Correspondence

Rotavirus immunisation programme: changes from September 2021 letter

Published 15 September 2021

NHS England and NHS Improvement Regional Directors

NHS England and NHS Improvement Directors of Commissioning

NHS England and NHS Improvement Directors of Public Health and Primary Care

NHS England and NHS Improvement Heads of Public Health Commissioning

NHS England and NHS Improvement Heads of Primary Care

NHS England and NHS Improvement / Public Health England Screening and Immunisation Leads

Clinical Commissioning Groups Clinical Leaders

Clinical Commissioning Groups Accountable Officers

General Practitioners

Local Medical Committees

Local Authority Chief Executives

Local Authority Directors of Public Health

Paediatricians

TB Services

Health visitors

For information

Chief Pharmacists of NHS Trusts

NHS Foundation Trusts

NHS Trusts

NHS Specialist Pharmacy Service

Royal College of Paediatrics and Child Health

Royal College of Physicians

Royal College of Nursing

Royal College of General Practitioners

15 September 2021

Guidance on rotavirus vaccination at 8 weeks of age in relation to the forthcoming evaluation of the introduction of newborn screening for Severe Combined Immunodeficiency (SCID).

Dear Colleague

This is a follow up communication to the letter dated 27 July 2021 which informed Bacillus Calmette–Guérin (BCG) vaccination providers of the evaluation of the introduction of screening for Severe Combined Immunodeficiency (SCID) from September 2021, and the necessity to move neonatal BCG vaccination to when the child reaches 28 days of age or soon after to ensure that babies with SCID are not given the live attenuated BCG vaccine.

Rotavirus (Rotarix®) oral vaccine is also a live vaccine which is given routinely from 8 weeks of age. Diarrhoea and prolonged excretion of the vaccine virus has been reported in severely immunosuppressed individuals and so the vaccine is contraindicated in babies with SCID. This letter will inform providers of what action to take in relation to babies born on or after 1 September 2021.

As with the changes to the BCG programme, it is necessary to adopt this guidance for the rotavirus vaccination nationally to ensure consistency and safety for all babies across the country.

This letter is aimed at health professionals who are responsible for delivering the routine infant immunisation schedule. We encourage you to share this guidance with all those involved in your area.

Key points about the impact of the SCID evaluation on rotavirus vaccination

This guidance applies to babies born on or after 1 September 2021, who will attend for their routine 8 week immunisation appointment from 27 October 2021.

Rotavirus (Rotarix®) vaccine is a live oral vaccine routinely given at 8 and 12 weeks of age as part of the infant immunisation schedule. All live vaccines, including Rotarix®, are contraindicated in babies who receive a SCID diagnosis.

in the areas participating in the SCID evaluation, SCID screening will form part of the routine newborn screening test at 5 days, with most results expected within 10 to 12 days. All babies should have a result available by 28 days, including those in non-screening areas where they will be assigned a ‘SCID screening not offered’ result.

Childhood Information Systems (CHISs) will receive SCID screening outcomes (as part of newborn blood spot results), and will inform practices when available and ahead of the 8 week immunisation appointment.

Practices should update their protocols to ensure that where SCID results (including SCID screening not offered) have been received by the practice, they are available to the patient record for the practice nurse at the 8 week immunisation appointment.

Parents and GP practices will receive a direct communication from the immunology team to alert them that a child has a suspected or confirmed SCID diagnosis and this will include information on which vaccines should not be given.

Immunisers should make reasonable efforts to ascertain the SCID screening outcome before administering rotavirus vaccine. This would involve checking for a record in the Red Book, the GP record, screening outcome information sent by CHIS, or with the parent or caregiver. In the absence of an abnormal SCID screening result, or if no result can be found, rotavirus vaccination can go ahead. PHE have developed an algorithm to assist immunisers with this check on the PHE rotavirus collection page. It is advised that practices include this algorithm in their local protocols.

In areas where SCID screening will not be offered routinely, immunisers need to be aware that there may be movers-in who have been tested and have a result available from another area.

It is important to use all opportunities to remind parents and caregivers to bring the Red Book and the letter with the outcome of newborn bloodspot screening when they are invited for their routine 8 week immunisation appointment. This could include an explicit mention in the invitation letter (CHIS or GP) and text message reminders.

To ensure consistency and safety for all babies across the country, it is necessary for immunisation providers to adopt this guidance nationally, and regardless of whether the GP practice is located in an area participating in the SCID screening evaluation.

Additional information

All relevant immunisation information for parents and caregivers will be updated and available on the PHE immunisation collection page and available to order from the Health Publications website.

Further detailed healthcare professional information and guidance on rotavirus vaccination, including training slides, will be updated.

An algorithm for the process of checking for SCID screening results will be developed for practices.

The current Patient Group Direction (PGD) for the administration of Rotarix® already excludes those with a diagnosis of SCID, therefore changes are not required.

A summary of key information is set out in Annexe A.

If you have any queries about the content of this letter, please contact immunisation@phe.gov.uk

We would like to take this opportunity to thank all involved for their continuing hard work in delivering childhood immunisation programmes.

Yours faithfully,

Julie Hughes

NHS England and NHS Improvement

Deputy Director of Public Health Commissioning and Operations

Dr Mary Ramsay

Public Health England

Head of Immunisation