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From the Chief
9th March 2001
Medical Officer,
CURRENT VACCINE AND IMMUNISATION
the Chief
ISSUES
Nursing Officer,
This letter is to update you on several important
immunisation issues, namely:
and the Chief
1.
The latest concerns about MMR vaccine;
Pharmaceutical
2.
The Meningitis C immunisation programme;
3.
Meningococcal immunisation for asplenic patients;
Officer
4.
Meningococcal immunisation for pilgrims travelling
to Saudi Arabia;
Professor Liam Donaldson
5.
Influenza immunisation;
MSc, MD, FRCS(Ed), FRCP, FFPHM
6.
Anaphylaxis management.
Sarah Mullally
1.
MMR VACCINE
RN, MSc, BSc
The latest concerns
Dr Jim Smith
1.1
Colleagues will be aware of renewed media interest
BPharm, PhD, FRPharmS, MCPP,
MIInfSci
in MMR and of the continuing concerns of some parents
about the safety of the vaccine. This has arisen because of
Richmond House
publicity given to an article by Drs Andrew Wakefield and
79 Whitehall
Scott Montgomery before and after its publication
London SW1A 2NS
(‘Through a glass, darkly’, Adverse Drug Reactions and
Toxicological Reviews(1)). Dr Wakefield has been in the
PL/CMO/2001/1, PL/CNO/2001/1,
PL/CPHO/2001/1
forefront of suggesting a link between MMR vaccine and
long term health problems, especially inflammatory bowel
For action
disease (IBD) and autism. Media interest has also
•
District Directors of Public Health
focussed on the use of single antigen vaccines as opposed
•
Immunisation Co-ordinators
to the recommended combined vaccine.
•
HA Influenza Co-ordinators
•
Consultants in Communicable
1.2
We should like to emphasise the following
Disease Control
points:
•
Medical Directors of NHS Trusts
•
Chairs of Primary Care Groups
q
A review of Wakefield and Montgomery’s paper by
•
General Practitioners
the Medicines Control Agency identified that it
•
Nurse Executive Directors
contains no new data relevant to the safety of MMR
•
HA Nurse Advisors
vaccine, that its analyses are incorrect and that it has
•
Community Services Pharmacists
failed to mention other published work that does not
support the views put forward. A detailed critique can
For information
be found at www.doh.gov.uk/mmrresponse.htm.
Regional Directors
Regional Directors of Public Health
q
The Government’s independent expert committees,
Regional Pharmaceutical Advisors
the Committee on Safety of Medicines (CSM) and the
Chief Executives of HAs
Joint Committee on Vaccination and Immunisation
Chief Executives of NHS Trusts
(JCVI), have both reviewed a draft of the paper and
Regional Nurse Directors
Infection Control Doctors
advised that “MMR vaccine is very safe”.(2)
All Pharmacists

q
The suggested link between MMR and inflammatory
Current Vaccine and
bowel disease and autism has been thoroughly
Immunisation Issues
investigated. In the light of Dr Wakefield’s article, the
CSM conducted a further detailed review of the
PL/CMO/2001/1, PL/CNO/2001/1,
information available at the times of MMR licensing from
PL/CPHO/2001/1
1972 onwards and the subsequent safety data on MMR
vaccine.
9 March 2001
q
The view of both the CSM and the JCVI remains that, on
Page 2 of 12
the scientific evidence available, there is no causal link
between MMR vaccine, autism and bowel disease. This
For further information please
contact Dr David Salisbury
view is supported by expert groups convened by the
(Medical issues, items 1, 2 and 6),
Medical Research Council; and is the view of the World
(Room 607A);
Health Organisation (WHO).
Dr Jane Leese (Medical issues,
items 3, 4 and 5), (Room 605A);
q
The British Medical Association, the Royal College of
Nick Adkin (Policy issues),
General Practitioners, Royal College of Paediatrics and
(Room 606A);
Carole Fry (Nursing issues),
Child Health, Royal College of Nursing and the
(Room 604A);
Community Practitioners and Health Visitors Association
Loraine Gershon (Pharmacy issues),
issued the following joint statement on 12 January: “We
(Room 602A);
welcome this positive statement from the Chairs of these
Debby Webb (Vaccine Supply issues),
(Room 602A); of
expert committees about MMR vaccine. MMR is a safe
The Immunisation Team,
and effective vaccine. By contrast, there is a real concern
Department of Health, Skipton House,
about having the vaccines separately, since children
80 London Road, London SE1 6LH
would be left unnecessarily at risk from these potentially
serious diseases. We strongly recommend that
Requests for further copies should
be addressed to:
children are protected with MMR”.(3)
Fax: 01623 724 524
Write to Department of Health
q
The overwhelming evidence from worldwide experience
PO Box 777, London SE1 6XH
is that MMR remains the safest way to protect children
Email: [email address]
against these three potentially serious diseases. The
WHO said on 24 January 2001: “WHO strongly supports
For correction of any discrepancies
the use of MMR vaccine on the grounds of its convincing
in changes of address, practice or
name, please contact:
record of safety and efficacy”.
The Medical Mailing Company
PO Box 60, Loughborough
q
There has been no new research that changes our
Leicestershire, LE11 0WP
previous advice: Children should not be given
Tel: Freephone 0800 626387
separate measles, mumps and rubella vaccines in
place of MMR, since there is no evidence of benefit
This letter is also available on the
Internet at:
and a clear risk of harm from such a practice.
http://www.doh.gov.uk/cmo/cmoh.htm
q
We are aware that it has been suggested that the
administration of licensed single rubella vaccine to
children will allow a practitioner to justify the importation
of unlicensed measles and mumps vaccines.
‘Immunisation against infectious disease’(6) advises that
rubella vaccine should be used for the protection of sero-
negative women, and that children, of whatever age up to
school-leaving, should be immunised with MMR vaccine.
Information
1.3
We want to ensure that all have access to the best
factually accurate scientific information.

Page 3 of 12
To meet this need the Department is – following a meeting with various health organisations on
22 January – looking once again at its MMR information resources for both the public and health
professionals with the aim of updating those materials. This will involve:
q
An information programme to provide factually accurate scientific information to parents
and health professionals;
q
The preparation of revised leaflets and Factsheets; these will be published as soon as
possible and sent to you direct and also be available through health promotion units;
q
The provision of posters and a media information campaign;
q
A seminar programme to provide information to health professionals.
1.4
In the meantime, Annex 1 to this letter contains responses to some of the questions most
frequently asked by parents which we hope you find helpful. We would encourage all involved
in delivering primary care immunisations to familiarise themselves with both the existing
comprehensive guidance from the Department and also the revised material when it
becomes available. Detailed information is already on the NHS Health Promotion England
immunisation website: www.immunisation.org.uk. This website will be regularly updated as new
material becomes available.
2.
THE MENINGITIS C IMMUNISATION PROGRAMME
2.1
You will be aware that in November 1999 we initiated a major public health programme to
offer the new meningococcal C conjugate (MenC) vaccine to everyone under the age of 18 years(4).
We have recently been able to announce the great success of this programme and the
impact which the new vaccine has had on this devastating disease(5).
2.2
Before the introduction of the vaccine, meningococcal Group C caused an estimated 1,530
cases of meningitis and/or septicaemia with 150 deaths in 1998, mainly in young children and
teenagers. In the last six months of 2000 the vaccine reduced meningococcal C disease across
all under 18s by 71% (this will have included many children still to be immunised as the
programme rolled out), compared with the same period of 1999. In the first groups to be
immunised, disease has been reduced by 90% (in 15-17 year olds) and 82% (in under 1s).
2.3
We would like to take this opportunity to formally thank and congratulate everyone involved
in delivering this programme; and especially doctors, practice nurses, school nurses, community
nurses, health visitors, pharmacists and teachers. Implementing this important initiative involved
much hard work and commitment from many people in the health and education sectors. The
programme has been a wonderful achievement for the NHS. The UK took a leading role in
developing the vaccine and is the first country to introduce it. Babies and young people are alive
and well today who would otherwise have died.
Item of Service fee
2.4
We would encourage all practices to review their patient lists to ensure, in
collaboration with the local immunisation co-ordinator, any children or young people
missed during the school campaigns are offered the chance through primary care to be
protected against this devastating disease. An Item of Service Fee (rate B) is now
available for GPs giving the vaccine to anyone under 18 years of age. It is particularly
important that we offer vaccine to anyone who was missed in last year’s campaign.
2.5
We would also like to remind colleagues to remain alert to the signs and symptoms of
meningococcal disease. The MenC vaccine does not protect against meningococcal B disease
(now responsible for almost all childhood cases) and not all individuals have been immunised
with the new vaccine.

Page 4 of 12
3.
MENINGOCOCCAL IMMUNISATION FOR ASPLENIC PATIENTS
Meningococcal C conjugate vaccine is now recommended for people with an absent or
dysfunctional spleen.
3.1
Patients with an absent or dysfunctional spleen (through operative splenectomy, functional
hyposplenism or congenital aplasia) are at increased risk of overwhelming bacterial infection.
Infection is most commonly pneumococcal, but other organisms such as Haemophilus
influenzae type b and meningococci may be implicated.
3.2
In addition to the routinely recommended vaccines, immunisation with pneumococcal, Hib
and influenza vaccines is currently recommended for hyposplenic individuals(6). Up to now,
meningococcal immunisation (with meningococcal A&C vaccine) was recommended only in high
risk situations, such as travel to a high risk area, on the grounds that most infections in the UK
were due to group B strains and any protection from the polysaccharide A&C vaccine was likely
to be of short duration(7). In view of the better efficacy and longer duration of immunity likely
to be conferred by conjugate meningococcal C (MenC) vaccine, the JCVI now
recommends that MenC vaccine is offered to all patients with an absent or dysfunctional
spleen.
3.3
When travelling to a high risk area for meningococcal infection, such patients will
still require the additional protection conferred by polysaccharide A&C or quadrivalent
(A,C,W,Y) vaccine.
4. IMMUNISATION FOR PILGRIMS TRAVELLING TO SAUDI ARABIA FOR HAJJ
OR UMRAH
4.1
Saudi Arabia requires pilgrims entering the country for Hajj or Umrah to be immunised
against meningococcal A infection. Previously the UK has recommended meningococcal
polysaccharide A&C vaccine. Following a recommendation from the JCVI, this advice has now
changed.
4.2
Last year, an outbreak of meningococcal W135 infection was associated with the Hajj(8).
Up to 7 November 2000, 49 cases with the infection had been reported to the Public Health
Laboratory Service and 7 people had died. The UK Health Departments therefore now
recommend that the quadrivalent meningococcal polysaccharide vaccine, which provides
protection against A, C, W135 and Y strains, is more appropriate.
4.3
One licensed product, ‘ACWY Vax’ (SmithKline Beecham), is available. Details on this are
contained in Annex 2 to this letter. The vaccine should not be used in infants of less than
two months. When issuing a certificate of meningococcal immunisation, doctors should
indicate which vaccine has been given.
4.4
Most children and young people up to the age of 18 years in Britain will now have been
immunised with MenC vaccine, either by their GP or in school. MenC vaccine protects only
against meningococcal C infection. Children and young people travelling for Hajj or Umrah will
still need the additional protection against A and W135 strains afforded by the quadrivalent
vaccine. An interval of at least two weeks is recommended before administering the quadrivalent
(or A&C) vaccine where MenC immunisation has only recently been given.
4.5
The Department has worked with the Muslim Council of Britain to make this information
widely available to the Muslim community. An A4 poster with information for the public has been
distributed to Mosques and copies are available from the Immunisation Team at the Department
of Health. Versions of the poster in Arabic, Bengali and Urdu are available on
www.doh.gov.uk/traveladvice/hajj.htm

Page 5 of 12
5.
INFLUENZA IMMUNISATION
5.1
Congratulations are due to all those involved in the influenza immunisation programme for
2000/01. Preliminary data show a national uptake of vaccine in those aged 65 and over of 65%,
with 91% of Health Authorities reaching the target of at least 60% which was set for the first time.
5.2
It is now time to start planning for next winter. The World Health Organisation has
announced their recommendations for the virus strains to be included in the 2001/02 vaccine,
and manufacturers are already making their production plans. These include having to place
their orders for the eggs on which the vaccine viruses will be grown, which is the main volume-
limiting factor in the production of influenza vaccines.
5.3
Full details of the immunisation programme for next year will be issued shortly. In the
meantime, practices must assess their vaccine needs for their risk groups. This requires lists
or registers to be made to include all patients aged 65 and over, those in residential care,
and those under 65 in the ‘high risk’ groups:
RISK GROUPS FOR INFLUENZA IMMUNISATION
Those with chronic respiratory
This includes chronic obstructive pulmonary disease
disease, including asthma
(COPD), including chronic bronchitis and
emphysema, bronchiectasis, cystic fibrosis,
interstitial lung fibrosis, pneumoconiosis, asthma
requiring continuous or repeated use of inhaled or
systemic steroids or with previous exacerbations
requiring hospital admission.
Those with chronic heart disease
This includes chronic ischaemic heart disease,
congenital heart disease and hypertensive heart
disease requiring regular medication and follow-up
(but excluding uncomplicated controlled
hypertension), and chronic heart failure.
Chronic renal disease
Including nephrotic syndrome, chronic renal failure,
renal transplantation.
Diabetes
Diabetes mellitus requiring insulin or oral
hypoglycaemic drugs.
Immunosuppression
Due to disease or treatment, including systemic
steroids equivalent to 20mg prednisolone daily for
more than 2 weeks. However, please note that
some immunocompromised patients may have a
suboptimal immunological response to vaccine.
Hospitalisation for any of the above conditions within the last year would be an indication for flu
vaccine.
5.4
Some categories of medication nearly conform to the risk criteria. However, they are not
concordant with the risk groups and it is recommended they are only used as an ancillary aid in
compiling disease-based registers.
5.5
Orders for vaccine for the 2001/02 season should be placed as soon as possible.

6.
ANAPHYLAXIS MANAGEMENT.
Current Vaccine and
Agreement has been reached between JCVI, the Resuscitation
Immunisation Issues
Council and the BNF, on the dosage guidelines for adrenaline
to be given, and the route of administration, in cases of
PL/CMO/2001/1, PL/CNO/2001/1,
anaphylaxis following immunisation(9). This clarified guidance is
PL/CPHO/2001/1
given at Annex 3 to this letter.
9 March 2001
Page 6 of 12
Professor Liam Donaldson
Chief Medical Officer
Sarah Mullally
Chief Nursing Officer
Dr Jim Smith
Chief Pharmaceutical Officer
REFERENCES:
(1) Adverse Drug Reactions and Toxicological Reviews 2000, 19(4), 265-283.
(2) Department of Health Press Release 2001/0027, 12 January 2001
(http://tap.ccta.gov.uk/doh/intpress.nsf/page/2001-0027); Public Health Link
CEM/CMO/2001/1 (12 January 2001).
(3) BMA Press Release ‘Joint professional statement on MMR” 12 January 2001
(http://web.bma.org.uk/pressrel.nsf).
(4) PL/CMO/99/2, PL/CNO/99/4, PL/CPHO/99/1; PL/CMO/99/4, PL/CNO/99/8,
PL/CPHO/99/3; PL/CMO/99/5, PL/CNO/99/9, PL/CPHO/99/4
(www.doh.gov.uk/cmo/cmo2.htm).
(5) Department of Health Press Release 2001/0007, 3 January 2001
(http://tap.ccta.gov.uk/doh/intpress.nsf/page/2001-0007).
(6) UK Health Departments: ‘Immunisation against Infectious Disease’. London:
HMSO, 1996.
(7) Working Party of the British Committee for Standards in Haematology Clinical
Haematology Task Force. Guidelines for the prevention and treatment of infection
in patients with an absent or dysfunctional spleen. BMJ 1996; 312: 430-4.
(8) CDSC. Meningococcal infection in pilgrims returning from the Hajj. CDR
Weekly 200; 10: 125, 149 and 169.
(9) Royal Pharmaceutical Society of Great Britain and British Medical Association.
British National Formulary BNF No.40, p155, September 2000, Pharmaceutical
Press, London.

Page 7 of 12
ANNEX 1
MMR QUESTIONS AND ANSWERS
1.
General statement on safety of MMR vaccine
The suggestion of an association between measles, measles vaccine, MMR vaccine,
inflammatory bowel disease (IBD/Crohn’s disease) and autism was made by researchers at the
Royal Free Hospital, London, led by Dr Andrew Wakefield. Rigorous scrutiny by the Department
of Health and a number of independent expert advisory groups has established that the present
evidence does not support any such association.
2.
What has the Government done on this concern?
The Government has ensured this issue has been thoroughly looked at. The view of our
independent expert committees – the Joint Committee on Vaccination and Immunisation (JCVI)
and the Committee on Safety of Medicine (CSM) - remains that, on the scientific evidence
available, there is no causal link between MMR vaccine and long term health problems such as
bowel disease or autism. This view is supported by non government organisations such as the
Medical Research Council (MRC) and World Health Organisation which recognises MMR as
being a “highly effective vaccine which has such an outstanding safety record”.
3.
Does MMR cause autism and Inflammatory Bowel Disease?
Reviews by both the CSM and the MRC did not identify a causal link between MMR and
Measles/Rubella vaccines, autism and IBD. Such views are further reinforced by the report of a
CSM Working Party and by a study undertaken in North Thames region, both of which found no
evidence of a causal link between MMR and autism, by the latest report from the MRC’s group
of experts and also by recently published research from the UK.
4.
What about the article published in the journal Adverse Drug Reactions and
Toxicological Reviews on 21 January 2001 by Wakefield and Montgomery?
The Governments’ independent expert committees have reviewed the paper and have advised
that: it contains no new data relevant to the safety of MMR vaccine; its analyses are incorrect;
and it has failed to mention published work that does not support the hypothesis that MMR
causes inflammatory bowel disease and autism.
5.
Was MMR vaccine properly tested prior to licensing?
Five combined measles, mumps and rubella vaccines have been licensed in the UK. Three of
these are still licensed and two are used in the national immunisation programme (Priorix and
MMRII). In accordance with the principles of good clinical practice, the majority of clinical trials
that supported licensure of these vaccines were sponsored by the company, were conducted by
investigators experienced in the field, and were monitored by company personnel.
After careful review, the Department of Health and the Medicines Control Agency (MCA) reject
any suggestion that combined measles, mumps and rubella (MMR) vaccines were licensed
prematurely. The Department of Health and the MCA are confident that the licensing process
was properly conducted on the basis of safety, quality and efficacy of the vaccines in adequate
numbers of children.
Most of the studies enrolled children in the second year of life, although some enrolled children
up to 13 years old. Details of adverse reactions were mostly recorded over 4-6 weeks post-
injection because children returned for assessment of their response to the vaccines around this
time. In clinical trials fewer than 200 children were followed for one year. However, post-
marketing reporting of adverse reactions provides much additional information on the safety of
these products.

Page 8 of 12
q
In 1972 the first measles, mumps and rubella combination vaccine was licensed in the UK
(MMR-I). Information on protection in nearly 900 previously non-immune children and
safety information on about 2,000 children was available.
q
MMR-II replaced MMR-I in 1987. Detailed safety data were available for more than 800
children who received MMR-II in clinical trials.
q
The approval of Pluserix in 1988 (not now licensed) was based on data from more than
600 children.
q
The approval of Priorix in 1997 was based on trials in which almost 6000 children received
the vaccine.
q
The approval of Immravax in 1989 (licensed but not in use in the UK) was based on clinical
studies in which at least 6,400 subjects received the vaccine.
By the time the UK came to introduce MMR in 1988, there had already been substantial use in
Scandinavia and the USA. Currently MMR is used in over 90 countries worldwide. Over 500
million doses have been given.
6.
Has the safety of MMR been looked at in other countries?
Research conducted in Scandinavian countries has looked at measles infection and MMR
vaccination in relation to reports of autism and Crohn’s disease. In common with the latest
information from the UK, no causal link was found between measles infection and MMR vaccination
and either autism or Crohn’s. For example, a study conducted in Gothenburg, Sweden over a ten
year period during which time MMR vaccine was introduced into the childhood immunisation
programme, showed that the incidence of autism was unaffected by the introduction of MMR.
7.
Do some children develop autism after vaccination?
MMR vaccine is first given between the ages of 13 and 15 months. Autism is frequently
diagnosed in the second year of life. This means that purely by chance, some children would
have developed their autism around the time of vaccination. Expert reviews have not shown a
cause and effect between MMR and autism.
8.
Should MMR vaccine be given as 3 separate vaccines?
The UK has never recommended three separate injections. We are not aware of any country that
recommends single vaccines rather than MMR. The policy is not based on financial
considerations but on the best way to protect children. If there were any evidence of real risk the
Department of Health would act immediately. By contrast, separating vaccines puts children at
risk and there is no evidence of a benefit over MMR. It is vital for children to be immunised with
MMR or these three diseases will return.
9.
What are the risks in using single vaccines?
q
There is no convincing evidence of any additional benefit from using single vaccines
instead of MMR.
q
There is very considerable evidence for the safety of MMR vaccine. The WHO stated on 24
January 2001: “WHO strongly supports the use of MMR vaccine on the grounds of its
convincing record of safety and efficacy. The combination vaccine is recommended rather
than monovalent presentation [single vaccines] when available and the disease burden
justifies its use”.
q
Separating the vaccines – it has been suggested, without any scientific evidence, that there
should be a gap of at least 12 months between vaccines – leaves children at risk of
infection whilst waiting between vaccines.
q
Children would be left at risk up to age 3 years from either measles (which is potentially a
very serious disease) or rubella (with the risk to the unborn child this brings for unprotected
pregnant women) or mumps (which, before MMR, was introduced was the main cause of
viral meningitis).

Page 9 of 12
q
As six injections would be required rather than two, separating the vaccines exposes
children to the risks of repeated reactions at the site of injection.
10.
Can you get single measles and mumps vaccines privately?
The importation of unlicensed vaccine when a licensed alternative is available is restricted under
the Medicines Act and this restriction applies equally to NHS and private sectors.
11.
Why are single measles and mumps vaccines not available?
Although licenses for single measles and mumps vaccines do exist in the UK, no licensed single
measles or mumps vaccines are manufactured for, or available for, the UK market. The MCA has
restricted the importation of single measles and mumps vaccines on the grounds that under law,
unlicensed medicines should not be imported when a safe and effective licensed alternative
which meets a patient’s needs – that is, MMR – is available. The MCA was also concerned about
the evidence that the single mumps vaccine (Rubini strain) being imported was ineffective and
that the mumps Urabe strain was less safe. Neither of these two vaccines can now be imported.
12.
Other countries
No country in the world recommends MMR be given as 3 separate vaccines. MMR is used in
93 countries around the world. Over 500 millions doses have been given worldwide.
Single rubella vaccine is available in the UK as it is recommended for women who are not
immune. France has been mentioned as a country where single vaccines are given. However,
the position is that in France children are given single measles vaccine from 9 months of age IF
they are in a nursery and there is a risk of a measles outbreak. These children then receive
2 further MMR vaccinations, at the same time as the UK. France does not recommend single
mumps vaccine.
13.
Situation in Japan
Japan immunises against measles and rubella separately because they do not have a suitable
MMR vaccine. However, Japan has suffered from endemic and epidemic measles. Between
1992-97, there were 79 measles deaths in Japan. There have been no deaths from acute
measles in the UK since 1992. There is no recent data on CRS prevention in Japan. Between
1997 and 1999, there were no cases of CRS in England and Wales detected through active
surveillance.
14.
MMR vaccine contains 3 viruses in one: is this too much for young children?
Evidence shows that babies’ and young children’s immune systems cope daily, without difficulty,
with many different challenges from the wild viruses and bacteria that are found virtually
anywhere. In addition, the three vaccines in MMR work at different speeds, so they don’t all
impact on the child at once. Splitting MMR into separate doses may be harmful because it
exposes children unnecessarily to potentially serious diseases.
15.
Consequences of fall in MMR vaccine uptake
MMR vaccine uptake has fallen over the past few years at age two and has now stabilised at
around 88%. This is too low to maintain sufficient levels of protection in the population, especially
against measles (95% is needed). We are very close to the point where serious outbreaks of
measles will occur as in Ireland where there have been deaths from measles. Mumps and rubella
may not be far behind. Every child who is not immunised is at risk and also increases the risk of
a return of these potentially very serious diseases. The latest scientific evidence shows MMR
remains the safest way to protect children against these diseases.
In addition, further information can be found on each of the following web sites:
www.immunisation.org.uk
www.doh.gov.uk
www.open.gov.uk/mca

Page 10 of 12
ANNEX 2
IMMUNISATION FOR PILGRIMS TRAVELLING TO SAUDI ARABIA
FOR HAJJ OR UMRAH
1.
Last year, an outbreak of meningococcal W135 infection was associated with the Hajj(8) The
UK therefore now recommends that the quadrivalent meningococcal polysaccharide vaccine,
which provides protection against A, C, W135 and Y strains, is more appropriate.
2.
One licensed product, ‘ACWY Vax’ (SmithKline Beecham), is available and the details are
as shown below.
3.
‘ACWY Vax’ comes in a vial containing one dose of 0.5ml freeze-dried vaccine with an
ampoule of diluent for reconstitution. It is recommended for both adults and children aged two
years and over. Children 2 months to 2 years who are at particular risk of infection may also be
immunised. However, although immune responses may be achieved to serogroup A, W135 and
Y antigens in children less than 2 years old, the degree of protection may be unreliable and is
likely to be short-lived. The vaccine should not be used in infants of less than two months.
4.
‘ACWY Vax’w will be supplied in the following pack sizes:-
SB
Product
Pack
Trade Price
Order in
IMS
PIP Code
EAN Number
Code
size
(excl VAT)
multiples of
Code
7309
ACWY
1
£17.14
1
SCVM
275-8167
5000483730901
Vax
Ordering - With immediate effect, all orders for ‘ACWY Vax’ should be directed to your usual
wholesaler/supplier:
5.
For further information please contact:
Customer Response Centre
SmithKline Beecham Pharmaceuticals
Mundells
Freephone orders: 0808 100 9997
Welwyn Garden City
Freephone Enquiries: 0808 100 2228
AL7 1EY

Page 11 of 12
ANNEX 3
ANAPHYLAXIS GUIDANCE
The dosage guidelines for adrenaline to be given, and the route of administration, in cases of
anaphylactic reactions in children following immunisation by First Medical Responders is as
follows:
Adrenaline (epinephrine) 1:1000 solution(i)
>12 years:
500 micrograms IM (0.5 ml)
250 micrograms if child is small or prepubertal(ii)
6-12 years:
250 micrograms IM (0.25ml)(ii)
> 6 months–6 years:
120 micrograms IM (0.12ml)(ii)
< 6 months:
50 micrograms IM (0.05ml)(iii)
(i)
For profound shock, judged immediately life threatening, give CPR/ALS if necessary.
Consider slow intravenous (IV) adrenaline (epinephrine) 1:10,000 solution. This is
hazardous and is recommended only for an experienced practitioner who can also obtain
IV access without delay. Note the different strength of adrenaline (epinephrine) that may be
required for IV use.
(ii)
For children who have been prescribed EpiPen, 150 micrograms can be given instead of
120 micrograms, and 300 micrograms can be given instead of 250 micrograms.
(iii)
A crystalloid may be safer than a colloid.