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18 July 2014

Next update: 25 July 2014

Last updated 18 July 2014, Vol. 8, No 28 (790 KB PDF).

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JCVI advises continuation of maternal pertussis vaccination programme

PHE has welcomed the Joint Committee on Vaccination and Immunisation's advice to the Department of Health that the pertussis vaccination programme for pregnant women should continue for a further five years [1].

Available data relating to the coverage, effectiveness and safety of the programme, its impact on disease and current epidemiology were considered by the JCVI at its June 2014 meeting and on the basis of these data it has advised that the programme should be extended [2].

An overall decline in pertussis cases since the maternal vaccination programme began in October 2012 is apparent in data on pertussis infections in England to end-May 2014, published in this issue of HPR (see following news report, in which references to newly published safety and effectiveness data are included) [3].

References

1. Continuation of whooping cough vaccination programme for pregnant women advised as new evidence on effectiveness and safety published, PHE press release, 16 July 2014.

2. Minutes of Joint Committee on Vaccination and Immunisation meetings, 16 July 2014.

3. Laboratory confirmed pertussis in England: data to end-May 2014, HPR 8(28), Advanced Access report published on 16 July 2014.

 

Laboratory confirmed pertussis in England: data to end-May 2014

With the exception of a small expected seasonal peak in July and August 2013, overall pertussis activity in England continued to fall through to April 2014 but has increased slightly into May and continues to persist at raised levels compared to the years preceding the outbreak in 2012. An increase in laboratory confirmed cases has been observed in adolescents aged 10-14 years from December 2013, in infants <3 months of age from April 2014 and in adults aged 15 years and older in May 2014. There have been five deaths in infants with pertussis diagnosed in 2014 to the end of May. Immunisation of pregnant women continues to be important in the face of these continued raised levels of pertussis and recent infant deaths and with the newly published high effectiveness (>90%) and safety of the pertussis immunisation in pregnancy programme [1,2]. This news report presents current pertussis activity to 31 May 2014, updating the previous report that included data to the end of December 2013 [3].

A level 3 incident was declared in April 2012 to coordinate the response to the ongoing increased pertussis activity observed in the third quarter of 2011 and extending into 2012 (see figure 1 in Advanced Access version of this report) [4]. In response to this ongoing outbreak, the Department of Health announced on 28 September [5,6] that pertussis immunisation would be offered to pregnant women from 1 October 2012 to protect infants from birth whilst disease levels remain high. Available data relating to the coverage, effectiveness and safety of the programme, its impact on disease and current epidemiology were considered by the Joint Committee on Vaccination and Immunisation (JCVI) at its June 2014 meeting and on the basis of these data it has advised that this programme should be extended for a further five years [7].

In infants under 3 months of age low numbers of cases have been sustained since December 2012 with <10 cases per month up to August 2013 and six or fewer cases reported each month between September 2013 and March 2014. Cases increased in April and May 2014, however, with 11 and 14 cases respectively; the highest number of monthly cases since 23 reported in November 2012. The greatest decrease in disease since the peak in 2012 has been in infants under six months of age who are targeted by the maternal pertussis vaccination programme.

Disease incidence has, as expected, continued to be highest in this age group. There have been five deaths reported in young babies (<2 months) diagnosed with pertussis this year. In total eight deaths have been reported in young babies with confirmed pertussis who were born after the introduction of the pregnancy programme on 1 October 2012. Seven of these eight babies were born to mothers who had not been vaccinated against pertussis.

Pertussis activity in infants aged 3-11 months of age remained low with occasional cases reported, almost all in infants who had not received three primary doses of vaccine. Confirmed pertussis also remains low in children aged 1-4 years and, whilst small numbers of cases were confirmed in those aged 5-9 years, these increased slightly to 10-13 cases each month from February 2014 and in the first five months of 2014 exceeded the number of cases in the same time period confirmed each year from 2008.

Pertussis activity in adolescents, teenagers and adults (aged 10-14 and =15 years) was lower in January to May 2014 when compared to the equivalent period in 2013 (see table 1 in the Advanced Access version of this report). Monthly cases in the 10-14 year age group had increased, however, from December 2013. Cases in those aged 15 years and older were relatively stable in the first four months of 2014 but appeared to increase in May. Overall, confirmed cases of pertussis have been lower between January and May 2014 than in the first five months of the two preceding years but cases continue to exceed those confirmed in years prior to 2012. High pertussis activity has been observed across all regions in England with a third of cases in 2014 reported from the South of England (see table 2 in the Advanced Access version of this report).

The pertussis vaccination in pregnancy programme continues to be important for the prevention of serious disease and death in young babies. To optimise protection of their babies, women should ideally be immunised between 28-32 weeks gestation but may be immunised up to week 38 of pregnancy. Immunisation after week 38 is not ideal as it is unlikely to provide direct passive protection to the infant. Pregnant women who remain unprotected can be offered vaccination after 38 weeks as can new mothers who have not been vaccinated in pregnancy. At this stage of pregnancy, however, vaccination would potentially only directly protect the mother against disease and thereby just reduce the risk of exposure to her infant.

Approximately 60% of all pregnant women in England are currently being vaccinated in pregnancy [8]. This is important because around 75% of all cases of pertussis in babies occur before they can be protected by even the first dose of infant vaccine and when there is a high risk of serious disease. The babies that have died from pertussis in England over recent years all acquired pertussis in the first few weeks of life. Information generated from the pertussis immunisation in pregnancy programme in England has shown high levels of protection against disease in babies born to vaccinated women. Babies born to women vaccinated at least a week before delivery had a 91% reduction in the risk of disease in their first weeks of life when compared to babies whose mothers had not been vaccinated [1]. In addition, no safety concerns were found relating to pertussis vaccination in pregnancy in a study undertaken by the Medicines and Healthcare Products Regulatory Agency [2].

References

1. Amirthalingam G, Andrews N, Campbell H et al. Effectiveness of maternal pertussis vaccination in England: an observational study. Lancet 2014.

2. Donegan K, King B, Bryan P The safety of pertussis vaccination in pregnant women in the UK: An observational study. BMJ 2014; 349: g4219.

3. Confirmed pertussis cases in England and Wales: update to end-December 2013. HPR 8 (6): news, 14 February 2014. http://www.hpa.org.uk/hpr/archives/2014/news0614.htm#prtsss.

4. A level 3 incident is the third of five levels of alert under the PHE's Incident Reporting and Information System (IERP) according to which public health threats are classified and information flow to the relevant outbreak control team is coordinated. A level 3 incident is defined as one where the public health impact is significant across regional boundaries or nationally. An IERP level 3 incident was declared in April 2012 in response to the ongoing increased pertussis activity (HPR 6(15), http://www.hpa.org.uk/hpr/archives/2012/news1512.htm).

5. "Pregnant women to be offered whooping cough vaccination", 28 September 2012. Department of Health website, http://www.dh.gov.uk/health/2012/09/whooping-cough/.

6. "HPA welcomes introduction of whooping cough vaccination for pregnant women as outbreak continues", HPA press release, 28 September 2012.

7. Joint committee of Vaccination and Immunisation minutes, 16 July 2014.

8. Pertussis Vaccination Programme for Pregnant Women: vaccine coverage estimates in England, October 2012 to March 2014.

 

Impact of chlamydia screening on sexual behaviour of young adults in England

PHE has published Components of chlamydia screening and the impact of screening on behaviour [1,2] which presents the results of a National Chlamydia Screening Programme online survey, carried out in January 2014, that examined the impact of chlamydia screening on young adults' sexual health awareness and sexual risk behaviours. It updates data from an earlier survey carried out in 2012.

The survey report analyses the results and evaluates the wider impact of the chlamydia screening programme, over and above its diagnostic and treatment aims. It confirms that the programme provides an effective means of delivering sexual and reproductive health messages to young adults and results in self-reported behaviour change. Ninety percent of respondents said they had received sexual health information at the time of their last test and the majority said that testing had an impact on their knowledge (eg they would know how to avoid chlamydia in future), health seeking (eg they would be more likely to test again in future) and sexual risk behaviour (eg they would use condoms with new partners).

Free access to effective contraception and sexual health services are regarded as an essential component of national programmes for the improvement of young people's sexual health. Coinciding with the publication of the second NCSP web survey report, PHE has published updated guidance for those considering the development, provision or commissioning of free condom distribution schemes, which have proved a successful element of national strategy. Produced in collaboration with Brook, a leading provider of sexual health services and advice to young people, the updated guidance [2,3] incorporates what has been learned by practitioners since the guidance was first published in 2008.

References

1. NCSP. Components of chlamydia screening and the impact of screening on behaviour: 2014 National Chlamydia Screening Programme web survey report.

2. Chlamydia screening and condom schemes encourage safer sexual behaviour in young adults, PHE press release, 14 July.

3. C-Card condom distribution schemes why, what and how, available at: www.brook.org.uk/c-card.