In this case-based module, Dr Toni Hazell discusses key vaccinations available to children on the NHS and how to manage potential questions and concerns parents may have about them
Learning objectives
This case-based module will support your knowledge and understanding of:
• The rationale behind current and future eligibility for chickenpox vaccine on the NHS.
• Evidence supporting use of multiple and combination vaccines, and how to reassure parents concerned about ‘vaccine overload’ in children.
• Potential complications of rotavirus vaccination and how to explain the benefits versus risks to parents.
• Considerations for children with egg allergy receiving flu vaccine.
• How to advise parents regarding porcine ingredients of the nasal flu vaccine.
Note all cases are hypothetical scenarios designed for illustrative purposes
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Case 1. Parent requests chickenpox vaccination for toddler
You are just finishing a smear test appointment, when the patient asks if she can book her two- year-old daughter in for a chickenpox vaccination. She says that she has heard that there is new guidance saying that it must be offered to every child; she’s nervous about getting into trouble at work if she has to take time off to look after a child with chickenpox.
1. What guidance is she referring to, and is the chickenpox vaccine available on the NHS?
The NHS vaccination schedule starts with primary vaccination at 8, 12 and 16 weeks, with further doses given at the age of one, before starting school, and in senior school. Primary age children (and some in secondary school) are also entitled to the flu vaccination every year. Vaccination against varicella zoster, the virus which causes chickenpox, is not universally available on the NHS. This parent has probably seen the 2023 Joint Committee on Vaccination and Immunisation (JCVI) document, recommending universal chickenpox vaccination.1 At, the time of writing (October 2024), no part of the NHS has responded to this recommendation, so she is slightly premature in asking for her child to be vaccinated.
Chickenpox vaccination is available on the NHS, but it is targeted at certain groups.2 This includes non-immune close contacts of immunocompromised patients (for example the siblings of a child with leukaemia); it is also sometimes given to non-immune patients before they become immunocompromised. This can only happen if the treatment which will cause immunocompromise can be delayed long enough for both doses of the vaccine to be given. Healthcare professionals and laboratory staff who work with the virus and are not immune to chickenpox may also be vaccinated, usually by occupational health at their place of work.
2. Why is the chickenpox vaccination not currently universally available on the NHS, and what are her options if her child is not entitled to it?
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In 2009, the JCVI felt that the chickenpox vaccine was not cost-effective. Chickenpox is unpleasant, but most children do not need to see a doctor or be admitted to hospital, and so the healthcare costs are limited. It is more serious when caught in adulthood, and particularly by a woman who is pregnant. The previous decision also factored in the risk that universal vaccination might lead to more cases of shingles in adulthood; it was thought that repeated minor exposures to children with chickenpox provides older adults with some protection against chickenpox. The 2023 review reconsidered this and changed the recommendation. This was based on a variety of factors, in particular a consideration that the costs of chickenpox may have been underestimated, and that in the United States, no increase in adult shingles was seen after chickenpox vaccination became routine.
The JCVI recommendation is for universal vaccination at 12 and 18 months, with a catch-up programme for those aged up to and including five when the vaccine comes in, with consideration of catch-up vaccination for those aged up to 11. Your patient’s daughter is two, so if this is becomes NHS policy in the next few years, she may be entitled to it then. If she feels that she cannot wait, the vaccine is widely available in the private sector – from pharmacies or private GPs.
To read and complete the full module visit the Nursing in Practice 365 website.
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Dr Toni Hazell is a GP in north London
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References
1. Department of Health and Social Care (DHSC). JCVI statement on a childhood varicella (chickenpox) vaccination programme. 14 November 2023
2. UK Health Security Agency (UKHSA). Green book. Chapter 34 – Varicella. 25 September 2024
