Practice Nurses: Conversing with anxious parents & older children about Immunisation. NEW! Updated with the latest Men B and Men C advice.

Transcription

1 NEW! Updated with the latest Men B and Men C advice. This guide is intended for healthcare professionals. Practice Nurses: Conversing with anxious parents & older children about Immunisation Produced by the Makers of

2 Immunisation schedule The table below shows the latest NHS Routine Immunisation Schedule (correct at time of print: June 2016). 2 months How is it given? Possible side effects* 5-in-1 (DTaP/IPV/Hib) vaccine Pneumococcal conjugate vaccine (PCV) Combined Injection Separate Injection Pain, redness and swelling at the injection site Irritability and increased crying Being off-colour or having a fever Possible redness and swelling at the injection site. Mild fever Decreased appetite Irritability Rotavirus vaccine Oral Administration Possible mild diarrhoea and irritability when dose given Men B vaccine Separate Injection Fever likely within 24 hours Pain, swelling or redness at the injection site Irritability Vomiting and/or diarrhoea 3 months 5-in-1 (DTaP/IPV/Hib) vaccine 2nd dose Men C vaccine - this vaccine will be removed from the schedule from July 1st 2016 Rotavirus vaccine - 2nd dose 4 months 5-in-1 (DTaP/IPV/Hib) vaccine 3rd dose Pneumococcal conjugate vaccine (PCV) - 2nd dose Combined Injection Separate Injection Oral administration Combined Injection Separate Injection Pain, redness and swelling at the injection site Irritability and increased crying Being off-colour or having a fever Pain, redness and swelling at the injection site Mild fever Vomiting and diarrhoea Possible mild diarrhoea and irritability Pain, redness and swelling at the injection site Irritability and increased crying Being off-colour or having a fever Possible redness and swelling at the injection site. Mild fever Decreased appetite Irritability Men B vaccine - 2nd dose Separate Injection Fever likely within 24 hours Pain, swelling or redness at the injection site Irritability Vomiting and/or diarrhoea 2

3 12 months Immunisation schedule (continued) Hib/Men C booster Combined Injection Pain, redness or swelling at the injection site Fever Irritability Loss of appetite MMR vaccine (Measles, Mumps and Rubella) Pneumococcal conjugate vaccine (PCV) 3rd dose Combined Injection Separate Injection Measle-like rash Fever Loss of appetite Possible redness and swelling at the injection site. Mild fever Decreased appetite Irritability Men B vaccine - 3rd dose Separate Injection Fever Pain, swelling or redness at the injection site Irritability Vomiting and/or diarrhoea 2, 3, 4 years (and children in school years 1, 2 & 3) Influenza (annual) 3 years, 4 months or soon after 4-in-1 (DTaP/IPV) pre-school booster MMR vaccine (Measles, Mumps and Rubella) 2nd dose Girls years Human Papillomavirus (HPV) vaccine years old Nasal Spray or separate injection (if spray unsuitable) Combined Injection Combined Injection 2 injections given between 6 months and 2 years apart Runny nose Fever Headache Feeling slightly unwell Loss of appetite Loss of appetite Irritability Mild fever Pain, swelling and redness at the injection site Measle-like rash Fever Loss of appetite Less chance of side effects after the second dose of MMR vaccine than the first Soreness, redness or swelling at the injection site. 3-in-1 (Td/IPV) teenage booster Combined Injection Loss of appetite Irritability Mild fever Pain redness and swelling at the injection site Men ACWY vaccine Combined Injection Redness, hardening and itching at the injection site Headache Nausea Fatigue *This list of side-effects is not exhaustive; for more information on vaccines and side effects, visit: Always read the label. CALPOL Infant Suspension contains paracetamol. For pain and fever relief. 3

4 Reassuring anxious parents at the point of immunisation As parents are naturally concerned for the safety of their child, their concerns and anxieties should be respected and handled gently and effectively 6. Nurses should ensure that the appointment is long enough to 2 : Assess patient s suitability for immunisation following a risk assessment Advise parent on possible side effects Answer parent (or older child) queries Obtain consent Consult the patient s records if available Administer the vaccine Complete all documentation Patients will be more anxious if they feel that the nurse is in a hurry 2. Tips for constructive dialogue during clinics 3 : Give the parent or older child 30 seconds to settle in before starting the consultation. Speak face-to-face so that you can see each other.start by listening. Ask questions to ensure the person is confident they have given all the essential information. Show you understand, and acknowledge what the person has said. Provide advice on immunisation. Find out if both you and the person have understood what you ve discussed. If a parent is anxious about watching their child receive a jab, another member of staff could assist by holding the child during the procedure 2. 4

5 Reassuring nervous children at the point of immunisation Nervous parents can pass on their anxiety to their children, so it may be helpful to consider the following 2 : Adopt a calm, sympathetic approach Use distraction techniques Prepare the vaccine and administer the injection out of sight of the child if possible Explain that an injection is quick and simple and it is not the same as taking blood Where a child needs to be given more than one injection at a visit, it can help if two members of staff inject simultaneously. The child is usually not aware that two injections have been given, so distress is minimised. This is usually appropriate for children who are old enough to receive injections in the upper arm 2. Sit the child on the parent s lap with both arms accessible Face the child forward, looking at something of interest Engage the child in conversation Give both injections simultaneously, using a prearranged signal 5

6 Post-immunisation fever and tips for parents What temperature constitutes a fever? Parents of young children may ask you to clarify what constitutes a fever and when medication is required. A fever is usually defined as a temperature of over 37.5 C. Parents should contact their GP or health visitor urgently if their child is: Under 3 months old and has a temperature of 38 C (101 F) or higher 3 to 6 months old and has a temperature of 39 C (102 F) or higher Any age and, as well as a fever, has other signs of being unwell such as floppiness and drowsiness 4 Fever advice to help parents make their child feel more comfortable 4 NHS recommends: Give the child plenty of fluids Cover them with a lightweight sheet if necessary Keep the room well aired and at a comfortable temperature (about 18 C or 65 F) by adjusting the radiators or opening a window If the child is distressed and uncomfortable, give them paracetamol (suitable from 2 months, weighing over 4kg and not premature) or ibuprofen (suitable from 3 months, weighing over 5kg). Sponging is no longer recommended 6

7 Latest Updates: Men B vaccine The Men B vaccine was added to the schedule on 1st September Babies born on or after 1 July 2015 will be offered the Men B vaccine when they come in for their other routine immunisations at 2, 4 and 12 months 5. One off catch-up There was a one-off catch-up for babies born on or after 1 May 2015, who were 3 or 4 months old in September 2015, and would be having their routine immunisations at that time 5. Babies born before 1 May 2015 are not eligible to receive the Men B vaccine 5. High incidence of post-immunisation fever: Overall, fever ( 38.0 C) after any vaccination was reported in 76% of infants receiving the new Men B vaccine and routine vaccines together, compared to 51% in infants receiving the routine vaccinations alone 5. Other common side effects include irritability and redness and tenderness at the injection site 6. Fever management advice for the new Men B vaccine differs from others: As fever was reported as a very common adverse reaction in clinical vaccine trials, concerns were raised that an increase in fever may have a detrimental impact on the uptake of future immunisations. The JCVI therefore recommends the use of prophylactic paracetamol at the time of immunisation 7. 7

8 Men B and Paracetamol: What does this mean for you in practice? It is important to reassure parents that fever is a common response to immunisation 7. Parents should be advised to buy infant paracetamol for use after the two month and four month routine infant vaccination appointments 7. It is important to explain dosage: 2.5ml (60mg) dose (half a sachet) at the point of immunisation measured appropriately, followed by a further two doses at home 7. Dosage and timing of infant paracetamol suspension (120mg/5ml) for use after vaccination at two and four months 8 Age of baby Dose 1 Dose 2 Dose 3 2 months / 4 months One 2.5ml (60mg) dose as soon as possible after vaccination One 2.5ml (60mg) dose 4-6 hours after first dose One 2.5ml (60mg) dose 4-6 hours after second dose It s important that the baby has the recommended three doses of paracetamol after each of the first two Men B vaccinations to reduce the chances of fever. Advise parents that this new prophylactic advice relates only to the new Men B vaccine 8. 8

9 Latest Updates: Men C vaccine The Men C vaccine given at 3 months will be removed from the schedule on 1st July Changes to the schedule: The Joint Committee on Vaccination and Immunisation (JCVI) have recommended that infants no longer require vaccination against MenC at 3 months 9. The Hib/MenC vaccine (Menitorix) dose given at 12 months of age and the Men ACWY conjugate vaccine dose given at around 14 years of age are unaffected by the change and will still be given 9. Rationale for the removal of the infant dose of Men C vaccine: The JCVI noted that, because of the successful MenC programme introduced in 1999, there are now very few cases of invasive MenC disease. Vaccination of adolescents with MenC conjugate vaccine which began in the 2013/14 academic year, and later, MenACWY conjugate vaccine; should sustain good herd protection and therefore the risk to infants will remain low. The dose of combined Hib/MenC offered at 12 months of age will provide good protection to toddlers and younger children. Bexsero (i.e. MenB vaccine) introduction in to the infant programme is likely to provide a degree of protection against some cases of invasive MenC disease 9. 9

10 Common Questions from Parents Q. How does immunisation work? A. Immunisation works by stimulating your child s immune system to produce antibodies to fight harmful disease, without them actually becoming infected with the disease. If they then come into contact with the disease itself, their immune system will recognise it and immediately produce the antibodies needed to fight it 10. Q. Why do I need to immunise my child? A. If your child isn t immunised, they will be at increased risk of catching potentially serious illness diseases. Immunisation is the best defence against epidemics that used to kill or permanently disable millions of children and adults 11. Q. Are there any side effects following immunisation? A. All medicines have side effects, but vaccines are among the safest. The benefits of vaccinations far outweigh the risk of side effects. Most side effects from vaccination are mild. It s quite usual for people to have redness or swelling in the place where they had the injection, but this soon goes away. Younger children or babies may be a bit irritable or unwell or have a slight temperature. If they have a high temperature following the immunisation and are distressed, infant paracetamol suspension (like CALPOL Infant Suspension (suitable from 2 months, for babies weighing over 4kg) can help. The risk of fever is higher when the Men B vaccine is given with other routine vaccinations at 2 and 4 months, and in this instance it is advisable to give a dose of infant paracetamol at the time of the injection, not waiting for the fever to start. Q. Why do I need to give my baby paracetamol following the two month and four month vaccinations? A. Fever can be expected after any vaccination, but is very common when the MenB vaccine is given with the other routine vaccines at two and four months. Giving paracetamol will reduce the risk of fever, irritability and general discomfort (including pain at the site of the injection) after vaccination. Parents should be advised to give the baby a total of three doses of paracetamol (2.5ml of infant paracetamol 120mg/5ml suspension) to prevent and treat any potential fever after both the two month and the four month vaccination visits. The first dose of should be given as soon as possible after the two month vaccination visit. The second dose should be followed after the four to six hours later, and the third dose four to six hours after that. The same steps should be folowed after the four month vaccinations. At 12 months, the risk of fever after routine vaccinations with or without the Men B vaccine is similar. Therefore the baby does not need three doses of paracetamol with their routine 12 month vaccinations. However, if the baby does get fever at home or appears to be in discomfort, they can be given paracetamol at that time 8. Q. What if my baby still has a fever after having had the three doses of paracetamol? A. Even after having three doses of paracetamol, some babies may still develop a fever. In the 48 hours after vaccination, if your baby still has a fever but is otherwise well, you can continue to give the same 2.5ml dose of infant paracetamol. You should always leave at least 4 hours between doses and never give more than four doses in any 24 hour period 8. Q. Is the MMR vaccine linked to autism? A. There has been some controversy about the MMR vaccine in recent years, following a study published in The Lancet in 1998 by Dr Andrew Wakefield. However, the study actually stated We did not prove an association between MMR vaccine and the syndrome described. No study has since found a link 12. Q. How can I keep my baby/toddler calm during the vaccination? A. Take along a favourite toy to distract them. While the vaccine is being administered, hold your baby/ toddler close giving them a reassuring hug. Giving your baby a feed afterwards may help to soothe them. Consider giving toddlers an appropriate treat after their vaccination. 10

11 References 1. Routine childhood immunisations attachment_data/file/465880/9406_phe_2015_routine_childhood_immunisation_schedule_12.pdf Last accessed: October UK Guidance on Best Practice in Vaccine Administration documents/861/uk%20best%20practice%20guidance%20vacc%20admin% pdf Last accessed: October Data on file; Report from a collaborative design workshop, facilitated and authored by Professor Bob Sang, sponsored by CALPOL. 4. NHS Choices, Fever in Children Last accessed: October Immunisation against meningococcal B disease for infants aged from two months: Information for healthcare professionals file/462553/phe_menb_informationforhealthprofessionals_final_ v3.pdf Last accessed: October NHS Choices, Men B vaccine aspx Last accessed: October Immunisation against meningococcal B disease for infants aged from two months: Information for healthcare professionals file/444636/phe_menb_informationforhealthprofessionals_final_v2.pdf Last accessed: October Using paracetamol to prevent and treat fever after MenB vaccination uploads/system/uploads/attachment_data/file/450890/9413-paracetamol-menb-2page-a4-05-web.pdf Last accessed: October Removal of the infant dose of meningococcal serogroup C (MenC) conjugate vaccine given at three months from 1 July 2016: Information for immunisation pactitioners and other health professionals infant_schedule_letter-final 1_.pdf Last accessed: May NHS Choices, How Vaccines Work Last accessed: October NHS Choices, Benefits and risks of vaccination benefits-and-risks.aspx Last accessed: October NHS Choices, MMR Vaccine Last accessed: October

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