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Immunization 

Immunization
Chapter:
Immunization
Author(s):

Jeremy Hull

, Julian Forton

, and Anne Thomson

DOI:
10.1093/med/9780199687060.003.0059
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Introduction

  • Children with lung disease are more likely to become unwell with intercurrent infection. It is important that they are protected against infection by immunization where this is possible. This guidance refers to children with the following conditions:

    • CF;

    • bronchiectasis;

    • CLD of prematurity;

    • persistent asthma;

    • ILD;

    • children undergoing home ventilation or with neuromuscular disorders.

  • Children with these conditions should receive:

    • routine childhood immunizations, including live vaccines;

    • pneumococcal vaccine;

    • annual influenza vaccination from the age of 6 months.

  • Immunization schedules will differ between countries. The following comments apply largely to the UK.

  • The evidence that the influenza vaccine reduces the risk of exacerbation in children with asthma is not robust.

Pneumococcal vaccine

  • At-risk children between the age of 2 and 12 months should be given the 13-valent pneumococcal conjugate vaccine (PCV), according to the routine immunization schedule, at 2, 4, and 13 months of age. They should also receive one dose of the 23-valent pneumococcal polysaccharide vaccine (PPV) after their second birthday.

  • Unimmunized at-risk children between the ages of 12 months and 5 years of age should receive two doses of PCV, separated by 2 months, and a single dose of PPV after their second birthday and at least 2 months after their last dose of PCV.

  • Unimmunized at-risk children over the age of 5 years should receive one dose of PPV only.

Influenza vaccine

  • While most viruses are antigenically stable, the influenza viruses A and B (especially A) are constantly altering their antigenic structure, as indicated by changes in the haemagglutinins (H) and neuraminidases (N) on the surface of the viruses.

  • It is essential that influenza vaccines in use contain the H and N components of the prevalent strain or strains. Every year, the WHO recommends which strains should be included in that year’s vaccine.

  • As part of the winter planning, NHS employers should offer vaccination to health care workers directly involved in patient care.

  • Influenza vaccination in children aged <6 months is not recommended.

  • Annual immunization is recommended in children aged 6 months to 18 years with the conditions listed. In addition, in children with asthma on chronic corticosteroid therapy and those previously admitted to hospital with lower respiratory tract disease.

  • Two main types of influenza vaccine exist: the inactivated influenza vaccine is administered IM and may be given from aged 6 months; the live attenuated influenza vaccine is administered intranasally (Fluenz®) and may be given from the age of 2 years.

  • The dosage is age- and manufacturer-dependent and should be taken from the manufacturer’s summary of product characteristics (SPC).

  • The Joint Committee on Vaccination and Immunisation (JCVI) recommends that children in clinical risk groups under 9 years of age who are offered the influenza vaccination for the first time should be offered a second dose of vaccine 4–6 weeks later. Children older than 9 years are given a single dose. (This may differ from the product SPC.)

  • Most vaccines have some basic contraindication to their use, and the product literature should be consulted for details. In general, vaccinations should be postponed if the individual is suffering from an acute illness. Minor infections without fever or systemic upset are not contraindications.

  • The influenza vaccine should not be given to those who have a confirmed anaphylactic reaction to a previous dose of the vaccine or any component of the vaccine.

  • The live attenuated intranasal influenza vaccine should only be given to children aged 2–18 years. It cannot be given to children with certain immune deficiencies, poorly controlled asthma or severe asthma, or in those with egg allergy. It is not contraindicated for use in children who are receiving inhaled corticosteroids or low-dose systemic corticosteroids.

  • The majority of influenza vaccines are prepared in hen’s eggs and contain very small amounts of ovalbumin. These vaccines may be safe in patients with egg allergy, but, if available, egg-free influenza vaccine (e.g. Optaflu®) should be given. If no egg-free vaccine is available, these patients can be immunized in primary care, using an inactivated influenza vaccine with low ovalbumin content. Patients with confirmed anaphylactic hypersensitivity to egg or severe uncontrolled asthma, in addition to egg allergy, should be referred to hospital for influenza vaccination.

Passive immunization against respiratory syncytial virus

  • Monthly injections of the monoclonal antibody against RSV (palivizumab) will provide 40–50% protection against severe disease (defined as disease requiring hospital care).

  • In the UK, where there is a clear RSV season, injections are usually given from October to February.

  • Effectiveness has been shown in infants born prematurely, in those who have chronic lung disease, and in those with haemodynamically significant or cyanotic congenital heart disease.

  • Palivizumab should be prescribed under specialist supervision. The specific groups of children who receive the drug will vary according to local policy. This reflects the high cost of the treatment.

Further information

British National Formulary for Children (2013).Find this resource:

    Department of Health (2013). Immunisation of individuals with underlying medical conditions, Department of Health Green Book. Department of Health, London.Find this resource: