*VACCINATION* Childhood vaccination

[andrewscolm]

User Requirements

This codelist aims to identify patients who have had any type of childhood vaccination.

Existing codelists

https://github.com/opensafely/vaccinations-dashboard/blob/d8823f759fddf1b0e30f6551e120b1f32a0c4890/analysis/study_definition.py#L21-L39 Uses deprecated VaccinationsStudyDefinition() function

Search Terms

https://jobs.opensafely.org/datalab/opensafely-internal/tpp-vaccination-names/outputs/25/output/vaccination_names.csv

Inclusion Criteria for Codes

Terms relating to childhood vaccinations (BCG, MMR, DTaP, etc.)

Exclusion Criteria for Codes

NA

@opensafely/clininform

[chrisjwood16]

As discussed with Colm - initial use case will be for patient standardisation in Covid-19 vaccine effectiveness study. Output will be as a csv file including appropriate codes from vaccination_names.csv shared above. Main aim is to identify vaccines from the UK’s routine immunisation programme. Children up to age of 16 years will be included - need to consider possible changes to routine immunisation programme over this time - e.g. introduction of Hep B in late 2017. Would be desirable to also include vaccines which might be given to selected individuals e.g. BCG - annotated as such.

[speed-vm]

Starting to compile list: Sources: Red Book version last updated August 2021 NHS Vaccinations Guide The routine immunisation schedule From Feb 2022 UKHSA UKHSA Routine immunisation schedule update history

Standard list

8 weeks

• [ ] Meningococcal B vaccine
• [ ] Rotavirus vaccine
• [ ] Diphtheria / Tetanus / acellular pertussis (whooping cough)/inactivated polio vaccine / haemophilus influenzae b vaccine/ hepatitis B vaccine

12 weeks

• [ ] Pneumococcal conjugate vaccine
• [ ] Rotavirus vaccine
• [ ] Diphtheria / Tetanus / acellular pertussis (whooping cough)/inactivated polio vaccine / Haemophilus influenzae b vaccine/ hepatitis B vaccine

16 weeks

• [ ] Meningococcal B vaccine
• [ ] Rotavirus vaccine
• [ ] Diphtheria / Tetanus / acellular pertussis (whooping cough)/Inactivated polio vaccine / Haemophilus influenzae b vaccine/ hepatitis B vaccine

One year

• [ ] Meningococcal B vaccine
• [ ] Pneumococcal conjugate vaccine
• [ ] Meningococcal C vaccine and Haemophilus influenzae b
• [ ] Measules, Mumps, & Rubella

Annually from two years

• [ ] Influenza Vaccine

Three years and four months (Pre-school immunisations)

• [ ] Diphtheria or low dose diphtheria, tetanus, acellular pertussis (whopping cough), inactivated polio vaccine)
• [ ] Measles, Mumps & Rubella

12 and 13 years old (school year 8)

• [ ] Human papillomavirus vaccine (2 doses, 6 months apart)

14 years old (school years 9 - 10)

• [ ] Low dose diphtheria, tetanus, inactivated polio vaccine)
• [ ] Meningococcal ACWY vaccine

Non-standard*

*Some 'At-risk' babies may need BCG, hepatitis B, or the children's flu vaccine.

Hepatitis B - Given to babies whose mothers have hepatitis B birth, 4 weeks and 12 months

BCG - Children born in areas of the country where there are high numbers of TB cases or children whose parents or grandparents were born in a country with many cases of TB

Children's Flu Vaccine - Children 6 months to 17 years old with long-term health conditions

The chickenpox vaccine is not part of the routine childhood vaccination schedule.

Important changes in the last XX years:

• 12 July 2019 Added autumn 2019 schedule which includes the HPV universal programme.

• 12 April 2018 Removed HPV vaccination for MSM from the April 2018 schedule.

• 3 April 2018 Added HPV for MSM vaccination programme to the spring immunisation schedule.

• 7 July 2017 Revised complete immunisation schedule includes the new Infanrix hexa© vaccine for the infant programme.

• 28 June 2016 Revised to include changes to the MenC programme and the shingles vaccine administration.

• 2 June 2016 Updated schedule, including recent changes to MenC immunisation programme.

• 12 May 2016 Routine immunisations from spring 2016 includes update to HPV dosage to 'two doses 6-24 months apart'.

To be continued...

[chrisjwood16]

CSV file of vaccines with added column detailing components: https://docs.google.com/spreadsheets/d/1lDy_FF_oqgexegvlMul16yK3Z8ZGPUyF6QF4pRkdEcc/

[chrisjwood16]

Discussed with Colm and Will.

Given study looks at up to 15 years old and complexities this brings due to changes to vaccination schedule/brands used over time - agreed reasonable to have a couple of representative vaccines rather than attempt to cover all vaccines. Agreed for now look to include

• DTaP/IPV/Hib or DTaP/IPV/Hib/HepB containing vaccines
• DTaP/IPV - given as booster
• MMR vaccine - vaccine with lower uptake of primary course

Tasks:

• [x] Check for national published data on vaccine update which can be used for comparison with results Available here - https://www.gov.uk/government/collections/vaccine-uptake
• [ ] Consider how vaccine info is recorded for <16 years if moving GP - between same EHR/different EHR/countries
• [ ] Look at practicalities of catch-up programme

[chrisjwood16]

Timeline of vaccination schedules: UKHSA timeline of introduction to UK routine vaccination programmes

Green Book 1996 - for reference only (p51)

Green Book 2006 - Chapter 11 Immunisation schedule Green Book Dec 2010 As of September 2008 As of Dec 2009 As of May 2010 As of May 2011 As of Nov 2012 From June 2013 From Summer 2014 From Summer 2015 From Spring 2016 From Summer 2016 From Autumn 2017 From April 2018 From Autumn 2018 From Autumn 2019 From Jan 2020 From June 2020 From Feb 2022

Using 2006 Green Book Schedule as starting point:

• DTaP/IPV/Hib in schedule pre-2006 to Autumn 2017 then replaced by DTaP/IPV/Hib/HepB
• dTaP/IPV or DTaP/IPV in schedule pre-2006 onwards - specified as dTaP/IPV from Jan 2022 onwards
• MMR in schedule pre-2006 onwards
• PCV (3 doses) in schedule pre-2006 to Jan 2020 - then reduced to 2 doses from Jan 2020 onwards
• Hib/Men C in schedule pre-2006 onwards (note future plans to change this due to discontinuation of combined product - although no changes to schedule to date and supplies expected to last until 2025)
• Td/IPV in schedule pre-2006 onwards
• Men C only vaccine in schedule pre-2006 removed Summer 2016 - excluded for now

Vaccines in Feb 2022 schedule not in 2006 schedule - excluded for consistency across study period:

• Men B
• Rotavirus
• Influenza
• HPV
• Men ACWY

[chrisjwood16]

User Requirements This codelist aims to identify patients who have had any of a key set of childhood vaccinations. Patients included in the study will range from 0-16 - i.e. born approx 2007 or later.

Resources used Immunisation against infectious disease - 'The Green Book' - archived versions 1996, 2006 Immunisation.nhs.uk - Routine Childhood Immunisation Schedule 2008 Health Protection Agency - Routine Childhood Immunisation Schedule Dec 2009, May 2010, May 2011, Nov 2012 Department of Health - Routine Childhood Immunisation Schedule June 2013 Public Health England - Routine Childhood Immunisation Schedule Summer 2014, Summer 2015, Spring 2016, Summer 2016, Autumn 2017, April 2018, Autumn 2018, Autumn 2019, Jan 2020, June 2020, Feb 2022

Search Terms/Methods

• A list of vaccine names was exported using OpenSAFELY-TPP which contained a combination of generic names, brand names and also included a number of non-vaccine products e.g. immunoglobulins, monoclonal antibody products used for prevention of infectious disease (e.g. palivizumab).
• A clinical informatician manually reviewed the list, categorized the products by components and filtered out non-vaccine products.
• The categorized list was reviewed manually against inclusion / exclusion criteria listed below and relevant codes selected.

Inclusion Criteria for Codes Vaccines containing any of the following combinations:

• DTaP/IPV/Hib
• DTaP/IPV/Hib/HepB
• dTaP/IPV or DTaP/IPV
• MMR
• PCV
• Hib/Men C
• Td/IPV

Exclusion Criteria for Codes

• Single vaccines of combination vaccines listed above - e.g. Hep B vaccine given alone, Diptheria vaccine given alone
• Combination vaccines with similar but non-identical components to those listed above - e.g. DTaP/Hib, DTaP/IPV/Hib/MenC
• Vaccines containing none preferred form of vaccine for childhood immunization - e.g. pneumococcal polysaccharide vaccine - (pneumococcal conjugate vaccine is recommended and included)
• Vaccines not listed above

Borderline Cases to Highlight

• dTP + Polio / dTP + Polio + Hib - listing Polio rather than IPV - assume IPV as appears to be part of vaccine injection - (live polio vaccine given orally - UK switched to IPV in 2004) - included both of these for completeness.
• V419 (PR51) - trial vaccine - appears to have been trial name for Vaxelis - included as equivelent of Vaxelis / Infanrix Hexa
• Pneumococcal - Not specified if PPV or PCV - included as if given to study population (<=16 years) expected to be PCV.

Important notes

• Vaccines chosen are based on UK vaccination schedule 2006 - Feb 2023 - recommended vaccinations may differ if study includes patients born pre-2006 or post Feb 2023.
• Vaccination schedules outside the UK may differ - vaccine records may be added retrospectively to electronic health record on registration in the UK but vaccines given outside UK may differ from those in this codelist.

Codelist

selected_childhood_vaccines.csv csv updated 15/05/23 to clarify "Pneumococcal" included under PCV

VaccinationName	Type	Comments
Boostrix-IPV	dTaP/IPV
DTaP/IPV	DTaP/IPV
dTP + Polio	dTaP/IPV
Infanrix-IPV	DTaP/IPV
Repevax	dTaP/IPV
DTaP/IPV/Hib	DTaP/IPV/Hib
dTP + Polio + Hib	dTaP/IPV/Hib
Infanix Quinta 5	DTaP/IPV/Hib
Infanrix-IPV+HIB	DTaP/IPV/Hib
Pediacel	DTaP/IPV/Hib
DTaP/IPV/Hib/HepB	DTaP/IPV/Hib/HepB
Infanrix Hexa	DTaP/IPV/Hib/HepB
V419 (PR51)	DTaP/IPV/Hib/HepB	Trial vaccine
Vaxelis	DTaP/IPV/Hib/HepB
HIB + Meningitis C	Hib/MenC
Menitorix	Hib/MenC
Measles/Mumps/Rubella	MMR
MMR II	MMR
MMRvaxPRO	MMR
Priorix	MMR
Pneumococcal	PCV	Not specified PCV or PPV included to improve sensitivity - assume PCV based on study population
Pneumococcal polysaccharide conjugated vaccine (PCV)	PCV
Prevenar	PCV
Prevenar - 13	PCV
DT + Polio	Td/IPV
Td/IPV	Td/IPV
Tetanus Diphtheria LD and Polio	Td/IPV
Revaxis	Td/IPV

For clinical informatician second check @speed-vm

[speed-vm]

@chrisjwood16 Just had a look through and had two comments:

1. Suggest to include the reason why the following are excluded, on the basis that DTaP/IPV and DTaP/IPV/Hib/HepC are included: DTaP/Hib DTaP/IPV/Hib/MenC Or should they be included?

2. In the exclusion to also say not including the individual elements of the DTaP, or include within the Hep B example to keep concise?

[chrisjwood16]

@speed-vm I've updated the exclusions:

1. Combination vaccines with similar but non-identical components to those listed above - e.g. DTaP/Hib, DTaP/IPV/Hib/MenC
2. Single vaccines of combination vaccines listed above - e.g. Hep B vaccine given alone, Diptheria vaccine given alone I've also added an "important notes" section

[speed-vm]

@chrisjwood16 yes, thats covered those 2 points, and the important notes are important for the correct use of the codelist, agree. I am happy with the list above and supporting text

[chrisjwood16]

Discussed with @andrewscolm Looking to identify all patients who have received all doses of selected vaccines. Age groups covering range 5-15. Agreed remove Tetanus, diphtheria and polio booster (Td/IPV) as given only at 14 years old (minority of included population). Rest of vaccines expected would be given before 5th birthday (due on or before 3years 4months) so relevant to include. Need to account for changes occurring from Autumn 2017 - so would expect in the included group to be given EITHER DTaP/IPV/Hib OR DTaP/IPV/Hib/HepB selected_childhood_vaccines-updated.csv