Nursing in Practice Spring 2023 | Page 28

28 | Nursing in Practice | Spring 2023

Table 1

Summary of the current UK immunisation schedule for 2023 , with proposed changes from the JCVI in green ²

1 year Hib / MenC PCV booster MMR MenB booster

18 months New vaccine appointment

Eligible age groups ( yearly )

3 years and 4 months ( or soon after )

Table 2

HPV immunisation programme evolution ³

Live attenuated influenza vaccine ( LAIV )

dTaP / IPV MMR ( check first dose given )

12-13 years HPV ( 2 doses 6-24 months apart )

14 years School year 9 / 10

Td / IPV MenACWY ( check MMR status )

There has been no final decision yet on the JCVI ’ s advice to bring the second MMR dose forward to 18 months , although studies in London and elsewhere have shown doing so increases overall uptake . ¹³

Adoption of the proposals ( Table 1 ) will require a policy decision by the Department of Health and Social Care ( DHSC ) in England and equivalents in the devolved nations . The NHS and public health would enact the changes and communicate these to healthcare teams and the public .

Removal of the Hib / MenC Menitorix vaccine No change to other vaccines

Hib-containing multivalent vaccine – DTaP / IPV / Hib / HepB MMR second dose and check first dose

No change

Preschool booster dTap / IPV to remain Check on 2 doses of MMR and other vaccines

HPV ( single dose )

No change

2008 HPV vaccine introduced to the UK programme with Cervarix ( bivalent vaccine HPV ) for all 11- to 14-year-old girls , with a catch-up for girls up to age 18

2012 Gardasil quadrivalent vaccine replaced Cervarix in 2012 to give wider HPV coverage

2018 Programme implemented for men who have sex with men ( MSM ) offering HPV vaccination up to age 45 . This is due to increased risk of HPV infection especially alongside other infections , in particular HIV

2019 Universal HPV vaccination for all 11- to 14-year-old girls and boys and age for eligibility increased to 25 for eligible cohorts . No further catch-up for men not eligible before 2019 ( those born on or after 1 September 2006 , eligible )

2022 Vaccine switch to Gardasil 9 , a nonovalent ( nine-in-one ) vaccine

2022 Two-dose schedule for all cohorts , except immunocompromised and HIV positive ( still three-dose course )

2023 / 24 * One-dose schedule may be introduced for under-25s , except immunocompromised and HIV positive . * Expected in academic year 2023 / 24 at the earliest

Further considerations for human papillomavirus ( HPV ) vaccine The UK immunisation programme for HPV began in 2008 , with vaccination offered to all girls ( Table 2 ). HPV viruses are very common ; many cause harmless warts but some types cause genital warts and cancers : 99 % of cervical cancers are due to HPV . Initial trial data for the HPV vaccine indicated that , when coupled with ongoing screening , vaccination would considerably reduce the burden of cervical cancer . This was the initial aim of the programme .

Increasing evidence that other cancers are related to HPV infection , such as those of the anogenital area , head and neck , has seen this aim extended to include protection against HPV infection and all associated cancers and genital warts .

The impact in reducing cervical cancer has been significant . ¹⁴ Protection has also been demonstrated by a reduction in genital warts among vaccinated girls and also indirectly in unvaccinated boys of the same age cohorts . ¹⁵ There is also considerable evidence that one dose of vaccine is sufficient , particularly when given to younger people . The JCVI advice is therefore to reduce the routine schedule of HPV vaccinations to a single dose for adolescents and ages up to 25 years . There are exceptions for the immunosuppressed ( who are advised to have three doses ) and over-25s in the MSM programme ( two doses ). The reduction in the routine programme for adolescents will increase schoolage immunisation service capacity to allow opportunistic catch-up for those who miss their dose at age 12-13 years , thereby maintaining and improving overall HPV vaccine uptake .

The JCVI statement also highlighted the need to ensure appropriate lead-in time to plan for the changes and make sure communication is in place .

Staying up to date The massive success of the Covid-19 vaccine implementation has led to more interest than ever in vaccine programmes . However , concerns over the gradual fall in vaccine uptake across all children ’ s programmes , ¹⁶ and the stark reality that vaccinepreventable diseases still present threats , ensure the focus on vaccination continues . The recent detection of polio virus in sewage and outbreaks of diphtheria inside immigration centres are timely reminders of the fragility of vaccination programme outcomes and the need for high population and individual-level coverage .

There is , therefore , a need to make sure that members of the public are informed about the facts and have access to reliable , good-quality information , so they feel confident in taking up the vaccines offered to them . Healthcare professionals remain the most trusted source of immunisation advice . The JCVI , as an independent expert advisory body , provides robust assurance for all changes to the vaccine programmes and the rationale behind its decisions ; all immunisers need to be familiar with the national advice and guidance , and the evidence supporting these .

Any change to the vaccine programme may bring a level of anxiety . Healthcare practitioners must ensure they are well informed and are able to reassure vaccine recipients and carers , and make sure they fully understand the changes and the reasons for them . Signing up to the UKHSA ’ s regular vaccine update ¹⁷ is a good way to do this .

Helen Donovan and Pauline MacDonald are independent nurse consultants and immunisation specialists