Pharmacy magazine – Child health – Feb 2020 issue

 

Protection across the board

The HPV vaccination became available to boys from last autumn, eleven years after it was introduced for girls. What opportunities does this program, and others like it, offer community pharmacy?

By Sasa Jankovic

 

The human papillomavirus HPV vaccination which protects against cervical cancer was introduced for girls aged 12-13 years old in September 2008. Although it was initially considered that the ‘herd immunity’ this offered would be enough to protect boys, since September 2019, the NHS program has been expanded to include all 12- and 13-year-old boys as well as girls.

 

Eligibility criteria

This decision was based on advice from the Joint Committee on Vaccination and Immunisation (JCVI), the independent body that advises UK health departments on immunisation, in a bid to help prevent more cases of HPV-related cancers and genital warts in boys and girls.

 

In England, girls and boys aged 12 to 13 years will be routinely offered the first HPV vaccination when they're in school Year 8, with a second dose offered 6 to 12 months after the first (in school Year 8 or Year 9).

 

It's important to have both doses to be protected, and those who missed their HPV vaccination in school Year 8 can continue to have the vaccine up to their 25th birthday. However, young people who start the HPV vaccination after the age of 15 will need three doses as they do not respond as well to two doses as younger people do.

 

While that sounds like pretty straightforward reasoning, customers may still be confused about what HPV is and how it causes cancer, giving community pharmacy teams the opportunity to offer some clear explanations.

 

Different types of HPV

HPV is the name given to a very common group of more than 100 different viruses, with around 40 that affect the genital area. Because HPV is so common and can be caught through any kind of sexual contact with another person who already has it, most people will get an HPV infection at some point in their lives but their bodies will get rid of it naturally without treatment.

 

However, some people infected with a high-risk type of HPV will not be able to clear it. Over time this can cause abnormal tissue growth as well as other changes, which can lead to cancer if not treated. High-risk types of HPV are linked to different types of cancer, including cervical, vaginal, vulval, anal and cancer of the penis, as well as some cancers of the head and neck.

 

Infection with other types of HPV may also cause genital warts – the most common viral sexually transmitted infection (STI) in the UK, skin warts and verrucas, and warts on the voice box or vocal cords (laryngeal papillomas).

 

Nearly all cervical cancers (99.7%) are caused by infection with a high-risk type of HPV, but only some of the anal and genital cancers, and cancers of the head and neck, with the concern being that because HPV infections do not usually cause any symptoms most people will not know they're infected in the first place.

 

Vaccine protection

Currently, the national NHS HPV vaccination programme uses the Gardasil vaccine which protects against four types of HPV: 6, 11, 16 and 18.

 

Between them, types 16 and 18 are the cause of more than 70% of cervical cancers in the UK, according to NHS England, and they also cause some anal and genital cancers, and some cancers of the head and neck. HPV types 6 and 11 cause around 90% of genital warts, so using Gardasil helps protect girls against both cervical cancer and genital warts.

 

However, pharmacy teams can ensure that customers understand that HPV vaccination does not protect against other infections spread during sex, such as chlamydia, and it will not stop girls getting pregnant, so it's still very important to practise safe sex.

 

An opportunity for pharmacy

Although primarily a school-based service, there are opportunities for community pharmacies to get involved beyond just being a repository of advice about HPV and sexual health.

 

Boots has offered the HPV vaccine for women aged 18-44 since 2009, extending the service to boys and girls aged 12-16 in 2017, and in November last year LloydsPharmacy introduced an HPV vaccination service for people aged between 12-45 in 13 stores in cities around the UK, situated close to universities.

 

“HPV is a virus that most of us will come into contact with at some point, therefore we feel it’s important to give customers the opportunity to get vaccinated at their convenience”, says Deep Patel, healthcare services manager at LloydsPharmacy. “This is an opportunity to demonstrate that pharmacists can play an even bigger role in helping their communities to better manage their health by delivering more services.”

 

Rekha Shah, chief executive officer at Pharmacy London and of Kensington Chelsea & Westminster LPC, was involved in the pharmacy pilot for HPV vaccination back in 2010 and says pharmacies are in an even better position now to promote this kind of service.

 

“When I was vaccinating young women who had missed the catch-up program in school back in the 2010 pilot, word of mouth was the only thing that directed people to the service”, she says, “but community pharmacies are much better known now as destinations for vaccinations thanks to pharmacists running flu and with travel clinics so they are quite capable of running an HPV service.”

 

In fact, Shah says “it’s a no brainer as far as I’m concerned” and thinks the service should be more widely rolled out in community pharmacy. “We’ve already got the infrastructure, the training and the competencies”, she says, “but as is so often the case the powers that be who can influence are quite slow at realising the huge potential to help public health that the pharmacy sector can offer. If this can roll out to a bigger scale in pharmacies it could be a real success.”

 

Pharmacy promotion

In the meantime, whether your pharmacy is involved in vaccinating people or simply making referrals to other services, there is plenty that pharmacy teams can do to promote and encourage the take-up of the vaccine to the public.

 

DH advice to all frontline health and care professionals is to make use of contact with patients as a means to check their vaccination status and offer outstanding doses – if you do these yourself – or signpost to immunisation services. You could also send text messages to remind patients and parents when further immunisation appointments are due, and give parents and young people tailored information, advice and support to ensure they know about the recommended routine vaccinations and the benefits of immunisation.

 

Vaccine safety

Nonetheless, with so much mis-information continuing to circulate about the safety and efficacy of vaccinations in general, you may find parents and carers of eligible children are hesitant and need reassurance.

 

The World Health Organization (WHO) recently listed vaccine hesitancy – where people with access to vaccines delay or refuse vaccination – as one of their top 10 biggest threats to global health, so you and your team can explain that all vaccines are thoroughly tested to make sure they are safe, often taking many years to make it through the trials and tests it needs to pass for approval.

 

Oxford University’s Vaccine Knowledge Project (http://vk.ovg.ox.ac.uk/vk/vaccine-safety) is a useful resource that you can also direct customers to have a look at. Its advice is that in the case of all the vaccines used in the current UK routine schedule, the overwhelming evidence is that vaccinating is safer than not vaccinating, and it is rarely necessary to delay immunisation, although if someone is very unwell with a high temperature it is a good idea to put off vaccination until they have fully recovered. This is so that symptoms of the illness do not get confused with a reaction to the vaccine.

 

And while anti-vaccine stories continue to be spread online through social media, you can assure customers these are not be based on scientific evidence and could put their child at risk of a serious illness.

 

It is being able to give clear, confident advice like this that can make a huge and often life-saving difference to people’s health. “The more people know, the more likely they are to seek out vaccinations”, says Anna Ruthven, head of services at McKesson UK (parent company of LloydsPharmacy). “Prevention is far less costly to the NHS and more preferential to patients than cure. The more trust we can build in the service, the more vaccinations we will be able to administer, and the cases of HPV, and more specifically cervical cancer, will continue to fall.”

 

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Box: Common childhood illnesses and their treatment

All children experience common illnesses like coughs, colds and chickenpox. You can reassure parents and carers they are all part of growing up, and antibiotics are not needed for every illness. Instead, treating their child’s illness with advice and medicines from the pharmacy can often be the easiest and quickest way to help them recover.

 

Earache

Symptoms: Earache (usually on one side), congested cold, fever, feeling unwell, irritable, frequent ear rubbing and poor appetite. Earache can also be caused by other things such as teething or even swimming.

 

Treatment: Give pain relief such as children’s liquid paracetamol or ibuprofen. Holding a warm towel against the ear may be helpful. Children’s decongestants may also give some temporary relief.

 

Coughs and colds

Symptoms: Runny or blocked nose, sneezing, sore throat, cough, headache, mild fever, tiredness, aches and pains.

 

Treatment: Remind parents/carers there is no medical cure for a cold and they can only treat the symptoms. If the child has a fever, pain or discomfort, offer them children’s paracetamol or ibuprofen. Nose drops from the or rub-on decongestant may help the child breathe more easily. Increase the amount of fluid the child normally drinks, and if they are over the age of one, try a warm drink of lemon and honey.

 

Sore throat

Symptoms: Pain or soreness in the throat especially on swallowing, hoarse voice, feeling unwell, tired with a mild fever.

 

Treatment: Viral infections are the cause of most sore throats so antibiotics will have no effect in most cases. Simple painkillers, such as children’s liquid paracetamol can be an effective way of alleviating any pain or discomfort. Cold drinks or ice cream are often soothing.

 

Diarrhoea & vomiting

Symptoms: It is common for young children to get an upset tummy from time to time. This will usually cause one or more of three symptoms: vomiting, diarrhoea and stomach pains. If the child is otherwise well it is likely the diarrhoea and vomiting will get better on its own within 24 hours.

 

Treatment: Drink plenty of fluids to avoid dehydration. Avoid giving solid foods and encourage small, frequent sips of water or oral rehydration fluid. Also avoid fruit juice, cow’s milk or squash, as these drinks can worsen diarrhoea.

 

Chickenpox

Symptoms: Chicken pox is characterised by a red, itchy rash which blisters and crusts over within two weeks. It is extremely common as it is highly infectious – spread by coughing, sneezing or by directly touching the rash. A mild flu like illness is usually present before the appearance of the rash, and children may suffer from a fever, body ache, headache, nausea and loss of appetite.

 

Treatment: No specific medical treatment is required. Pain relief such as children’s paracetamol can help with pain or a fever. Antihistamines or calamine lotion may help with the itching. Children should stay at home until the blisters have crusted over and avoid contact with pregnant women.

 

Impetigo

Symptoms: Impetigo starts with red sores or blisters which quickly burst and leave crusty, golden-brown patches. These can spread to other parts of the body, be itchy and sometimes painful.

 

Treatment: A prescription for antibiotic cream or tablets can speed up recovery if the impetigo is very bad.

 

Rashes

Symptoms: Childhood rashes are very common and are often a result of a viral infection or simply due to heat, food or a change in washing powder.

 

Treatment: If a rash is very itchy, keep the child cool and apply calamine lotion to the skin. Encourage the child to rest and drink plenty of fluids, and keep an eye on them for any signs of further illness. If the rash gets worse or any other symptoms develop, seek advice from their GP, health visitor or NHS111.

 

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