An expert committee is set to recommend significant changes to the Republic's childhood immunisation scheme, The Irish Timeshas learned.
Vaccines against pneumococcal disease, a bacteria that causes meningitis and pneumonia, and against hepatitis B, a virus that can lead to liver failure, are to be included in the universal immunisation scheme available free to all children in the State.
The National Immunisation Advisory Committee (NIAC) of the Royal College of Physicians in Ireland is about to advise the Department of Health that the risk to public health from these diseases is such that preventive vaccination is now required.
The Minister for Health, Mary Harney, has told the Dáil that she and the Health Service Executive (HSE) "will be guided by the expert advice from the NIAC".
However, it could be some time before the new schedule will be implemented. Negotiations on fees will have to be agreed with the Irish Medical Organisation (IMO), representing the general practitioners who administer childhood vaccines. And the HSE will have to meet the significant costs of the new vaccines, with the pneumococcal vaccine alone costing in the region of €70 for each shot.
The addition of the new vaccines will mean that infants will still get two injections at two months and four months: a new six-in-one injection (including hepatitis B) with a pneumococcal injection given at two months and a vaccine against meningitis C given at four months. Six-month-old infants will require three injections: the six-in-one, meningitis C and pneumococcal vaccinations. In addition, a booster pneumococcal vaccine will be required at 12 months. It will be given along with the MMR vaccine, with meningitis C and Hib (haemophilus influenzae B) boosters now given at 13 months.
Both hepatitis B and pneumococcus are killed (inactivated) vaccines and have a low incidence of side-effects. The infant pneumococcal vaccine has been widely used in Europe since 2001, while the hepatitis B vaccine has been part of childhood immunisation programmes in the US for some years. A separate pneumococcal vaccine has been available for older people and those at increased risk of infection.
There has been mounting pressure to introduce the pneumococcal vaccine, with the Meningitis Trust lobbying for its introduction for some time. The pneumococcal bug is the second most common cause of bacterial meningitis in the Republic, responsible for about one in 10 cases of the disease.
A report by the Health Protection Surveillance Centre, Invasive Pneumococcal Disease in Ireland, said there were 400 cases of the disease in the Republic in 2004. The highest incidence rates were found among older people and children aged under four.
The National Centre for Pharmaco-economics based at St James's Hospital, Dublin, recently carried out an economic valuation to assess the impact of introducing universal vaccination against pneumococcus. It concluded that when the effect of growing immunity against the bacteria in the population (the herd effect) was included, "a universal infant pneumococcal vaccination programme could be considered highly cost-effective in the Irish healthcare setting, from the perspective of the HSE".
Hepatitis B vaccination has been available for some time for healthcare workers and those travelling to areas where infection with the virus is endemic.
A high incidence of the disease among immigrants, coupled with increasing foreign travel by Irish people, are among the main reasons why the NIAC is about to recommend universal vaccination against hepatitis B.
The pneumococcal vaccine for infants is manufactured by the pharmaceutical company Wyeth. It is understood there are plans to begin making this at its facility in Clondalkin, Co Dublin, early next year.
Pneumococcal disease
Pneumococcal disease is caused by the bacterium streptococcus pneumoniae (also called pneumococcus).
It is a common cause of acute ear infection, infected sinuses, pneumonia and meningitis.
Pneumococcal disease occurs most commonly in the very young and in older people.
Others at increased risk of infection with the bacteria include those who have had their spleen removed and people with chronic kidney, liver or heart disease.
The microbe is surrounded by a capsule predominantly made up of complex sugars called polysaccharides.
With more than 90 different capsule types, it is the nature of the capsule that determines how infective each type of pneumococcus is.
The vaccine to be given to all infants contains polysaccharides from seven different capsule types, while that administered to older people has material from 23 types of capsule.
Globally, pneumococcal disease has been identified as the most important vaccine-preventable cause of death in children less than five years.
Vaccination has been shown to reduce the incidence of serious pneumococcal infection.
The new vaccine will be administered intramuscularly into the infant's thigh. It may cause a local reaction at the injection site or a transient fever. Irritability and drowsiness have also been reported.
Side effects such as seizures and allergic reactions are rare. - Dr Muiris Houston
Hepatitis B
Hepatitis B is an important cause of serious liver disease, including hepatitis, cirrhosis and liver cancer.
The hepatitis B virus is transmitted through blood and sexual contact.
Infection often occurs as a result of blood-to-blood contact; healthcare workers may be injured by contaminated needles, whereas drug addicts contract the infection by sharing needles.
As well as blood, saliva, semen and vaginal fluids have been shown to be infectious.
Acute hepatitis B infection can produce symptoms ranging from a mild flu-like illness to fatal liver failure.
Between 2 and 10 per cent of infected adults become chronic carriers of the virus.
Chronic hepatitis can persist for years. Usually the inflammation it causes is mild, with little liver damage.
In some people, however, continuous inflammation damages the liver over time, leading to cirrhosis (severe scarring of the liver), liver failure and liver cancer.
The number of hepatitis B notifications to the Health Protection Centre was over 900 in 2005, compared with 724 cases in 2004.
Some 82 per cent of chronic hepatitis B infection occurred in adults aged between 20 and 44.
The hepatitis B vaccine may cause transient local soreness and redness at the injection site.
Low-grade fever, fatigue and nausea have also been reported by recipients.
- Dr Muiris Houston