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Childhood vaccinations

Communication > Explaining

Immunisation schedule

  • 2 months: 6 in 1, rotavirus, meningitis B

  • 3 months: 6 in 1, rotavirus, pneumococcal

  • 4 months: 6 in 1, meningitis B

  • 1 year: MMR, pneumococcal, meningitis B, Haemophilus influenzae type B/meningitis C

  • Preschool (3 years 4 months): MMR, 4 in 1 (diphtheria, polio, tetanus, pertussis)

  • 12-13 years: HPV (two injections 6-12 months apart)

  • 14 years: 3 in 1 (diphtheria, tetanus, polio), meningitis ACWY

 

6 in 1: diphtheria, tetanus, polio, pertussis, Haemophilus influenzae type B, hepatitis B

MMR = measles, mumps, rubella   NB: influenza annual nasal vaccine is also offered to 2-10 year olds

Reference: NHS ‘NHS vaccinations and when to have them’ 2019

Possible stations

  • Parent wants to find out more about childhood vaccinations
  • Parent disagrees with vaccinating their child
  • Parent has heard something on the news, e.g. MMR causes autism (it doesn’t!)

Aims of the station

  • Empathise and be non-judgemental
  • Address the patient’s concerns and pick up on their cues
  • Explore their beliefs
  • Explain how the benefits of getting vaccinated outweigh the risks of the vaccines
  • Convey the importance of vaccinations

Overview of diseases vaccinated against

6 in 1 childhood vaccine

  • Diphtheria

    • Illness: fever, sore throat, grey membrane on tonsils can narrow lumen

    • Complications: cardiomyopathy, kidney injury

  • Tetanus

    • Illness: muscle spasm in jaw and other muscles (including respiratory muscles)

    • Complications: respiratory muscle impairment

  • Polio

    • Illness: destruction of nerves resulting in muscle weakness and paralysis

    • Complications: paralysis

  • Pertussis

    • Illness: whooping cough (‘hundred day cough’)

    • Complications: pneumonia, convulsions, bronchiectasis

  • Haemophilus influenzae type B

    • Illnesses: can cause epiglottitis, meningitis, pneumonia

  • Hepatitis B

    • Complications: liver cirrhosis

Rotavirus

  • Illness: diarrhoea and vomiting

  • Complications: extreme dehydration

Pneumococcal

  • Illnesses: meningitis, pneumonia

Meningitis vaccines B/C/ACWY

  • Illness: different strains of meningitis

  • Complications: deafness, cerebral oedema, memory difficulty, learning disability

MMR

  • Measles (M)

    • Illness: high fever, cough, conjunctivitis, coryza, rash

    • Complications: encephalitis, corneal ulcer/scar

  • Mumps (M)

    • Illness: mild illness with gland swelling and headache

    • Complications: orchitis (and infertility), unilateral deafness, encephalitis, meningitis

  • Rubella (R)

    • Illness: flu-like illness with rash

    • Complication in pregnant women: congenital rubella syndrome

NB: A paper, published in 1998, linked the MMR vaccine to autism. This research has since been discredited and the author has been struck off the medical register for serious misconduct. Further detailed studies have shown there is no link between the MMR vaccine and autism.

Human papillomavirus (HPV)

  • Risks: cervical cancer, oral cancer, anal cancer, vaginal cancer

  • Given as 2 injections, 6 months apart

Risks vs. benefits of vaccinations

  • Benefits
    • Prevent serious diseases with severe consequences
    • To maintain eradication of diseases that can kill and disable millions of children
    • It’s much safer to have the vaccines than not have them
  • Safety
    • Vaccines are extremely safe
    • Continually monitored
  • Risks
    • As with all medications, vaccines can have side effects (below)
    • However, they are rarely serious and generally only last a couple of days

Contraindications to vaccination

  • If your child is ill with a fever, the vaccine should be postponed
  • Avoid live vaccines (MMR, BCG, Varicella, nasal flu vaccine) in immunocompromised
  • Avoid if known anaphylactic reaction to vaccine or any ingredient
  • MMR and flu vaccines contain egg
    • Egg in MMR is from chick embryos and does not trigger allergy
    • Flu vaccine may cause reaction in patients allergic to eggs – use egg-free alternative

Possible side effects of vaccination

  • Local effects: swelling, redness, lump
  • Fever
  • Allergic reaction and anaphylaxis (can be treated)
  • Specific side effects by vaccine (e.g. MMR – fever, swollen glands, rash)

Now test your knowledge, list some vaccines in the following categories…

Live attenuated

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Inactivated

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Toxoid

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Subunit/conjugate

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mRNA

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Explaining