Aims

  1. For all children aged 8 weeks to 4 years 3 months in the practice population to be fully immunised against:
    • Diphtheria 
    • Tetanus 
    • Whooping Cough 
    • HIB Meningitis 
    • Polio 
    • Measles 
    • Mumps 
    • Rubella
  2. For the provision of a smooth running, safe clinic, which is easily accessible to families, and in which waiting times are held to a standard. (Suggested standard: no longer than 20 minutes beyond appointment time).

Target group

In order to achieve this target, newly registered infants and children will have to have their immunisation status established at registration with practice.

Identification of patients

Patients to be identified by:

  1. Birth register held by health visitors and the clerical assistant.
  2. Practice computer search monthly.
  3. Appointments will be made using an appointment book designed solely for use at the immunisation clinics.
  4. For new births, the appointment for first immunisation will be given to parents at the health visitor's primary visit or at the 6 week check.
  5. Appointments for the second and third immunisations will be given following attendance at the clinic for the previous injection.
  6. For the MMR, due at 13 - 15 months of age, the health visitor's clerical assistant will send patients an appointment by post, 7-14 days beforehand.
  7. For the pre-school booster dose of diphtheria, tetanus, polio and MMR, the health visitor's clerical assistant will send patients an appointment by post 7-14 days beforehand.
  8. Health visitors will give opportunistic advice about immunisation at antenatal visits and onwards. This advice is reinforced by good quality, easily understood information either in the book Birth to Five Years or child health record.
  9. Specific advice on the care of a child following immunisation will be given to parents, both verbally and in written form, following each immunisation.
  10. Patients who fail to attend will be sent one further appointment by post by the clerical assistant. If this is not successful, the health visitor concerned will contact the family and negotiate a new appointment.

Protocol

Consent

Consent must always be obtained before immunisation. It is the responsibility of the health visitor to ensure that this is informed consent and that all parents' questions have been answered and concerns about immunisation have been sensitively considered. Written consent provides a permanent record, but consent, either written or verbal is required at the time of each immunisation after the child's fitness and suitability have been established.

Consent before the occasion on which the child is brought for immunisation is only an agreement for the child to be included in the programme.

Bringing a child for immunisation after an invitation to attend for this purpose will be viewed as acceptance that the child may be immunised. When a child is brought for this purpose, and fitness and suitability have been established, consent to immunisation will be implied in the absence of any expressed reservation to the immunisation proceeding at that stage.

Childhood vaccinations

All Vaccinations
  1. Child's name and date of birth.
  2. Is the child well? - if you are uncertain or think the child is unfit for vaccination ask the doctor to see.
  3. Have the child's notes available plus claim forms.
  4. Check immunisation to be given
    • In notes. (Write in notes which batch no.)
    • In immunisation record
    • With parents

Before the administration of any injection, the contra indications and side effects must be discussed with the parents.
2nd & 3rd vaccinations and pre-school booster
  1. Child's name and date of birth.
  2. Is child well? Any diarrhoea? (polio).
  3. Was there any reaction to previous vaccination?.
  4. Has the child been well since previous vaccination? (check in notes).
  5. Any of polio vaccine contra-indications?
Polio Contra-indications (Live) 
  1. Febrile illness.
  2. Vomiting and diarrhoea.
  3. Suppression of immune system eg drugs, steroids, radiation, tumours, leukaemia, lymphoma and Hodgkin's disease.
  4. Siblings of immuno-suppressed children, (but can have inactivated polio vaccine).
  5. When live vaccine has been given if second live vaccine is needed, there must be an interval of 3 weeks.
Pertussis  Contraindications
  1. Neonatal cerebral damage - evolving neurological problems until condition is stable.
  2. Febrile illness.

Special Considerations - discuss with doctor 

  1. Severe local or general reaction to previous pertussis vaccination (see Green Book page 163). 
  2. Epilepsy in parents or siblings.
  3. Personal or family history of febrile convulsion.
Measles, Mumps and Rubella Contra-indications (Live)
  1. Acute febrile illness.
  2. True egg allergy (anaphylaxis).
  3. Immunosuppression - drugs, steroids, irradiation, malignancy. 
  4. Allergy to Neomycin or Kanamycin  (would have had serious ) had any illness to have these). 
  5. Within three weeks of previous live vaccination or 3 months of immunoglobulin.

 
  • Available from notes
  • Has child illness or treatment. 

Advice

"About 5 - 10 days after MMR vaccination some children are slightly unwell with fever and occasionally a rash. This is not serious. It is like a very mild form of measles and your child is not infectious. It is important to give Paracetamol Paediatric Suspension - one teaspoon four times a day to prevent a high temperature and keep your child cool".

NB You can give DPT and Polio or Polio or DT and Polio at the same time as MMR, i.e. if child comes late for 3rd DPT and Polio but is at least one year old. When recording - white batch no. of vaccine and injection site.

Convulsions

The parents of children with a tendency to have convulsions should be counselled on the management of any fever developing after immunisation. Febrile convulsions may occur 5-10 days after measles immunisation (or MMR) whereas they may take place in the first 72 hours after pertussis immunisation. Suggestions may include paracetamol, sponge with tepid water, give extra fluids, dress in thin clothing and place in a cool room. In high risk children, an antipyretic drug may be suggested routinely for the first 72 hours after immunisation. Where the tendency is severe, the parents may be instructed on rectal diazepam administration.

Therefore ask about:

  1. Was the birth normal?
  2. Did the baby need any special attention?
  3. Has the baby been well since birth?
  4. Is there FH of epilepsy? In who?
  5. Has the baby had any fits?

Discuss any queries with doctor or if parents are not happy about baby having pertussis vaccination, encourage parent to report any reaction to first vaccination and give Paracetamol Paediatric Suspension - leaflet and prescription.

Anaphylactic shock

NO ABSOLUTE CONTRAINDICATION TO USE ADRENALINE IN LIFE THREATENING CONDITIONS

Anaphylaxis