4.3 Immunisation & Public Health Screening Programmes

The UK Routine Immunisation Schedule (Green Book)

Immunisation is one of the most effective public health interventions worldwide. In the UK, vaccine policies and schedules are established by the Joint Committee on Vaccination and Immunisation (JCVI) and published in UK Health Security Agency's (UKHSA) Immunisation against infectious disease (commonly known as the Green Book).

Routine Childhood Schedule Highlights

Nurses administering vaccines must be familiar with key childhood milestones:

• 8 Weeks: 6-in-1 vaccine 1st dose (DTaP/IPV/Hib/HepB—Diphtheria, Tetanus, Pertussis, Polio, Haemophilus influenzae type b, Hepatitis B), Rotavirus (oral), MenB (Meningococcal group B) 1st dose.
• 12 Weeks: 6-in-1 2nd dose, Pneumococcal conjugate vaccine (PCV) 1st dose, Rotavirus 2nd dose.
• 16 Weeks: 6-in-1 3rd dose, MenB 2nd dose.
• 1 Year (12-13 Months): MMR 1st dose (Measles, Mumps, Rubella), MenB booster, Hib/MenC booster, PCV booster.
• 3 Years 4 Months: 4-in-1 pre-school booster (DTaP/IPV), MMR 2nd dose.
• 12-13 Years (School Year 8): HPV vaccine (Human Papillomavirus—single dose routine schedule protecting against cervical/head and neck cancers and genital warts).
• 14 Years (School Year 9): 3-in-1 teenage booster (Td/IPV), MenACWY vaccine.

Adult & Targeted Immunisation Schedules

• Annual Influenza Vaccine: Offered to adults aged 65+, clinical risk groups (e.g., chronic respiratory, cardiac, renal disease, immunosuppression), pregnant women, healthcare workers, and children (nasal spray).
• COVID-19 Boosters: Seasonal autumn campaigns for older adults (65+), care home residents, immunosuppressed individuals, and frontline health/social care workers.
• Shingles Vaccine (Shingrix): Offered routinely at age 65 and 70 (and to severely immunosuppressed individuals aged 50+). Shingrix is a non-live recombinant vaccine replacing live attenuated Zostavax.
• Pneumococcal Vaccine (PPV23): Single dose offered to adults aged 65+ and high-risk clinical groups.

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Vaccine Storage, Cold Chain Management & Nursing Role

Vaccines are delicate biological products. Maintaining the cold chain ensures that vaccines are stored continuously within their approved temperature range from manufacture through to administration.

Cold Chain Storage Requirements

• Standard Temperature Range: +2°C to +8°C at all times. The optimum target temperature is +5°C.
• Freezing Warning: Vaccines must NEVER be allowed to freeze. Freezing irreversibly denatures protein antigens and causes aluminum-adjuvanted vaccines to precipitate, destroying potency and increasing local reactogenicity.

Daily Monitoring & Refrigerator Protocols

1. Dedicated Refrigerator: Vaccines must be stored in a validated, lockable medical vaccine refrigerator (never a domestic refrigerator).
2. Temperature Logging: A calibrated maximum-minimum thermometer probe must be placed inside the fridge (center shelf). Minimum, maximum, and current temperatures must be recorded at least once daily on every working day.
3. Fridge Organization: Vaccines must be kept in original cartons to protect from light. Air must circulate freely—do not overfill shelves or place boxes against the back cooling wall.
4. Cold Chain Breach Protocol: If a temperature excursion occurs outside +2°C to +8°C:
   • Quarantine affected vaccines immediately within the fridge (mark 'DO NOT USE').
   • Do NOT discard vaccines immediately.
   • Report breach immediately to the pharmacy/public health lead.
   • Contact vaccine manufacturers to determine stability data.

Vaccine Administration & Anaphylaxis Protocol

Prior to administration, nurses must confirm valid consent, check the UK Green Book contraindications (e.g., live vaccines in severely immunocompromised patients or pregnant women), verify prescription/PGD (Patient Group Direction), and inspect batch numbers/expiry dates.

Anaphylaxis Emergency Protocol (Resuscitation Council UK):

• Anaphylaxis is a rare but severe life-threatening systemic allergic reaction.
• First-Line Drug: Adrenaline (Epinephrine) 1:1,000 (1 mg/mL) given via Intramuscular (IM) injection into the anterolateral aspect of the middle third of the thigh.
• Adult Dosage: 0.5 mg (0.5 mL of 1:1,000 solution). Repeat at 5-minute intervals if no response.
• Child Dosage (<6 yrs): 0.15 mg (0.15 mL); Child (6-12 yrs): 0.3 mg (0.3 mL).
• Call emergency services immediately (999), secure airway, administer high-flow oxygen, and place patient flat with legs elevated (unless breathing is compromised).

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UK National Public Health Screening Programmes

Public health screening aims to identify apparently healthy individuals who may be at increased risk of a disease or condition, enabling earlier intervention and better health outcomes.

Detailed Overview of Key Programmes

1. Cervical Screening Programme

• Primary HPV Testing: Samples are screened first for high-risk Human Papillomavirus (hrHPV). If hrHPV is negative, the sample is reported as normal and the individual returns to routine screening. If hrHPV is positive, cytology (microscopic examination of cells) is performed on the same sample.
• Colposcopy Referral: If hrHPV is positive and abnormal cytological cells (dyskaryosis) are present, or if hrHPV persists at 12-month follow-up, the patient is referred for colposcopy.

2. Breast Cancer Screening Programme

• Method: Digital mammography to detect non-palpable microcalcifications or early-stage breast lesions.
• Interval: Women aged 50 to 71 receive invitations every 3 years. Women over 71 can continue to self-refer every 3 years.

3. Bowel Cancer Screening Programme

• FIT Kit Mechanism: The Faecal Immunochemical Test (FIT) detects minute traces of human hemoglobin in stool. It requires a single stool sample collected at home and returned by post.
• Abnormal Result: A FIT score above the clinical threshold indicates hidden gastrointestinal bleeding and prompts urgent referral for colonoscopy.

4. Abdominal Aortic Aneurysm (AAA) Screening

• Rationale: AAAs are far more common in men aged 65+ and are usually asymptomatic until rupture (which carries an 80% mortality rate).
• Outcomes:
  • Normal aorta (<3.0 cm): Discharged from screening.
  • Small AAA (3.0–4.4 cm): Annual ultrasound surveillance.
  • Medium AAA (4.5–5.4 cm): Quarterly (3-monthly) ultrasound surveillance.
  • Large AAA ($\ge 5.5\text{ cm}$): Urgent referral to vascular surgery for elective repair.