HKMA Vaccination Advice for Young Children Dr. Alvin Yee Shing CHAN MBBS (HK), MRCP (UK), DCH (GLASG), FHKCPaed, FHKAM (Paediatrics), MRCPCH, FRCP (Edin) Vice-President, The Hong Kong Medical Association Chairman, Task Force on Vaccination PPI Co-Chairman, Health Education Committee Central Coordinator, HKMA Community Network Co-Chairman, International Affairs Committee

HKMA Vaccination Advice for young children aged 2 and 6 香港醫學會對2-6歲年幼學童之疫苗建議 2011年8月29日

現時香港兒童免疫接種計劃 有些有效的兒童疫苗 並不包括在政府的 疫苗計劃內

現時香港兒童免疫接種計劃 香港醫學會對兩歲至六歲學童之疫苗建議 ： 水痘疫苗 肺炎鏈球菌疫苗(13價) 流感疫苗(每年注射) 甲型肝炎疫苗 香港醫學會一向關注年幼學童健康，故此本會特別向家長建議為二至六歲之年幼學童接種政府計劃內不包括但世界衞生組織及美國疾病管制暨預防中心建議之有效及安全的疫苗。 香港醫學會對兩歲至六歲學童之疫苗建議 ： 水痘疫苗 肺炎鏈球菌疫苗(13價) 流感疫苗(每年注射) 甲型肝炎疫苗

The Government provides free vaccinations to children in Hong Kong against ten infectious diseases under “Childhood Immunization Programme” and subsidizes seasonal influenza vaccination to children under “Childhood Influenza Vaccination Subsidy Scheme” A few safe and effective vaccines are not covered by the Government programmes.

HKMA provides the Vaccination Advice for young children aged between 2 and 6 with the vaccines recommended by the World Health Organization and the US Centres for Disease Control and Prevention though not provided free by the Government

Pneumococcal Vaccine (13-valent) Vaccines that could be given to children between 2 and 6 years old Chickenpox Vaccine Pneumococcal Vaccine (13-valent) Influenza Vaccine (Injection annually) Hepatitis A Vaccine

Recommended Immunizations for Children from Birth through 6 Years Old (extracted from CDC)

Vaccines “Vaccines have made a tremendous impact on the health of children,” Daniel Salmon, PhD, MPH, Director of National Vaccine Program Office, US Department of Health and Human Services in Washington, D. C.

Vaccines “Vaccination Programs have led to 93% to 100% elimination of many childhood diseases in the United States.”

Impact of Vaccines Dr. Salmon pointed out a direct overlap between countries with: higher rates of vaccine refusal and outbreaks of pertussis, a childhood disease that has seen resurgence in recent years.

Good Reports on Vaccines July 2011 –Chickenpox deaths in the US have been nearly eliminated due to wide spread use of the varicella vaccines, according to a new CDC study; Researchers have found that chickenpox deaths have dropped by 88% overall and by 97% among children and adolescents since 1995. Before the varicella vaccine became available, chickenpox was responsible for about 100 deaths and 11,000 hospitalization each year.

甚麼是水痘？ 由水痘病毒引致，潛伏 期約2~3星期 傳播途徑 : 飛沫 / 接觸患 者分泌物弄污的物件 傳染性極高，傳染期為 出疹前 5天至所有皮膚 結痂 病者在未出現病徵前，可能不經不覺將病毒傳給他人 13 13

甚麼是水痘？ 病徵:頭痛、發燒 患上一次後，身體會產生終生免疫能力 預防 : 接種水痘疫苗 出紅疹及水泡 併發症 大多數水痘病例的症狀都屬輕微，患者會自然痊癒。但抵抗力弱的人士產生併 發症如皮膚發炎、猩紅熱、肺炎及腦炎的機會較高。初生嬰兒若染上水痘，病 情可較嚴重，甚致危及性命。若婦女在懷孕初期染上水痘，可導致胎兒有先天 性缺陷。 14 14

VARICELLA VACCINE First dose : From 1 year of age onward. Second dose : at least 1 month later, usually 3 months to 3 years later. Allergy to EGG : Avoid.

HEPATITIS A VACCINE FROM 12 MONTHS ONWARD 2 DOSES AT LEAST 6 MONTHS APART Recommended for children living in high risk areas, like China. Endemic regions : high risk populations, children whose immunity against Hepatitis A is desired.

甚麼是肺炎球菌疾病？(1) 肺炎球菌是多重抗藥性細菌之一，有91種菌株的入侵性病菌，可入侵致人體的血液和器官並擴散開 全球每年大約有一百萬名小於五歲幼兒因肺炎球菌感染而死亡 日常的傾談、接觸互動都很可能互相感染 病菌可透過噴嚏, 咳嗽及飛沬傳播 病徵與感冒相似, 大多會有持續高燒及沒精打采 5歲以下的孩童 (特別是兩歲以下之幼兒) 上托兒所的幼童 曾服用抗生素之兒童 最近曾受耳部感染之兒童

甚麼是肺炎球菌疾病？(2) 肺炎球菌疾病有多嚴重 ? 20%健康幼童的鼻咽腔偶而會帶有肺炎球菌，當免疫力減低時，細菌就從呼吸道或血液侵襲器官 由肺炎球菌引起的疾病可分為「非入侵性」和「入侵性」兩個範疇, 若嚴重, 可引致併發症及造成生命危險 入侵性 腦膜炎 敗血症 心內膜炎 非入侵性 化膿性肺炎 急性中耳炎 鼻竇炎

肺炎球菌疫苗的比較 13價疫苗 10價疫苗 適用年齡 6週 至 5歲 6週 至 2歲 獲美國食品及藥物 管理局 (FDA) 批准  ╳ 覆蓋的血清型數目 13 10 能額外針對近年較常見 的類型如血清3、6A、 19A型 疫苗覆蓋率* 93% 47% *Department of Health http://www.dh.gov.hk/tc_chi/press/2011/110415.html accessed on 29August 2011 19 19

即使完成接種舊一代的肺炎球菌疫苗， 仍有小朋友受感染？ (瑪麗醫院血清3型個案)

PNEUMOCOCCAL VACCINE PNEUMOCOCCAL CONJUGATE VACCINE (PCV) Recommended for ALL children younger than 5 years old(from 6 weeks on) PCV series:1dose at 2,4,6 months & 1+year old Give 1 dose of PCV to all healthy children aged 24 to 59 months who are not completely vaccinated for their age. PCV series begun with 7-valent PCV(PCV7) should be completed with 13-valent PCV(PCV13)

PNEUMOCOCCAL VACCINE A supplemental dose of PCV13 is recommended for all children aged14 to 59 months who have received an age-appropriate series of PCV7, and For all children aged60 to 71 months with underlying medical illnesses who have received an age-appropriate series of PCV7. The supplemental dose of PCV7 should be at least 8 weeks after the previous dose of PCV7.

PNEUMOCOCCAL VACCINE Give Pneumococcal polysaccharide vaccine (PPSV) at least 8 weeks after the previous dose of PCV to children 2 years or older with certain underlying medical conditions including Cochlear implant . No study so far to document efficacy of one dose of PCV 13 after a series of PCV10.

美國疾病管制暨預防中心疫苗接種建議 嬰幼兒接種13價肺炎球菌之建議時間表 US Advisory Committee on Immunization Practices (ACIP) - recommended schedule for PCV13 amongst infants and children

甚麼是流行性感冒？ 流鼻水, 咳嗽 發燒 喉嚨痛 肌肉疼痛 由流感病毒引致，潛伏期為1~3日 高峰期：每年1~3月、7~8月 傳播途徑 : 飛沫，直接接觸患者分泌物 病徵 : 流鼻水, 咳嗽 發燒 喉嚨痛 肌肉疼痛 25

INFLUENZA VACCINE SEASONAL TIV(Trivalent inactivated influenza vaccine) Injection: at least 6 months old. 2 doses 4 weeks apart for first timer LAIV(Live attenuated influenza vaccine) intranasal rout: at least 2 years old. NOT for patients with asthma

INFLUENZA VACCINE GIVE 2 DOSES (separated by at least 4weeks) to children aged 6months through 8 years who are receiving seasonal influenza vaccine for the first time, or who were vaccinated for the first time during the previous influenza season but only received 1 dose. Children aged 6 months to 8 years who received no doses of monovalent 2009 H1N1 vaccine should receive 2 doses of 2011 seasonal influenza vaccine

Rotavirus vaccine(RV) Hemophilus Influenza type b conjugate vaccine(Hib) Meningococcal conjugate vaccine, quadrivalent(MCV4) 6 in 1 Combined vaccine: Hepatitis B, Hib, Diphtheria, tetanus toxoids, acellular pertussis, Inactivated poliovirus vaccine(IPV), Measles, rubella, mumps(MMR) Japanese B Encephalitis vaccine Human Papillo-virus vaccine

世界衛生組織(WHO)疫苗接種建議

THANK YOU!