25 January 2018
In October 2017, the Joint Committee on Vaccination and Immunisation (JCVI) advised a revised schedule for the PCV13 vaccination currently administered to children in the UK to protect against strains of pneumococcal bacteria. The current schedule is for doses at two, four and 12 months (also known as a 2+1 schedule). The revised schedule would replace the doses at two and four months with one at three months (1+1).
Infection with pneumococcal bacteria can lead to meningitis, and children under the age of five are most at risk (1). The vaccine schedule provides protection for this vulnerable age group, as well as providing protection for others through herd immunity.
CoMO members, the Meningitis Research Foundation (MRF), Meningitis Now, and the UK Sepsis Trust (UKST) have all commented on the latest recommendation and have raised concerns over the proposed changes.
All three charities have understandably raised concerns over the inability to precisely predict what effect the changes will have on incidence of the disease. Evidence provided by the JCVI suggests that the reduced dosage will not be detrimental to protection (2) but exactly how this conclusion was reached is not entirely clear and further consultation has been requested.
MRF and Meningitis Now have requested more information on what will be done if there is an increase in cases as a result of the changes and what the trigger point will be for this action. They have also stressed the importance of scrupulous surveillance to ensure any changes are immediately apparent.
The JCVI has opened a consultation, which ends on 2nd February. CoMO has written to the Committee to echo the concerns of its members.
As an international charity that represents more than 50 groups around the world, CoMO is also asking the JCVI to consider the impact such a change could make on other countries. The UK is a leader in vaccination and surveillance and as such, changes could result in other countries following suit without the necessary structures in place. We have asked that the JCVI address these concerns by stating that it would be unwise for other countries to follow their example without due consideration to these factors.
References
1. O'Brien KL, Wolfson LJ, Watt JP, Henkle E, Deloria-Knoll M, McCall N, et al. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet. 2009;374(9693):893-902.
2. Goldblatt D, Southern J, Andrews NJ, Burbidge P, Partington J, Roalfe L, et al. Pneumococcal conjugate vaccine 13 delivered as one primary and one booster dose (1 + 1) compared with two primary doses and a booster (2 + 1) in UK infants: a multicentre, parallel group randomised controlled trial. Lancet Infect Dis. 2017.