Communicable diseases are caused by infections that can be transmitted from person to person. Examples include measles, meningitis, influenza (‘flu’) and tuberculosis, as well as sexually transmitted infections (such as chlamydia) and HIV.

For many communicable diseases, particularly those for which the consequences of infection can be serious, there is a programme of immunisation in place. Table 1 describes the current childhood immunisation schedule in the UK.

Table 1: Routine childhood immunisation schedule in England (as of summer 2016)

When Diseases protected against Vaccine given
2 months Diphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenzae type b (Hib) DTaP/IPV/Hib
Pneumococcal PCV
Meningococcal group B MenB
Rotavirus gastroenteritis Rotavirus
3 months Diphtheria, tetanus, pertussis, polio and Hib DTaP/IPV/Hib
Rotavirus Rotavirus
4 months Diphtheria, tetanus, pertussis, polio and Hib DTaP/IPV/Hib
Meningococcal group B Men B
Pneumococcal PCV
1 year Hib and meningococcal group C Hib/MenC booster
Pneumococcal PCV booster
Measles, mumps and rubella (German measles) MMR
Meningococcal group B MenB booster
2 to 6 years old Influenza (each year from September) Live attenuated influenza vaccine
3 years 4 months Diphtheria, tetanus, pertussis and polio DTaP/IPV
Measles, mumps and rubella MMR
Girls 12-13 years old Human papilloma virus (HPV) 16 & 18 (cervical cancer) and 6 & 11 (genital warts) HPV (two doses 6-24 months apart)
14 years old (school year 9) Tetanus, diphtheria and polio Td/IPV (and check MMR status)
Meningococcal groups A, C, W and Y MenACWY

Source: Public Health England

 

The BCG vaccine (which protects against tuberculosis) is normally given in Hackney and the City of London at the 6-8 week health check, although it is not currently available. This programme should resume by the end of 2017.

The aim of vaccination is to protect the individual who receives the vaccine and, by removing them as a potential source of infection, to also protect the wider population. In order to be effective, high levels of vaccination coverage are required in a population to achieve ‘herd immunity’ (Box 2). 5 In mobile populations, such as Hackney and the City of London, it is important to maintain vaccine coverage even once herd immunity has been obtained, due to the risk of infected individuals entering the population and reintroducing the infection. 6

Box 2: Herd immunity

Herd immunity refers to the situation where a large enough proportion of the population is immune to an infection to provide protection for individuals who are not immune. The extent of vaccination coverage required to achieve herd immunity varies by disease. For example, 95% of the population must be vaccinated against measles for this to be achieved.

Efforts should be made to ensure all children are immunised, even if they are older than the recommended age range, where medically appropriate. Children who have missed their scheduled vaccinations are not only at risk of specific infections, but are at a greater risk of having other health and wellbeing needs, and may be behind on other Healthy Child Programme activities.C

Vaccination is not always feasible or available, however. This is particularly relevant in relation to STIs, where prevention primarily rests on reducing exposure to infection through barrier methods of contraception (such as condoms). The National Chlamydia Screening Programme (NCSP) for 15-24 year olds also exists in England to reduce the burden of disease through early identification and treatment.D

As well as sexual behaviour and contraceptive use, important risk factors for sexually transmitted infections (STIs) include sexual orientation and ethnicity. For example, men who have sex with men (MSM) and people of Black African origin are the groups at highest risk of HIV, while other sexually transmitted infections (especially gonorrhoea) are much more common in the Black Caribbean community than in other ethnic groups. 7 8 The focus in this section is on chlamydia as the most important STI affecting young people.

 

 

Notes

  1. The Healthy Child Programme is a national evidence-based programme outlining good practice recommendations for a universal service to promote optimal health and wellbeing, and additional services for those with specific needs and risk factors. [ref]“Healthy Child Programme: From 5-19 years old,” Department of Health; Department for Children, Schools and Families, 2009.[/ref]
  2. For more information, please see:
    https://www.gov.uk/government/collections/national-chlamydia-screening-programme-ncsp
  3. The Healthy Child Programme is a national evidence-based programme outlining good practice recommendations for a universal service to promote optimal health and wellbeing, and additional services for those with specific needs and risk factors. [ref]“Healthy Child Programme: From 5-19 years old,” Department of Health; Department for Children, Schools and Families, 2009.[/ref]
  4. For more information, please see:
    https://www.gov.uk/government/collections/national-chlamydia-screening-programme-ncsp

References

  1. The green book – immunisation against infectious disease, Public Health England; Department of Health, 2013.
  2. National Institute for Health and Care Excellence, “Immunisations: Reducing difference in uptake in in under 19s [PH21],” 2009.
  3. “HIV Statistics,” HIV Aware, [Online]. Available: http://www.hivaware.org.uk/facts-myths/hiv-statistics. [Accessed September 2016].
  4. N. Low, J. Sterne and D. Barlow, “Inequalities in rates of gonorrhoea and chlamydia between black ethnic groups in south east London: cross sectional study,” Sexually Transmitted Infections, vol. 77, pp. 15-20, 2001.
  5. The green book – immunisation against infectious disease, Public Health England; Department of Health, 2013.
  6. National Institute for Health and Care Excellence, “Immunisations: Reducing difference in uptake in in under 19s [PH21],” 2009.
  7. “HIV Statistics,” HIV Aware, [Online]. Available: http://www.hivaware.org.uk/facts-myths/hiv-statistics. [Accessed September 2016].
  8. N. Low, J. Sterne and D. Barlow, “Inequalities in rates of gonorrhoea and chlamydia between black ethnic groups in south east London: cross sectional study,” Sexually Transmitted Infections, vol. 77, pp. 15-20, 2001.