Immunisations

You may want to know if your child should have routine immunisations and whether there could be an increased risk of complications because of the heart condition. We have sought the opinions of cardiologists and paediatricians to try to bring you a clear overview of why immunisations are important and what added precautions may need to be taken.

Your health visitor should be able to let you know where and when routine immunisation sessions are held in your area. If your child misses a vaccination appointment don’t worry; he or she does not have to start the course of vaccines again. But you will want to call your health centre to let them know why you were unable to attend, and to arrange another appointment.

Protection

Immunisations are given as injections. They help the body to protect itself against some infections. There is a recommended schedule for childhood immunisations, which changes frequently, visit www.nhs.uk/conditions/vaccinations. Routine immunisations start from two months old and are given throughout childhood. The final doses are usually given at fifteen years old.

Flu Vaccination – Influenza

From six months old children with complex heart disease will be offered a flu vaccination once a year from late September.

6 months – 2 years – Inoculation

2 – 17 years – Nasal spray (where appropriate see below)

18 years upwards – Inoculation

The yearly influenza immunisation may be offered as an intra-nasal preparation (nasal spray) when your child reaches two years of age. Most congenital heart disease patients can have this effective alternative except for those on Aspirin, those with life-threatening reaction to egg, those with significant immune compromise and those with breathing difficulties. Parents should talk to their cardiologists if they are concerned that one of these contraindications may be true for their child.

In addition to flu vaccinations, vaccinations against RSV (bronchiolitis) may also be offered to your child, but you should ask your child’s cardiologist for more advice on this. This is usually given monthly from October to February or March using a vaccine called Palivizumab and may require special arrangements with your GP or local hospital because of its expense.

What is it for?

Diphtheria

Diphtheria is a highly infectious disease caused by bacteria and is spread through people who are already infected when they sneeze or cough. In the early stage, the symptoms include a sore throat, swollen neck glands and a fever, but in the later stages diphtheria can cause damage to the lungs, heart and nervous system.

Tetanus

The germs that cause tetanus are found in soil and can be passed into your body through cuts and burns. They affect the muscles, causing stiff muscles, and interfere with breathing.

Whooping Cough

This is a very exhausting and painful disease for children who contract it, as it lasts several weeks and can cause vomiting and difficulties with breathing after long periods of coughing.

Hib (Haemophilus influenzae type B)

Despite the misleading name, this is a bacterial infection that is not actually related to influenza. It tends to affect mainly babies and children up to the age of four, and can lead to many serious illnesses, including meningitis, blood poisoning and pneumonia.

Meningitis ACWY

The MenACWY vaccine is given by a single injection into the upper arm and protects against four different strains of the meningococcal bacteria that cause meningitis and blood poisoning (septicaemia): A, C, W and Y.

The MenACWY vaccine is currently recommended for teenagers as they are most likely to carry the meningococcal bacteria at the back of their noses and throats.

The MenACWY vaccine protects teenagers and ‘fresher’ students going to university for the first time as this is when they’re most a risk of meningococcal disease. It also stops them carrying and spreading the bacteria to other people.

Vaccinating teenagers should also help protect other people, including babies and older people, against meningococcal disease, including the highly virulent Meningitis W strain.

Meningitis C

Meningitis C is one of the bacterial causes of meningitis or blood poisoning (septicaemia). Children can catch the infection through droplets from the sneezes and/or coughs of an infected person. Not all forms of meningitis can be prevented by immunisations.

Meningitis B

The Meningitis B vaccine will protect your baby against infection by meningococcal group B bacteria, which are responsible for more than 90% of meningococcal infections in children.

Polio

This is a virus which is passed on from human faeces, sewage or saliva of someone with the disease. Although immunisation means that it is no longer a problem in the UK, polio does still exist in developing countries. It affects the nervous system, leading to symptoms such as headaches, upset stomach and stiffness of back and neck. It can sometimes cause permanent muscle paralysis. The current vaccine is inactivated so that it can’t cause the disease – something that used to occur in rare cases with the polio drops.

Rotavirus

Rotavirus causes gastroenteritis with diarrhoea and vomiting. Before the vaccine came out this illness was so common that by the time children were five years old just about every child had had the infection. Children with heart problems have enough difficulties without losing a few days to this unpleasant illness so joining in with the rest of the population in having this vaccine is advisable. This vaccine is contraindicated after six months of age because there is a small risk of a serious bowel disorder.

MMR

Measles, mumps and rubella (German measles) are diseases that are all caused by viruses. Measles causes a rash and rarely severe pneumonia and encephalitis, while mumps causes swollen glands. Rubella is the mildest of all three but if contracted by a pregnant woman, it can harm her unborn baby.

Pneumococcal Infection

The pneumococcus is a bacterium that can cause serious chest infections, ear infections and meningitis. It is spread by people coughing and sneezing. This is a relatively recent addition to the routine vaccination schedule. Where your cardiologist considers your child to be at increased risk of this infection you will be offered an additional vaccination at two years which protects against a wider range of these bacteria.

RSV (Bronchiolitis)

This is a virus that causes a wheezy chest infection in children under one year old. It is spread by coughing, sneezing and on the hands of carers. The immunisation is short-lasting so it is given monthly over the winter if it is needed.

HPV

The HPV vaccine protects against two of the most serious human papilloma viruses that cause cervical cancer. The inoculation is given in three doses spread over six months to girls in secondary schools. This inoculation will not replace the need to have cervical screening later in life.

Hepatitis B

Hepatitis B is an infection of the liver caused by a virus that’s spread through blood and body fluids. This infection can be passed from an infected mother to her child at birth.

Hepatitis B is a serious cause of liver damage and liver cancer in children and adults. Although many people have only mild or no symptoms caused by an acute infection with Hepatitis B the virus can persist to cause damage later or to be transmitted to someone else.

Hepatitis B is not spread by kissing, holding hands, hugging, coughing, sneezing or sharing crockery and utensils.

Some questions and answers on immunisations

Why does my child need an injection when no one has the disease any more?

These illnesses still affect many millions of children across the world and are just a short plane journey away. If children were not vaccinated against the disease the illnesses would soon come back into the country: for example, whooping cough has increased because some parents decided not to immunise their child.

Should my child have all the vaccinations?

Yes, and it is important not to delay during the first year of your child’s life when they are often more prone to infections. By vaccinating them against serious life-threatening diseases you offer them some protection from unnecessary illness even though they may still get simple colds and coughs.

Most doctors now agree that immunisations should be given regardless of mild illnesses or planned surgery as these are the children who most need to be protected. Some vaccines do cause a mild reaction, including a temperature, so should not be given later than 48 hours prior to surgery. The MMR immunisation should not be given later than ten days prior to surgery. Immunisations close to surgery should be confirmed by your cardiologist prior to administration.

Are there any children who should not have immunisations?

If your child has problems in fighting infections because they have a reduced immunity it is extremely important to offer them immunisations to help to protect them, but extra care may be needed as to which form of injection is used.

Should my child have the immunisations if they’ve had a reaction to one before?

Research shows that the vast majority of children who have a reaction to a vaccination can be safely given further vaccinations. If the reaction was particularly severe you should discuss this with your health visitor, your GP and your cardiologist.

Will the immunisations react with any of my child’s medications?

Most routinely given cardiac medications will not react with immunisations. However, where children are on blood-thinning treatment such as Warfarin, then the vaccine may need to be given subcutaneously (just under the skin) rather than into the muscle. Talk to the doctor who prescribes the Warfarin before the injection is given.

If your GP or health visitor is concerned about giving any vaccination, they can ring your congenital cardiac specialist nurse or cardiologist for advice.

Are these immunisations safe?

Parents always worry about the risks of giving vaccinations. It would be wrong to say that vaccinations are 100% risk-free, but the risks of the vaccination are far lower than the risks if you had the disease. Always spend time making sure that you understand why an immunisation is being given before giving consent for the injection. Health visitors and GPs as well as paediatricians and cardiologists should be able to answer your questions.

If I want more information about immunisations, where can I find it?

All health centres now have written information on current immunisations and your health visitor and GP will be able to tell you more. You can also find more information on immunisations here. If you still have unanswered questions talk to the cardiac specialist nurse or outreach nurse attached to your hospital.