LCQ12: Vaccination for children
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Question:
Under the Hong Kong Childhood Immunisation Programme (HKCIP), children from birth to Primary Six should receive vaccines and boosters for 11 infectious diseases. Parents may bring their children from birth to five years of age to the various Maternal and Child Health Centres (MCHCs) for vaccination, while inoculators of the Department of Health (DH) visit schools to provide service for primary students. Moreover, children aged between six months and below 12 are eligible for free and subsidised seasonal influenza vaccination (SIV) under the Government Vaccination Programme (GVP) and Vaccination Subsidy Scheme (VSS) respectively. In this connection, will the Government inform this Council:
(1) of the following details of HKCIP in each of the past three years: the respective numbers of doses of vaccines administered to (i) newborn babies by public hospitals, (ii) newborn babies by private hospitals, (iii) pre-school children by MCHCs of DH, and (iv) primary school children at schools by DH's outreaching School Immunisation Team, with a tabulated breakdown by the infectious disease involved;
(2) of the respective vaccination coverage rates among (i) pre-school children and (ii) primary school children in each of the past three years;
(3) of the date on which the infectious diseases covered by HKCIP were last updated and, set out, by year of introduction of vaccines, the names of the vaccines introduced and the target groups;
(4) of the numbers of doses of vaccines (i) procured for HKCIP, (ii) discarded due to expiry or damage, and (iii) kept in stock, in each of the past three years by DH and the Hospital Authority respectively;
(5) of the number of primary schools participating in the outreach SIV activities at schools organised under VSS in each of the past three years, and the number of primary school students thereby receiving vaccination; the number of children receiving free SIV under GVP in each of the past three years; and
(6) given that some parents choose to bring their children to private clinics for vaccination, of the measures put in place by the Government to ensure that the vaccines provided by private clinics are registered pharmaceutical products procured from licensed wholesale dealers, and that the vaccines are stored in a manner in compliance with the relevant requirements?
Reply:
President,
In consultation with the Department of Health (DH) and the Hospital Authority (HA), consolidated reply to the various parts of the question is as follows:
(1) The Centre for Health Protection (CHP) of the DH has kept abreast of the latest position of the World Health Organization (WHO) on immunisation and vaccination, the scientific evidence of new vaccines, the latest global and local epidemiology of vaccine preventable diseases, and the advice and practical experience of other health authorities across the world. The Scientific Committee on Vaccine Preventable Diseases (SCVPD) under the CHP holds regular meetings and gives science-based advice and recommendations to the CHP regarding the types of vaccines to be incorporated into the Hong Kong Childhood Immunisation Programme (HKCIP) from the public health perspective in a timely manner.
Under the current HKCIP, Bacillus Calmette-Guerin (BCG) vaccine and the first dose of hepatitis B (Hep B) vaccine are first given to newborn babies in hospitals. Pre-school children from birth to five years old receive different types of vaccines and boosters at recommended ages of vaccination at DH's Maternal and Child Health Centres (MCHCs). As for primary school children, vaccination is provided at schools by DH's outreach School Immunisation Teams (SIT). Apart from DH's vaccination which is free-of-charge, parents may also arrange for their children to receive vaccination in private healthcare facilities or clinics at their own expense. The numbers of doses of various vaccines administered at public and private hospitals, MCHCs and by the SIT in the past three years are at Annexes 1, 2 and 3 respectively.
(2) Starting from 2001, DH has conducted territory-wide immunisation coverage surveys on a regular basis to monitor the immunisation coverage rates of pre-school children in Hong Kong (i.e. the percentage of children having received vaccination at recommended ages under the HKCIP) through checking the immunisation records (or vaccination cards) of a sample of children. According to the survey results, the overall immunisation coverage rates of various vaccines under the HKCIP has been maintained at a very high level of over 95 per cent (details at Annex 4).
In addition, primary school students' immunisation records are also checked by the SIT when it provides vaccination at their schools every year. The figures show that the immunisation coverage rates of primary one and primary six students have maintained at a level of over 97 per cent (details at Annex 5).
(3) In general, incorporation of a new vaccine into the HKCIP is based on scientific evidence with a number of public health considerations taken into account, including the overall disease burden on society, the efficacy and safety of the vaccine, the availability of other effective preventive measures, and the cost-effectiveness and public acceptance of the vaccine. The SCVPD will continue to review and develop from time to time public health strategies for vaccine preventable diseases in the light of changing epidemiology and the development of vaccines.
In the previous three years, HKCIP was updated following recommendations made by SCVPD as follows:
(i) SCVPD and the Scientific Committee on AIDS and Sexually Transmitted Infections under CHP of DH have, after reviewing the latest scientific evidence, recommendations from WHO and overseas experiences in relation to efficacy and safety of human papillomavirus (HPV) vaccines, as well as local studies on acceptability and cost-benefit analysis, reached consensus and made joint recommendation in September 2018 that HPV vaccination be included in the HKCIP for girls of suitable ages before sexual debut as one of the public health strategies for cervical cancer prevention. The CHP has started to provide HPV vaccination to primary five female students since the 2019/20 school year.
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(ii) In November 2018, the SCVPD reviewed the local and global epidemiology of measles, overseas experience and relevant scientific evidence, and made the recommendation that children in Hong Kong to be given the first dose of a combined measles, mumps and rubella (MMR) vaccine when they are one year old at MCHCs, followed by a second dose of a measles-containing vaccine (i.e. combined measles, mumps, rubella and varicella (MMRV) vaccine) when they are 18 months old at MCHCs instead of receiving the vaccination at Primary One at school.
(iii) In March 2019, after reviewing the latest scientific evidence and recommendations from overseas health authorities, the SCVPD recommended that the administration of 13-valent pneumococcal conjugate vaccine (PCV13) under the HKCIP be changed from the arrangement of a primary series of three doses of PCV13 at two, four and six months, followed by a booster dose at 12 months (referred as "3p+1 schedule") to two primary doses plus a booster dose (referred as "2p+1 schedule"). Under the updated schedule, children will receive two primary doses of PCV13 at two and four months, followed by a booster dose of PCV13 at 12 months. The change will simplify the vaccination schedules of the HKCIP with one vaccine spared at six months. The SCVPD regarded that the 2p+1 schedule is non-inferior to the current 3p+1 schedule and should provide comparable protection against invasive pneumococcal disease to children in Hong Kong.
Please refer to Annex 6 for the latest schedule of the HKCIP recommended by the SCVPD.
(4) Before ordering vaccines for the HKCIP, the Government will estimate the required quantity on the basis of the number of births for the year and the coverage rates in the past. The Government will then procure the estimated quantity of vaccines through tender in accordance with the established requirements and procedures. A flexibility clause will normally be included in the conditions of the tender to ensure that after the signing of the contract, the quantities ordered can be appropriately adjusted or the contract period can be extended if necessary, so as to minimise the number of vaccines to be discarded or expired vaccines. Vaccine suppliers are required to supply sufficient quantities of vaccines for the HKCIP according to the terms of contract.
At present, the Government procures for the HKCIP on a contract basis the following nine single or combined vaccines for children, namely (1) BCG vaccine; (2) Hep B vaccine; (3) varicella vaccine; (4) diphtheria, tetanus, acellular pertussis and inactivated poliovirus vaccine (DTaP-IPV vaccine); (5) diphtheria, tetanus, acellular pertussis (reduced dose) and inactivated poliovirus vaccine (dTap-IPV vaccine); (6) PCV13; (7) MMR vaccine; (8) MMRV vaccine and (9) HPV vaccine. As the HKCIP is an ongoing programme, contracts are signed for different vaccines and the contract periods vary accordingly. Suppliers are normally required under the contracts concerned to provide vaccines for a period of two to three years. Details of the contracts signed with vaccine suppliers that are still valid are at Annex 7.
(5) The number of primary schools joining seasonal influenza vaccination school outreach activities and the number of children aged between six months and under 12 who received free or subsidised seasonal influenza vaccination in the past three years are at Annexes 8 and 9.
(6) According to the Pharmacy and Poisons Ordinance (Chapter 138), pharmaceutical products must satisfy the requirements on safety, quality and efficacy and to be registered with the Pharmacy and Poisons Board of Hong Kong before they can be legally sold in Hong Kong. All registered pharmaceutical product should bear the registration number in the form of "HK-XXXXX" on its label. Information on registered pharmaceutical products in Hong Kong could be found from the website of Drug Office of DH (www.drugoffice.gov.hk) such as its product name, active ingredient and the holder of certificate of drug registration etc. for public and industry's inspection. Vaccines are pharmaceutical products and prescription drugs which should only be administered under the instruction of medical practitioners. Healthcare professionals should only purchase registered pharmaceutical products from licensed wholesale dealers. The Drug Office of DH provide information on vaccination in its website and through webpages, promotional videos and leaflets to remind the public not to purchase unregistered pharmaceutical products or products from doubtful sources.
Moreover, medical practitioners have the responsibility to exercise their professionalism to properly store vaccines and ensure that stored vaccines remain safe and effective. DH reminds doctors enrolled in Vaccination Subsidy Scheme (VSS) to properly store vaccines through various channels such as briefings, emails and the VSS Doctor's Guide on the CHP's website.
Ends/Wednesday, May 13, 2020
Issued at HKT 15:47
Issued at HKT 15:47
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