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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. Routine immunisations start from two months old and are given throughout childhood. The final doses are usually given at fifteen years old.

*Influenza and the 2 year old PPV are not part of the routine immunisation schedule but may be offered to give extra protection to children at special risk. It is recommended that the flu vaccine be given every year to children with heart conditions from the age of 6 months to 12 years. The vaccination should be repeated after 4-6 weeks if it is the first flu vaccination. Although the flu jab will not protect your child from every flu bug around it will offer protection from the common type each year. As long as your child is well, the vaccination will give added winter protection. The ideal vaccination time is in October just before winter sets in. Children who may have an allergy to egg should only have the Influenza immunisation after careful consideration with their doctor as this should not be given to children with a confirmed ‘anaphylactic’ reaction to egg.

In addition to flu vaccinations, immunisation 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 treatment called Palivizumab and may require special arrangements with your GP or local hospital because of its expense.

Questions and Answers

What is…?

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 can interfere with breathing.

Whooping Cough
This is a very exhausting and painful disease for children that 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 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.

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 as rarely occurred with the polio drops.

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 2 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 1 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.

Why does my child need an injection when no one has the disease anymore?
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 e.g. whooping cough has increased because some parents decided not to immunise their children.

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. Ordinary, non-live vaccines sometimes cause a mild reaction including a temperature within 48 hours so it may help doctors to care for your child if you arrange vaccination more than 48 hours before surgery. This period is 10 days for the MMR immunisation. Talk to your health visitor, GP and cardiologist if you are worried.

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 immunisation 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, GP and with 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 a 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 cardiac liaison sister 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 risk of having 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 get this and whom can I talk to?
If you can use the internet then the immunisation website www.immunisation.org.uk is a good place to start and even has cartoons for you child to explain them. Your health visitor will be particularly happy to talk to you about any immunisation concerns that you have. All health centres now have written information on current immunisations and your practice nurse and GP will be able to tell you more.

If you still have unanswered questions talk to the cardiac liaison sister/ outreach nurse attached to your hospital.

Written by Suzie Hutchinson
Edited by Dr Stephen Williams, Consultant Community Paediatrician, North Staffordshire Hospital and Dr Oliver Stumper, Consultant Paediatric Cardiologist, Birmingham Children’s Hospital.

Feb 2002

Adapted Jan 2004 AD

Reviewed SW 6/6/07