m
Children’s flu vaccine (live vaccine)
Diphtheria, tetanus, whooping cough, polio
MMR (pre-school immunisations)
1213yrs
HPV (cervical cancer) girls only 2 x doses 6 months apart
1318yrs
Diphtheria, tetanus, polio (school leavers immunisations)
Men ACWY
Increased
efficacy when
given at 1yr+
32
Meningococcal disease
• Caused by infection with bacteria Neisseria meningitidis
• 12 groups identified – A,B,C,E,H,I,K,L,W,X,Y & Z
• Historically, groups B,C, W & Y were most common in the
UK
• 5-11% adults and 25% adolescents carry the bacteria in their
nose and throat without symptoms
• Transmission occurs through aerosol, droplet or direct
contact with respiratory secretions
January 2016
• Most common presentation of meningococcal disease is
meningitis and septicaemia (or both)
• Other presentations include pneumonia, myocarditis,
endocarditis, pericarditis, arthritis, conjunctivitis, urethritis,
pharyngitis and cervicitis
January 2016
IMD in Europe (2009) data from PHE
January 2016
Confirmed cases meningococcal infection (E & W)
January 2016
Epidemiology and schedule changes
• Men C initially given on accelerated schedule of 2,3 & 4
months (1999) with catch up in young adults but for infants,
protection waned rapidly
• In 2006 additional dose given at 12 months to extend
protection
• Changing epidemiology of MenW = replace MenC with
MenACWY vaccine
• 2015 MenB introduced to schedule
January 2016
Vaccination schedule Sept 2015 (up to 18 years)
Age
Diseases protected against
2
months
Diphtheria, tetanus, whooping cough, polio, Hib, Pneumococcal,
Rotavirus, and Meningococcal group B (Men B)
3
months
Diphtheria, tetanus, whooping cough, polio, Hib, Meningococcal
group C (Men C) and Rotavirus
4
months
Diphtheria, tetanus, whooping cough, polio, Hib, Pneumococcal
and Men B
12-13
months
Hib/Men C
Pneumococcal, Measles, mumps & rubella (MMR) and Men B
2-6yrs
3yrs 4m
Children’s flu vaccine (live vaccine)
Diphtheria, tetanus, whooping cough, polio
MMR (pre-school immunisations)
1213yrs
HPV (cervical cancer) girls only 2 x doses 6 months apart
1318yrs
Diphtheria, tetanus, polio (school leavers immunisations)
Men ACWY
38
Pneumococcal disease
Spectrum of pneumococcal infection
•Bacterium - Streptococcus
pneumoniae
Meningitis
•Carried in the nose and throat
Sinusitis
(common)
Invasive Pneumococcal
Disease (bacteramia)
Otitis Media
Pneumonia
•Transmitted through infected
droplets through coughing,
sneezing & close contact
•Asymptomatic carriage possible
Soft Tissue Infection (rare)
Arthritis (rare)
Peritonitis (rare)
•Over 90 serotypes identified
but most invasive disease in UK
children caused by 8-10 of these
Invasive Pneumococcal infection, England & Wales,
incidence per 100,000 by age group 2000
80
70
60
50
40
30
20
10
0
<1
month
1-11
months
1-4
years
5-9
years
10-14
years
15-44
years
45-64
years
65-74
years
>75
years
Invasive disease
• Prior to introduction of vaccine in childhood schedule, 1 in 6000
children under 5y acquired IPD each year
• Risk is highest during the first year of life and in the winter months
• Boys are at greater risk than girls
• Factors such as attendance at day care and lack of breast feeding are
associated with a higher risk of pneumococcal disease
IPD may present as bacteraemia, meningitis or pneumonia
• Bacteraemia:
•
- most common and life-threatening form of IPD in children.
•
- can cause septicaemia which can lead to organ damage and carries a high mortality rate
•
- around 50 children under 2ys died from IPD each year prior to introduction of vaccine
At 2,4 & 12
months
UK Immunisation schedule Sept 2015 (18yrs+)
Age
Diseases protected against
65yrs+
Pneumococcal disease
(polysaccharide vaccine)
65yrs+
Influenza (each year)
70yrs
Shingles
• JCVI are reviewing adult vaccination with PPV23
• The efficacy of PPV in protecting adults against community acquired
pneumonia (CAP) is being examined
• In 2013/2014 74% of invasive disease in adults 65-69 were caused by
serotypes found in PPV23
• Decline in rates of invasive pneumococcal disease and CAP in adults caused by
the 13 serotypes in childhood PCV vaccine – indirect impact in a different
population
Rotavirus
• Different strain classified (G and P types) by outer layer proteins –
10G and 11P types found in humans
• Highly contagious – most often faecal-oral route but respiratory
transmission can occur
• Causes gastroenteritis which can lead to complications associated
with dehydration
• Before vaccination, it was estimated that virtually all children
would have had a rotavirus infection before 5th birthday
• Still a major cause of death in children in developing countries
Vaccination
• Live attenuated vaccine given orally (introduced in 2013)
• 2 x doses at 2 & 3 months (4 weeks apart)
• Observation of the infant’s age at vaccination is crucial to
avoid the potential risk of intussusception
STOP PRESS…….
• Rotavirus is similar to norovirus (winter
vomiting bug)
• Similar symptoms and transmission
• Different sections of population affected
– rotavirus more associated with infants
and young children
Measles, mumps, rubella
• All three are viral infections
• All spread via similar methods
• Varying incubation periods – this accounts for the side
effects post vaccination
Measles
• Morbillivirus
• Nose and throat secretions and airborne droplets via
coughing & sneezing
• Incubation = 7-18 days
Early
symptoms
January 2016
Huge risk of complications with measles
• In 30% cases
• Mostly in infants, adults & immunocompromised people
• Diarrhoea is a major problem for infants
• Pneumonia in 1-6/100 cases = commonest cause of death
• Otitis media, encephalitis
• SSPE – rare but fatal complication of measles infection
January 2016
January 2016
January 2016
1600
1400
1200
1000
800
1348
600
1144
990
400
739
438
200
308
2009
2008
2007
2006
2001
2005
2000
77
2004
70
2003
100
2002
92
1999
1997
11
1996
0
191
56
1998
177
January 2016
Measles notifications, E & W by age and region (Aug 2015)
January 2016
Mumps
• Paramyxovirus
• Incubation 14-25 days
• Headache, fever
• Parotid swelling
• Meningism can develop
• 30% cases in children asymptomatic
• Most severe in adults
January 2016
Complications
• Pancreatitis (4%)
• Oophoritis (5% women)
• Orchitis (25% men)
• Neuro complications – meningitis, deafness
• Before routine vaccination, mumps commonest cause of
viral meningitis in childre
• Nephritis, cardiac abnormalities and rarely death
January 2016
Current issues for Mumps
• Two doses of MMR are required for full protection from
mumps
• Cases still occurring in Universities since 2005 outbreak
• Opportunistic vaccination at “teenage” booster and
university entrance for those who have only received 1 MMR
vaccine
January 2016
Rubella
• “German measles” caused by Toga virus
• Direct or droplet contact with NP secretions
• Incubation 14-21 days
• General malaise, low fever, swollen lymph
glands & conjunctivitis
• Rash
• Swollen joints & joint pain more common
in adults
January 2016
Congenital rubella syndrome
• Risk if infected during pregnancy
• Risk of foetal damage estimated at:
90% in first 10 weeks
10-20% by 16 weeks
Rare after 20 weeks
• Birth defects include cardiac, auditory, ophthalmic & neuro
problems
• Before 1970 (routine vaccination) up to 70 cases of CRS
reported each year
• Ratio of therapeutic abortions 10:1
January 2016
Girls & nonimmune women of
childbearing age
PHE data, E & W 2012-2013 (Dec 2015)
• In the 10 years between 2005 and 2014 there have been 7 cases of
CRS born in the UK (PHE, 2015).
• Increased risk in immigrant women
January 2016
Human Papillomavirus
• Over 100 types (over 40 of these affect genital area)
• High risk types (16,18) cause cancer and account for 70% of
all cervical cancers
• Low risk types (6,11) cause genital warts
• Infection via direct contact – skin to skin (skin & mucosal
sites)
• HPV infection often asymptomatic and can resolve
spontaneously
January 2016
January 2016
Vaccination introduced in Sept 2008
• Two licensed vaccines:
•
Gardasil: protects against HPV 6,11,16,18
•
Cervarix: protects against HPV 16,18
• Normal 2 x dose schedule (3 x doses if starting over 15 yrs)
• Latest studies show protection 7 years post vaccination – ongoing
• HPV could prevent 2/3 of cervical cancers in women under 30 by 2025 BUT
uptake needs to be at 80%
• UK is on target for achieving this as uptake is good
January 2016
Local uptake
Doses given 1st September 2013 to 31st August 2014
Locality
Total No. of
girls in Cohort
11
Dose one
Number
Dose one and tw o
%
All three doses
Number
%
Number
%
NORTH YORKSHIRE AND HUMBER AREA TEAM
EAST RIDING OF YORKSHIRE LOCAL AUTHORITY
1834
1767
96.3
1751
95.5
1638
89.3
KINGSTON UPON HULL, CITY OF LOCAL AUTHORITY
1178
1082
91.9
1058
89.8
976
82.9
NORTH EAST LINCOLNSHIRE LOCAL AUTHORITY
812
773
95.2
768
94.6
743
91.5
NORTH LINCLONSHIRE LOCAL AUTHORITY
926
817
88.2
813
87.8
783
84.6
NORTH YORKSHIRE LOCAL AUTHORITY
2766
2363
85.4
2353
85.1
2317
83.8
YORK LOCAL AUTHORITY
1504
1430
95.1
1418
94.3
1389
92.4
January 2016
Varicella (chicken pox) and shingles
• Varicella – primary infection with varicella zoster virus
(VZV)
• Shingles (or herpes zoster) caused by reactivation of latent
VZV infection
• This is why shingles cannot occur in people unless they have
had chickenpox
• Virus from shingles can cause chicken pox in susceptible
people
• No evidence that this happens the other way around
January 2016
Varicella
• Highly infectious
• Personal contact, droplet spread,
infected articles
• Most common in children <10 years old
• 10-21 days incubation, infectious 1-2 days
before appearance of rash
• Peak March-May
• Initial flu-like symptoms (prodromal phase)
• Vesicular spots appear often in crops most commonly on trunk
January 2016
Complications
• Viral pneumonia, secondary bacterial infections &
encephalitis
Those at most risk:
• Adults
• Immunocompromised
• Pregnant women
• Neonates
• Congenital varicella
syndrome (first 20 weeks)
• Limb shortening, poor
muscle development,
cataracts, growth
retardation…
• Later infection = preterm
delivery or neonatal
varicella infection
January 2016
Shingles
• Abnormal skin sensations & pain (dermatome)
• Sometimes headache & photophobia
• Vesicular rash with dermatomal distribution
• Risk and severity of shingles increases with age
JAMA, 2011
January 2016
Complications
• Post Herpetic Neuralgia (PHN)
• Depends on area affected – e.g. facial palsy or ophthalmic
involvement (conjunctivitis, retinitis, glaucoma…)
• Disseminated disease – lungs, liver, gut, brain leading to
associated infections, e.g. pneumonia, hepatitis
• Most likely with severe immunosuppression
January 2016
The vaccines
Varicella (no plans to
introduce to routine
schedule)
Shingles (Sept 2014)
• Live vaccine
• Live vaccine – Zostavax
(Subcutaneous)
• 2 licenced in UK
• 1 licenced in UK
• 2 dose schedule
• Selective programme
• HCW – protect those
patients/clients at risk &
personal protection
• 1 dose schedule – being
monitored
• Mass programme (70yrs+)
• Contacts of
immunocompromised
January 2016
Influenza
• Viral infection types A, B & C
• Fever, chills, headache, myalgia, fatigue
• Transmission is by droplets, aerosol, or through direct
contact with respiratory secretions of someone with the
infection
• Type A causes yearly outbreaks – antigenic drift results in
new subtype. Also found in animals.
• Type B also subject to antigenic drift but much less
frequently, burden of disease in children
• Type C minor respiratory illness only
January 2016
In more vulnerable individuals can lead to
complications of:
• -secondary bronchitis
• -bacterial pneumonia
• -otitis media (in children)
Severe cases may lead to:
• -meningitis
• -encephalitis
• -meningoencephalitis
• -death (at least 3000-4000 each winter)
January 2016
Who is most at risk?
• Very old & very young
• Pregnant women – uptake not ideal
• People (including children) with LTCs
• People with depressed immunity
So these groups should be offered vaccination – every year (or
with every pregnancy)
January 2016
Vaccination
• Because of the changing nature of influenza viruses, the
WHO monitors the epidemiology of influenza viruses
throughout the world
• Each year the WHO makes recommendations about the
strains to be included in vaccines for the forthcoming winter
for the northern and southern hemispheres
• Trivalent (2 x A & 1 X B) and quadrivalent (2 x A & 2 x B)
• Live attenuated and inactivated vaccines available
Use in children –
intranasal vaccine
Use in adults – IM/SC
January 2016
Vaccine uptake 2015/2016 (in England, PHE)
GP Data with 96.5% of practices responding
Group
% uptake 14/15
% uptake 15/16
65+
68.5
66.9
All ages at risk
44.4
39.3
Pregnant women
38.5
38.3
Aged 2 (not risk group)
30.6
28.9
Aged 3 (not risk group)
32.6
29.9
Ages 4 (not risk group)
25.2
23.9
January 2016
Hepatitis B
• Viral infection of the liver
• 100x times more infectious than HIV
• Major cause of morbidity and mortality worldwide
• Transmission via body fluids
• Perinatal, parenteral, sexual transmission
• Acute symptoms include – malaise, upper right abdo pain, mild
fever
• Chronic infection complications include hepatic cirrhosis, hepatic
carcinoma, necrosis
January 2016
Vaccination
• Selective for neonates born to high risk mothers
• Can prevent over 90% infection
• There are many other groups considered high risk and
offered vaccination
• E.g. travel, occupation, exposure (contact with infected
individuals) and lifestyle
• Routinely offered in US, Australia, France….UK?
January 2016
Tuberculosis
• Caused by Mycobacterium tuberculosis
• Usually attacks the lungs (pulmonary – 60% of UK cases), but other parts of
the body, including the bones, joints and brain can also be affected (extrapulmonary)
• Only the pulmonary form of TB disease is infectious
• Transmission occurs through coughing of infectious droplets and usually
requires prolonged close contact with an infectious case
• Initial infection may be eliminated, progress to active TB over following
weeks or months or remain latent (no symptoms, bacteria remain in body)
• People of all ages can contract tuberculosis
• Risk of disease is highest in children <3yrs, older people and with weakened
immunity
January 2016
Symptoms & treatment
• General weakness, weight loss, fever and night sweats
• Pulmonary TB: persistent cough, haemoptysis, chest pain
• In young children, the only sign may be stunted growth or
failure to thrive
• Course of two or more anti-tuberculosis drugs for at least six
months
• A failure to take the prescribed medication, or to complete
their course of therapy or to have been given ineffective
treatments may lead to multi-drug resistant TB, which can
spread to others
January 2016
Some epidemiology (PHE, 2014)
January 2016
TB rates 2011-2013
(PHE, 2014)
January 2016
Vaccination – Bacille, Calmette, Guerin
1953 Mass
programme 11-13 yr
olds
2005
Mass programme
replaced with
selective programme
Why?
BCG vaccination –
efficacy of vaccine
uncertain
Problems post
vaccination (local
reactions)
2000s – 8,000 cases
but predominantly in
those born abroad
10,000 vaccines to
prevent 1 case
1950s – 50,000 cases
1980s - 5,800 cases
More cost effective to
target prevention in
high risk groups
January 2016
BCG recommended for:
• All babies, at or soon after birth, living in areas where the
incidence of TB is 40/100,000 or greater
• Children (<16yrs) whose parents or grandparents have lived in a
country with a TB prevalence of 40/100,000 or higher
• Previously unvaccinated new immigrants from high prevalence
countries countries for TB
• Contacts of cases of TB
• Travellers (<16yrs) to countries with high TB prevalence for >3m
• Occupational e.g. Healthcare workers <35yrs
January 2016
Information & data used in this presentation was
taken from:
• Immunisation against infectious disease (Green Book online):
https://www.gov.uk/government/collections/immunisation-againstinfectious-disease-the-green-book
• Public Health England (and search specific infection):
https://www.gov.uk/government/organisations/public-health-england
• WHO (and search specific infection): http://www.who.int/en/
• JCVI minutes: https://www.gov.uk/government/groups/jointcommittee-on-vaccination-and-immunisation
• Vaccine Preventable Diseases (HPA original slides):
http://webarchive.nationalarchives.gov.uk/20140714084352/http://ww
w.hpa.org.uk/EventsProfessionalTraining/HealthProtectionAcademy/A
dditionalOpportunitiesAndInformation/ImmunisationTrainingResource
s/hpacadvacc05SlideSetsforCoreCurriculumTeaching/
January 2016