Midland infectious disease activity summary (MIDAS), Vol 6 (1), Dec 2016

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1 Midland infectious disease activity summary (MIDAS), Vol 6 (), Dec 206 Item type Authors Publisher Other Health Service Executive (HSE) Dublin/Mid-Leinster (Midlands), Department of Public Health Health Service Executive (HSE) Dublin/Mid-Leinster (Midlands), Department of Public Health Downloaded 7-Apr :20:04 Link to item Find this and similar works at -

2 Midland Infectious Disease Activity Summary Volume 6 Issue Dec 206 New Primary Childhood Immunisation Schedule The new primary childhood immunisation schedule started on st December 206 for all babies born on or after st October 206. Children born before st October 206 should receive the old schedule regardless of when they present for vaccination. This means that the two schedules will be in place for at least 2 months. The new schedule has the following changes:. Addition of Meningococcal B vaccine (Men B) at 2, 4 and 2 months 2. Addition of the oral Rotavirus vaccine at 2 and 4 months 3. Change of timing of first Meningococcal C vaccine from 4 to 6 months 4. Change of timing of third Pneumococcal vaccine from 2 to 3 months 5. Replacement of Hib and MenC with a Hib/MenC combination injection at 3 months Visit for FAQs for Health Professionals and other information about the new schedule. Age (months) Contraindications, precautions and side effects of the new vaccines: MenB Vaccine: A recombinant multi-component vaccine which is not a live vaccine Contraindications:. Anaphylactic reaction to a previous dose of vaccine 2. Anaphylactic reaction to any constituent of vaccine including kanamycin and latex Precautions:. Acute severe febrile illness defer until well 2. Known coagulation defects caution with administration and apply pressure to the vaccine site for -2 minutes after vaccination MenB Vaccine Side effects:. Very common ( in 0): Fever (>38 degrees), tenderness/pain at injection site, skin rash, irritability, vomiting/diarrhoea, unusual crying 2. Uncommon ( in 00 to in,000): High fever (>40 degrees), seizures (including febrile seizures), eczema 3. Rare ( in,000 to in 0,000): Urticaria, Kawasaki s disease Fever with the Men B vaccine is very common. NIAC (National Immunisation Advisory Committee) advises to give paracetamol:. at the time of the vaccination, hours after the vaccination and Get your flu vaccine it s a lifesaver! Are you a healthcare worker or carer? Are you pregnant? Do you have a long term medical condition? Are you aged 65 or over? If you can answer YES to any of the above, get the flu vaccine Old Schedule Babies born on or after st October 206 Vaccine No of injections Vaccine No of injections 2 6 in + PCV 2 6 in + PCV + Men B + Rotavirus 3 + oral vaccine 4 6 in + Men C 2 6 in + Men B + Rotavirus 2 + oral vaccine 6 6 in +PCV 2 6 in + PCV + Men C 3 2 MMR + PCV 2 MMR + Men B 2 3 Men C + Hib 2 Hib/Men C + PCV 2 Contents Page New Primary Immunisation Schedule Page 2 New Primary Immunisation Schedule - continued Pertussis encourage vaccination in pregnancy Page 3 Measles HPV vaccine - when misunderstanding goes viral Page 4 Yellow Fever - one lifetime dose Infectious diseases notifications - HSE Midlands Our contact details Please note some data are provisional and subject to amendment 3. again 4-6 hours after the second dose of paracetamol. This should be done at both the 2 and 4 month vaccinations. (Continued on page 2)

3 Volume 6, Issue, December 206 New Primary Immunisation Schedule (continued) Rotavirus Vaccine: a live attenuated, oral vaccine Contraindications:. Confirmed anaphylactic reaction to a previous dose of rotavirus vaccines or its constituents 2 2. Severe Combined Immunodeficiency Disorder (SCID) 3. Previous history of intussusception 4. Malformation of the gastrointestinal tract 5. Hereditary fructose intolerance, sucrose-isomaltase deficiency or glucose-galactose malabsorption Precautions (defer until well):. an acute febrile illness 2. an acute vomiting or diarrhoea illness Side Effects:. Common ( in 0): Diarrhoea, irritability 2. Uncommon ( in 00): Abdominal pain, flatulence, dermatitis 3. Very rare ( in 50,000): Intussusception, blood in stools, gastroenteritis in babies with SCID Due to the increased risk of intussusception with increased age, rotavirus vaccine should not be given on or after 8 months and 0 days of age. Based on this, the latest time to complete the course of rotavirus vaccination is to give dose at 7 months of age. There should be a minimum of 4 weeks between doses and 2. If a baby presents between 7 months and 8 months and 0 days, they can receive only dose of the rotavirus vaccine. Pertussis - encourage vaccination in pregnancy Pertussis is most serious in babies less than 6 months of age, often resulting in hospitalisation with complications such as pneumonia and encephalopathy. Babies less than 6 months of age are too young to be fully vaccinated against pertussis. Pertussis vaccine is safe in pregnancy and is effective at preventing pertussis in babies under 6 months of age. Recent research concluded that early second-trimester maternal Tdap immunisation significantly Image courtesy of HWT Image Archives increased neonatal antibodies (figure ). Recommending immunisation from the second trimester onward would widen the immunisation opportunity window and could improve seroprotection. Figure 335 women (mean age, 3.0 ± 5. years; mean gestational age, 39.3 ±.3 GW) previously immunized with Tdap in the second (n = 22) or third (n = 23) trimester. Anti-PT and anti-fha GMCs were higher following second- vs third-trimester immunization (PT: 57. EU/mL [95% confidence interval {CI}, ] vs 3. EU/mL [95% CI, ], P <.00; FHA: EU/mL [95% CI, ] vs 40.2 EU/mL [95% CI, ], P <.00). The adjusted GMC ratios after second- vs third-trimester immunization differed significantly (PT:.9 [95% CI,.4 2.5]; FHA: 2.2 [95% CI,.7 3.0], P <.00). Expected infant seropositivity rates reached 80% vs 55% following second- vs third-trimester immunization (adjusted odds ratio, 3.7 [95% CI, ], P <.00). Maternal Immunization Earlier in Pregnancy Maximizes Antibody Transfer and Expected Infant Seropositivity Against Pertussis Updated NIAC guidelines 2 recommend that pregnant women should be offered Tdap as early as possible after 6 weeks and up to 36 weeks gestation in each pregnancy, to protect themselves and their infant. Tdap can be given at any time in pregnancy after 36 weeks gestation although it may be less effective in providing passive protection to the infant. Pertussis vaccination should be offered in the week after delivery to those women who were not vaccinated during pregnancy. In the Midlands we have had 6 notified cases of Pertussis to date in this year 5 laboratory confirmed and clinically diagnosed - so we know that pertussis is circulating in the area. In 205 we had 7 cases in total, 3 of which were lab confirmed. We must make every effort to protect babies in our society against pertussis by encouraging uptake of pertussis vaccination in pregnancy. GPs have an important role in this - please remind pregnant women of the importance of pertussis vaccination when they reach 6/40 and offer vaccination at this time.

4 Volume 6, Issue, December 206 Measles THINK MEASLES Children, teenagers, young adults and anyone who has missed their MMR vaccination can get measles. Measles is a highly infectious airborne virus. So far this year there have been 44 confirmed and 2 possible cases of measles notified to the Departments of Public Health/Medical Officers of Health in Ireland. Despite eight suspected cases in the Midlands, all were confirmed as negative. Well done to all GPs and practice nurses on attaining a high MMR vaccine uptake. Our MMR vaccine uptake in the Midlands is the best in Ireland at 96% for all of 205 3, surpassing the target of 95%, and this is reflected in our low incidence of measles. Congratulations to all staff involved! HPV Vaccine - when misunderstanding goes viral I m devastated that I won t see my boys grow into men and get married. That s what moms dream of, isn t it? Cervical Cancer and Human Papilloma Virus (HPV) In Ireland, 300 women are diagnosed with invasive cervical cancer every year. This is a cancer of young females, 90 of whom die every year. In most cases, the disease begins with the development of pre-cancerous cells that develop into invasive cancer over a long period of time. Every year more than 6500 women in Ireland are diagnosed with these precancerous lesions and undergo treatment. Some of these treatments, while vital, are associated with sub-fertility and adverse pregnancy outcomes. Infection with the Human Papilloma Virus (HPV) is responsible for the vast majority of cervical cancers. Most sexually active adults will carry a form of HPV at some stage in their lives. Many of us either clear or immunologically contain the virus, but a small percentage go on to develop cancer. Two types of HPV, 6 and 8, cause 70% of invasive cervical cancers. HPV Vaccine Gardasil Jade Goody before her death from cervical cancer OK Magazine Interview 2009 Gardasil is the vaccine used in the HSE s HPV vaccination programme; this is a quadrivalent vaccine that protects against HPV types 6,, 6 and 8. Over 200 million doses of the vaccine have been distributed worldwide and it has been used in over 25 European countries, in the US, Canada, Australia and New Zealand. Studies have shown that the vaccine is effective, with an 85% reduction in high grade cervical abnormalities reported. Unfortunately Irish figures from 205/6 indicate a reduction in vaccine uptake, with 5,000 girls unvaccinated compared to the previous year. This is due to unfounded concerns regarding the safety of the vaccine. HPV Vaccine Safety The safety of HPV vaccination has been monitored for over 0 years by the World Health Organisation (WHO), the Centre for Disease Control (CDC) and the European Medicines Agency (EMA). The conclusion of these bodies is that the vaccine is safe. In Ireland, and some other countries, a small number of girls have reported symptoms and syndromes such as chronic fatigue syndrome, which they have attributed to HPV vaccination. However, detailed analysis of these syndromes has revealed that incidence rates do not differ in vaccinated and unvaccinated girls, and an EMA review in 205 found that there was no link between these illnesses and the vaccine. In May of this year the UK Medicines and Healthcare Regulatory Agency reported that HPV vaccine has a very good safety record. The known common sideeffects from HPV vaccine are similar to other vaccines and include pain, swelling and redness at injection site, headache and nausea. The Consequences of Not Vaccinating Against HPV If 33,000 of our girls under the age of 5 are not vaccinated against HPV, 227 will develop cervical cancer - 65 of these girls will die. Most of these deaths are preventable. 3

5 Yellow Fever - one lifetime dose MIDAS Volume 6, Issue, December 206 From July 206 the certificate of vaccination against yellow fever is valid for the lifetime of the person vaccinated. This lifetime validity applies to all existing and new certificates, commencing 0 days after the date of vaccination. Accordingly, revaccination or a booster dose of yellow fever vaccine is no longer required for international travellers as a condition of entry into a country requiring yellow fever vaccination, regardless of the date that their international certificate of vaccination was issued. Yellow fever is the only disease specified in the International Health Regulations 2005 for which countries may require proof of vaccination from travellers as a condition of entry under certain circumstances. Countries may take certain measures if an arriving traveller does not possess the appropriate certificate. Reference: List of Infectious Diseases notified in HSE- Midland Area - 0/0/206-8//206* Disease Number Disease Number Campylobacter infection 87 Meningococcal disease 4 Chickenpox - hospitalised cases 6 Chlamydia trachomatis infection 62 Clostridium difficile infection 66 Cryptosporidiosis 56 Dengue fever Giardiasis 6 Gonorrhoea 34 Haemophilus influenzae disease (invasive) 5 Hepatitis A (acute) 3 Hepatitis B (acute and chronic) 8 Hepatitis C 29 Hepatitis E 5 Herpes simplex (genital) 28 Human immunodeficiency virus infection Influenza 29 Legionellosis 2 Lyme disease 2 Malaria 5 Editor: Dr Fionnuala Donohue, Consultant in Public Health Medicine Editorial Team: Dr Heather Burns, Specialist Registrar in Public Health Medicine Dr Fiona McGuire, Senior Medical Officer - Public Health Ms Caitlín Ni Shúilleabháin, Surveillance Scientist Dr Grainne O Sullivan, Specialist Registrar in Public Health Medicine Ms Laura Smith, Public Health Information Officer Please contact us if you would like a specific topic covered in a future issue. References:. S. Eberhardt et al. Maternal Immunization Earlier in Pregnancy Maximizes Antibody Transfer and Expected Infant Seropositivity Against Pertussis. Clinical Infectious Diseases 206:62 pages Mumps Noroviral infection Paratyphoid Pertussis 3. Immunisationuptakestatisticsat2and24monthsofage/File,954,en.pdf Respiratory syncytial virus infection Rotavirus infection Rubella Salmonellosis Shigellosis Streptococcus group A infection (invasive) Streptococcus group B infection (invasive) Streptococcus pneumoniae infection (invasive) Syphilis Toxoplasmosis Tuberculosis Verotoxigenic Escherichia coli infection Viral encephalitis Viral meningitis Department of Public Health, HSE - Area Office, Arden Road, Tullamore, Co. Offaly, R35 TY28. Phone: Fax: public-health@hse.ie Website: * data are provisional Best wishes for Christmas and 207 from all of us in the Department of Public Health - Midlands!