Scottish Vaccine Update
Issue 81

Published: 01 July 2024
Type: Reference materials
Author: Public Health Scotland

Immunisations

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Foreword

By Sam Ghebrehewet, Head of Vaccination and Immunisation Division

Welcome to the first edition of the reinstated Scottish Vaccine Update.

Going forward, this monthly publication will provide regular current information, both clinical and programmatic, for Scotland’s vaccination workforce.

This edition will focus particularly on pertussis (whooping cough) by looking at the increase in cases in 2024, and outlining the latest updates in the maternal pertussis programme, including changes from July onwards.

Over the years there have been many changes to the overall vaccination programme we offer in Scotland. This includes schedule changes, eligibility changes and the introduction of new vaccines, all of which have enabled increased prevention and protection for our population.

The vaccines we offer protect against diseases that can affect anyone at all stages of life.

When we think about vaccination, we often think primarily about the most obvious impact they have: they protect and they prevent.

For an individual this means protection against the risk of severe illness and potentially life-changing consequences or complications, but there may be much wider impacts than the initial period of illness.

For example, a vaccine-preventable disease such as pertussis in an infant can also impact upon their feeding, their attachment and increased parental anxiety during what can often be a prolonged period of illness.

The wider impacts of vaccination are also in terms of reduced pressure on healthcare and associated costs, which can include primary care appointments, hospitalisations, medicine use, plus any long-term complications, which will also be prevented.

Vaccination is one of the most effective health interventions we have, and it takes a lot of people to make a vaccination programme happen.

I’d therefore like to take this opportunity to thank all staff involved in Scotland’s vaccination programmes, as without your engagement and unwavering support for the public health agenda our communities would remain unprotected.

Providing this monthly update will keep healthcare practitioners informed on the latest activity within each of the vaccine programmes as we continue to collaborate with key stakeholders and work towards a Scotland where everybody thrives.

Increase in whooping cough cases in Scotland

An increase in pertussis, also known as whooping cough, is being seen across the UK and Europe.

Cases of pertussis have also increased in Scotland since the beginning of the year.

This is a bar chart showing the number of laboratory reports of Bordetella pertussis by month from 2012 through to the end of March 2024. The figure shows the outbreak that occurred in 2012 into 2013 with 1,896 and 1,188 reports, respectively, as well as an increase in activity that occurred in 2016 (1,075 reports). From the first quarter of 2020, cases can be seen to drop to nearly zero with only four cases reported in 2021 and three cases reported in 2022. Pertussis activity has been increasing since late 2023. 73 cases were reported in 2023, most of which were in the last quarter of the year, and there were 1,084 laboratory confirmed cases in the first quarter of 2024. — Image caption **Number of laboratory reports of Bordetella pertussis in Scotland by month, 2012 to March 2024**

You can see the latest surveillance data on the pertussis section of our website.

Benefits of getting vaccinated

Public Health Scotland (PHS) is encouraging pregnant women to get immunised against pertussis.

The vaccine offers vital protection to babies from birth until they are old enough to have their first routine immunisations, starting at 8 weeks of age.

Parents are encouraged to ensure their children are fully immunised against pertussis, as it is a highly contagious bacterial infection of the lungs and airways.

Pertussis causes long bouts of coughing.

Symptoms to look out for include:

cold-like symptoms, such as a runny nose, red and watery eyes, sore throat and slightly raised temperature
intense coughing bouts starting about a week later
coughing up thick mucus, which may be followed by vomiting
gasping for breath between coughs, which may cause a ‘whoop’ sound – although not everyone has this

Find out more about pertussis on NHS inform.

Getting vaccinated

Vaccination in pregnancy

Those who are pregnant are encouraged to speak to their midwife about getting the pertussis vaccine.

Find out more about pregnancy and baby immunisations on NHS inform.

If a child has missed a dose

Parents are encouraged to contact their local NHS immunisation team to arrange for their children to get vaccinated if they have missed any doses.

Contact details are available on NHS inform or by calling 0800 22 44 88.

Update to maternal Pertussis programme

Introduction of the programme

A safe and highly effective maternal pertussis vaccination programme was first introduced in October 2012, using dTaP/IPV (a combined tetanus, diphtheria, pertussis and polio-containing vaccine) to protect young infants from birth at highest risk of severe disease.

Evaluation of the programme in England has shown that maternal pertussis vaccination gives a very high level of protection against confirmed disease and death from pertussis in infants under 3 months of age.

Review of evidence

In October 2022, following a review of the latest evidence, the Joint Committee on Vaccination and Immunisation (JCVI) advised a preference for a non-IPV-containing pertussis vaccine in the maternal programme.

This followed studies measuring antibody levels in the infants of mothers who had received polio-containing vaccines (dTaP/IPV) in pregnancy. These studies showed lower antibody responses to polio (after completion of their primary infant schedule) compared to infants born to unvaccinated mothers, although all remained above the protective threshold.

New vaccine recommended

To address this potential immunity gap caused by the blunting of the infant’s polio response to primary vaccines, a non-IPV-containing (Tdap) vaccine, brand name ADACEL, has now been procured.

Tdap vaccine has been shown to have an excellent safety profile and to be effective in the maternal pertussis vaccine programmes in many other European countries, the USA and Australia, with millions of doses administered worldwide.

Key changes

From 1 July 2024, the preferred vaccine used in the programme will change to ADACEL.

The ADACEL vaccine, manufactured by Sanofi Pasteur, was licensed for UK use in 2016 and contains antigens to:

tetanus
diphtheria
pertussis (acellular)

The summary of product characteristics (SmPC) is available.

Scottish Government have released a CMO letter to highlight these changes.

ADACEL will be available for recording on the Vaccine Management Tool (VMT) from 1 July 2024.

ADACEL® vaccine supply

ADACEL is now available to order.

There is a limit of 5,400 doses per account per week. If this limit is too low for your health board, please contact PHS.

ADACEL is the preferred vaccine for vaccination from 16 weeks of pregnancy. However, it is not suitable for people with latex allergy.

For those with latex allergy, or where ADACEL is not available, Boostrix IPV or Repevax can continue to be used.

All pertussis-containing vaccines should be stored at 2 to 8°C, in the original packaging.

National specimen Patient Group Direction (PGD)

A national specimen Patient Group Direction (PGD) has been issued to NHS boards which combines all pertussis-containing vaccines.

Please refer to your locally approved PGD alongside the training materials from NHS National Education for Scotland (NES).

Informed consent materials

PHS has updated the information to support informed consent for the pertussis vaccine offered from week 16 of pregnancy.

From 1 July 2024, the vaccine offered will change from a 4-in-1 vaccine to a 3-in-1 vaccine providing protection against pertussis, diphtheria and tetanus.

This new leaflet replaces the previous version.

Please recycle any old stock as it should no longer be used from 1 July 2024.

You can also direct patients to NHS inform for further information, including the leaflets in alternative languages and formats (such as British Sign Language and Easy Read).

To order the leaflet in other languages or alternative formats (such as Easy Read and large print), email phs.otherformats@phs.scot

Workforce education materials

Workforce education materials will be available shortly, subject to availability of the updated Green Book chapter.

Find out about the workforce education materials on TURAS.

Vaccine-preventable disease surveillance data

Disease surveillance is an essential component of prevention and control.

PHS publishes a quarterly report on vaccine-preventable diseases under surveillance in Scotland, including data on diseases including pertussis (whooping cough), measles, meningococcal disease, polio and invasive pneumococcal disease.

The latest release, published on 4 June 2024, includes data to the end of quarter one of 2024.

The report presents data showing that there has been an increase in pertussis case numbers since late 2023, continuing into the first quarter of 2024, consistent with increases in pertussis cases seen across the UK and in Europe more widely.

The report also shows that there were six cases of measles in the first quarter of 2024, most of which were imported from outside the UK. These cases occurred in the context of a resurgence of measles across Europe.

The next quarterly release will be published on 3 September 2024.

Weekly updates on measles and pertussis case numbers in Scotland are available on the PHS website. Note that these figures are provisional and subject to change.

Vaccination and immunisation workforce education

NHS Education for Scotland (NES), in partnership with PHS, has developed a variety of workforce education resources to support the Scottish Vaccination and Immunisation Programme (SVIP).

These resources, available on Turas Learn, will be of interest to practitioners whose remit includes immunisation, whether administration or giving advice.

Promoting Effective Immunisation Practice (PEIP) is a learning programme aiming to help enable healthcare practitioners to promote and administer vaccinations confidently, competently and effectively.

This is in addition to vaccine-specific learning and learning to help support vaccination practice, such as:

injection techniques
informed consent
supporting those who experience procedural distress or anxiety
improving vaccine confidence

The learning resources available are updated and added to regularly to ensure that they continue to reflect current practice.

For example, resources to help support practitioners involved with travel health and NHS travel vaccine provision.

In practice there may be workforce groups with specific roles and responsibilities, such as midwives.

Learner pathways are available to support practitioners to identify the learning suitable to their needs. Proficiency assessment tools are available for use locally with support and supervision.