The national childhood flu immunisation programme 2015/16 Training for healthcare practitioners

The national childhood flu immunisation programme 2015/16

Training for healthcare practitioners

Key messages

• In 2012 the Joint Committee on Vaccination and Immunisation (JCVI) recommended that the seasonal influenza (flu) programme should be extended to all children aged between 2 years and less than 17 years

• This extension to the flu vaccination programme should reduce the impact of seasonal flu on children and reduce transmission of flu within the community

• The phased introduction of the childhood flu programme began in 2013 with flu vaccine being offered to all 2 & 3year olds and to some primary school-aged children in pilot areas. Each year, more age groups are being added to the programme

• From 1st September 2015, all 2,3 & 4 year old children, children of school year 1 and 2 age & primary school-aged children in areas that participated in pilots last year will be offered flu vaccine

• Once fully implemented, the children’s flu programme will ultimately avert many cases of severe flu and flu-related deaths in older adults and people in clinical risk groups

2 The national childhood flu immunisation programme 2015/16

Aims of resource

This purpose of this training resource is to:

• Develop the knowledge base of healthcare practitioners regarding the flu vaccination programme for children

• Support healthcare practitioners involved in discussing flu vaccination for children with parents and carers by providing evidence based information

• Promote high uptake of flu vaccination in children through increasing the knowledge of those involved in delivering the vaccination programme

• Provide information on the administration of Fluenz Tetra®


Learning Outcomes

Following training, healthcare practitioners will be able to:

• Understand the evidence base for the administration of flu vaccination to children

• Describe the aetiology of flu

• Understand how flu is transmitted and the possible effects of flu on children

• Explain which vaccine should be used and the contraindications and the precautions to this vaccine

• Explain the possible side effects from the live attenuated flu vaccine (Fluenz Tetra®)

• Explain the sequence of steps in Fluenz Tetra® administration

• Identify sources of additional information

• Understand the importance of their role in raising the issue of vaccination with parents and carers of children and providing evidence based information about flu vaccination


Key roles of healthcare practitioners

Key roles of healthcare practitioners in relation to the childhood flu programme are as follows:

• To understand the evidence base for the administration of the childhood flu vaccination

• To advise parents/carers of children who are eligible to receive the flu vaccination that it is strongly recommended that they are vaccinated against flu

• To safely administer Fluenz Tetra® (or other flu vaccine as appropriate) in accordance with the vaccine schedule

• To ensure any adverse effects are managed and reported appropriately


What is flu?

• Flu is an acute viral infection of the respiratory tract (nose, mouth, throat, bronchial tubes and lungs)

• Highly infectious illness which spreads rapidly in closed communities

• Even people with mild or no symptoms can infect others

• Most cases in the UK occur during an 8-10 week period during the winter

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Influenza virusesThere are 3 types of influenza viruses:

A viruses• Cause outbreaks most years and are the usual cause of epidemics

• Animal reservoir – wildfowl, also carried by other mammals

B viruses• Tend to cause less severe disease and smaller outbreaks

• Burden of disease mostly in children

• Predominantly found in humans

C viruses• Minor respiratory illness only


Flu A virus

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The blue protuberances represent haemagglutinin and the red spikes neuraminidase

Two surface antigens:

•Haemagglutinin (H)

•Neuraminidase (N)

Genetic material (RNA) in the centre

There are 16 different types of H and 9 different types of N

The national flu immunisation programme 2015/16

Genetic changes in the flu virus – what this means

Changes in the surface antigens (H &N) result in the flu virus constantly changing

• Antigenic drift: minor changes (natural mutations) in the genes of flu viruses that occur gradually over time

• Antigenic shift: when two or more different strains combine. This abrupt major change results in a new subtype. Immunity from previous flu infections/vaccinations may not protect against the new subtype, potentially leading to a widespread epidemic or pandemic

Because of the changing nature of flu viruses, WHO monitors their epidemiology throughout the world

Each year WHO makes recommendations about the strains of influenza A and B which are predicted to be circulating in the forthcoming winter

These strains are then included in the flu vaccine developed each year


Features of flu• Easily transmitted by large droplets, small-particle aerosols and by hand

to mouth/eye contamination from an infected surface or respiratory secretions of infected person

• People with mild or no symptoms can still infect others

• Incubation period 1-5 days (average 2-3 days) though may be longer especially in people with immune deficiency

Common symptoms include:

• Sudden onset of fever, chills, headache, muscle and joint pain and extreme fatigue

• Dry cough, sore throat and stuffy nose

• In young children gastrointestinal symptoms such as vomiting and diarrhoea may be seen


Possible complications of flu

Common:

• Bronchitis• Otitis media (children), sinusitis• Secondary bacterial pneumonia

Less common:

• Meningitis, encephalitis, meningoencephalitis• Primary influenza pneumonia

Risk of most serious illness higher in children under 6 months, pregnant women, older people and those with underlying health conditions such as respiratory disease, cardiac disease or immunosuppression


Flu epidemiology (all ages)

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Rate of influenza/influenza-like illness episodes in England (weekly returns to Royal College of General Practitioners), 2008–09 to 2014–15

• Flu activity usually between September to March (weeks 37 and 15)

• Impact of flu varies from year to year

• Moderate levels of flu activity seen in 2014/15 season

• ICU/HDU admissions in 2014/15 higher than seen in the previous few seasons


UK flu vaccination programme

Late 1960s: annual flu immunisation recommended to directly protect those in clinical risk groups who are at a higher risk of flu associated morbidity and mortality

2000: flu vaccine policy extended to include all people aged 65 years or over

2010: pregnancy added as a clinical risk category for routine flu immunisation 2013: phased introduction of an annual childhood flu vaccination programme for all children aged 2-16y began with vaccine offered to all children aged 2 and 3 years and seven geographical pilots in primary school aged children

2014: phased introduction of childhood flu vaccination programme continued with vaccine offered to all children aged 2, 3 and 4 years and geographical pilots in primary and secondary school aged children

2015: offer to all 2, 3 & 4 year old children and children of school year 1 & 2 age


Rollout of the childhood flu vaccination programme in England

• Extending flu programme to all children involves considerable planning and work in order to obtain a high level of uptake

• For this reason, programme is being rolled out over a number of flu seasons and includes geographical piloting in different age groups. The pilots have tested a number of delivery models – mostly primary schools but some through GP and community pharmacies

• The pilots will allow Public Health England and NHS England the opportunity to ascertain the most effective way of implementing it

In 2015/16, flu vaccination will be offered to • All those aged two, three and four years old (but not five years or older) on 31

August 2015 • All children of school year 1 and 2 age• Primary school aged children in the areas that participated in the primary

school pilots in 2014/15


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Why has the seasonal flu vaccination programme been extended to include children (between 2 years and less than 17 years of age)?


Why vaccinate children against flu?Extension of the seasonal flu vaccination programme to all children aims to appreciably lower the public health impact of flu by:

• Providing direct protection thus preventing a large number of cases of flu in children

• Providing indirect protection by lowering flu transmission from children to other children, to adults and to those in the clinical risk groups of any age

Reducing flu transmission in the community will avert many cases of severe flu and flu-related deaths in older adults and people with clinical risk factors

Annual administration of flu vaccine to children is expected to substantially reduce flu-related illness, GP consultations, hospital admissions and deaths

It has been estimated that if just 30% of children had the flu vaccine, there could be 2000 fewer deaths and 11 000 fewer hospitalisations due to flu each year


Recent review of burden of flu in children

• Average flu season: estimated 0.3% to 9.8% of 0-14 year old children present to a GP with flu

• Incidence rates can be markedly higher in the younger age groups

• Influenza-associated hospitalisation rates:

- 83-1,038/ 100,000 children 0-59 months old (highest in <6m) - 16-210/100,000 children 5-17 years

• Children more vulnerable to infection than adults when exposed

• Children with flu contribute to the burden of flu in all age groups because they are more likely to pass on the infection than adults


Cost effectiveness of extending seasonal flu vaccination programme to children

Studies commissioned by the JCVI suggest that despite the high cost, extending the flu vaccination programme to children is:

• Highly likely to be cost-effective

• Well below the established cost-effectiveness threshold when indirect protection to the whole population is taken into account, particularly over the longer-term


2014/15 childhood flu uptake and pilots• 2014/15: all 2, 3 and 4 year olds offered vaccination through GP surgeries

National uptake was 38.5% for two year olds, 41.3% for three year olds and 32.9% for four year olds

• The primary school age (4 to 11 years) pilot programme which began in 2013/14 continued and was extended to include secondary school age children (aged 11 to 13 years) in selected pilot areas

• In the14 pilot areas, overall uptake 53.2%. Uptake varied by pilot site

• Overall uptake in primary school children (4 to 11 years) was 56.8% (ranging by pilot area from 32.3% to 63.1%).

• Overall uptake in secondary school children (11 to 13 years) was 49.8% (ranging by pilot area from 21.2% to 62.0%).

• Overall uptake in community pharmacy and GP delivery pilot sites was notably lower than school-based delivery pilots


Impact of 2013/14 childhood flu pilotsIn 7 pilots areas, a total of 104,792 primary age children received at least

1 dose of flu vaccine (overall uptake of 52.5% in the target group)

Despite low flu activity in 2013/14, early results suggest a positive impact on flu transmission. In pilot areas compared to non-pilot areas:

• There were fewer GP consultations and A&E attendances for ‘influenza like’ and respiratory illness

• Fewer people tested positive for flu in primary care


Vaccine uptake for children in a clinical risk group

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• Vaccine uptake is particularly low in the younger age groups with clinical conditions that put them at most risk of complications from flu

• GPs and practice staff managing the flu programme should make sure that all at-risk children have the opportunity to receive flu vaccine.


Vaccine uptake for children in a clinical risk group

Target groups for vaccination % vaccine uptake

Six months to under two years in a clinical risk group 16.8

Two years to under 5 years in a clinical risk group 53.1

5 years to under 16 years in a clinical risk group 42.0

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Vaccine uptake figures show that uptake in children in clinical risk groups is higher in the age group where all children (healthy and clinical risk group) have been offered flu vaccination

It is hoped that with flu vaccine ultimately being offered to all 2- up to 17 year olds, more children in risk groups will be vaccinated


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Which flu vaccine should be used?


Types of flu vaccinesTwo main types of vaccine available:

• Inactivated – by injection • Live - by nasal application

None of the flu vaccines can cause clinical flu in those that can be vaccinated

Trivalent vaccines contain two subtypes of Influenza A and one type B virus (most inactivated vaccines are trivalent)

Quadrivalent vaccines contain two subtypes of Influenza A and both B virus types

As quadrivalent vaccines may be better matched and therefore may provide better protection against the circulating B strain(s) than trivalent flu vaccines, the live intranasal vaccine offered to children aged 2yrs and over is a quadrivalent vaccine, as is the inactivated vaccine recommended for children aged 3years and above who cannot received live vaccine


Live attenuated influenza vaccine (LAIV)

• A live attenuated intranasal spray called Fluenz Tetra® is the recommended vaccine for the childhood flu programme

• LAIV has been shown to be more effective in children compared with inactivated flu vaccines

• It may offer some protection against strains not contained in the vaccine as well as to those that are and has the potential to offer better protection against virus strains that have undergone antigenic drift

• Since this vaccine is comprised of weakened whole live virus, it replicates natural infection which induces better immune memory (thereby offering better long-term protection to children than from the inactivated vaccines)

• In addition to being attenuated (weakened), the live viruses in Fluenz Tetra® have been adapted to cold so that they cannot replicate efficiently at body temperature

• Fluenz Tetra® has a good safety profile in children aged two years and older


How many doses?• Two doses of the inactivated flu vaccines are required to achieve adequate

antibody levels in younger children

• However a single dose of LAIV should provide protection to previously unvaccinated healthy children

• Only modest additional protection provided by a second dose of LAIV

• Only children who are in clinical risk groups aged two to less than nine years who have not received flu vaccine previously should be offered a second dose of LAIV (given at least 4 weeks apart)

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Which type of vaccine to offer children under 18 years old


*children in clinical risk groups aged 2 years to less than 9 years who have not received flu vaccine before should be offered two doses of flu vaccine at least four weeks apart (Fluenz Tetra® or a suitable inactivated vaccine if Fluenz Tetra® is medically contraindicated)

Fluenz Tetra®

• Generic name: influenza vaccine (live attenuated, nasal)

• Brand name: Fluenz Tetra®

• Marketed by AstraZeneca

• Licensed from 24 months to less than 18 years of age

• Nasal spray (suspension) in a prefilled nasal applicator

• Supplied as pack containing 10 doses


Image courtesy of AstraZeneca

Active ingredients:

A/California/7/2009 (H1N1)pdm09-like virus

A/Switzerland/9715293/2013 (H3N2)-like virus

B/Phuket/3073/2013-like virus

B/Brisbane/60/2008-like virus

Excipients:

SucroseDibasic potassium phosphateMonobasic potassium phosphateGelatin (porcine type A)Arginine hydrochlorideMonosodium glutamate monohydrateWater for injection

Residues:Egg proteins (e.g. ovalbumin)Gentamicin

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Fluenz Tetra® composition 2015/16



Fluenz Tetra® presentation


• Single use prefilled nasal applicator

• Ready to use (no reconstitution or dilution required)

• Nasal spray (suspension)

• The suspension is colourless to pale yellow, clear to opalescent. Small white particles may be present

• Each applicator contains 0.2ml (administered as 0.1 ml per nostril)


Storage of Fluenz Tetra®

Fluenz Tetra® must be stored in accordance with manufacturer’s instructions:• Store between +2°C and +8°C • Do not freeze• Store in original packaging• Protect from light

Check expiry dates regularly:

• Fluenz Tetra® has an expiry date 18 weeks after manufacture – this is much shorter than inactivated flu vaccines

• It is important that the expiry date on the nasal spray applicator is checked before use


Fluenz Tetra® dosage and schedule reminder

• A single dose is 0.2ml (administered as 0.1ml per nostril)

• A single dose for all children not in clinical at risk group

• Children aged 2 years to less than 9 years who are in clinical at risk groups and who have not received flu vaccine before should receive two doses of Fluenz Tetra® (if not immunocompromised) with the second dose at least four weeks after the first

NB: This advice differs from that given in the Fluenz Tetra® SPC

Where Green Book advice differs from SPC, Green Book should be followed


Administration of Fluenz Tetra®

• Fluenz Tetra® is different from other flu vaccines - it is a live nasal vaccine and must not be injected

• Fluenz Tetra® can be administered at the same time as, or at any interval from other vaccines including live vaccines

• Patient should breathe normally - no need to actively inhale or sniff

• The vaccine is rapidly absorbed so no need to repeat either half of dose if patient sneezes, blows their nose or their nose drips following administration



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Supply and administration of flu vaccines

A range of mechanisms can be used for the supply and administration of vaccines, including :

• Patient Specific Prescription written manually or electronically by a registered medical practitioner or other authorised prescriber

• Patient Specific Direction

• Patient Group Direction

Where PGDs are developed, they must comply with the legal requirements specified in the Human Medicines Regulations 2012, and should reflect NICE good practice guidance on PGDs: (http://publications.nice.org.uk/patient-group-directions-mpg2)


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Fluenz Tetra® Applicator


Image taken from Fluenz Tetra® SPC 2014

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Images taken from Fluenz Tetra® SPC 2014

Administration videoA video for health professionals

on how to administer the Fluenz Tetra® vaccine has been produced by NHS Education for Scotland

It is available to view on the NES website at: http://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/public-health/health-protection/seasonal-flu.aspx


http://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/public-health/health-protection/seasonal-flu.aspx




There are very few children who cannot receive any flu vaccine

Where there is doubt, expert advice should be sought promptly so that the period the child is left unvaccinated is minimised

Where live flu vaccine cannot be given, it is likely that inactivated vaccine could be given instead


Contraindications to Fluenz Tetra®

• Confirmed anaphylactic reaction to a previous dose of flu vaccine

• Confirmed anaphylactic reaction to any component of the vaccine including gentamicin and gelatin

• Clinically severely immunodeficient due to conditions or immunosuppressive therapy such as:

• Acute and chronic leukaemias• Lymphoma• HIV infection not on highly active antiretroviral therapy (HAART)• Cellular immune deficiencies• High dose corticosteroids

• Receiving salicylate therapy • Known to be pregnant


Contraindications to Fluenz Tetra®


Severe asthma or active wheezing

• Live flu vaccine is not recommended for children who are currently taking or have been prescribed oral steroids in the last 14 days

• Children currently taking a high dose inhaled steroid - Budesonide >800 mcg/day or equivalent (e.g. Fluticasone > 500 mcgs/day) should only be given live flu vaccine on the advice of their specialist

As these children are a defined flu risk group, those who cannot receive LAIV should receive an inactivated flu vaccine

• Vaccination with Fluenz Tetra® should be deferred in children with a history of active wheezing in the past 72 hours or those who have increased use of bronchodilators in the previous 72 hours. If condition not improved after a further 72 hours then inactivated flu vaccine should be offered to avoid delaying protection in this high risk group


Egg allergy• Children with an egg allergy can be safely vaccinated with Fluenz Tetra® in

any setting (including primary care and schools)

• Those with both egg allergy and clinical risk factors that contraindicate Fluenz Tetra® (e.g. immunosuppression) should be offered an inactivated flu vaccine with a very low ovalbumin content (less than 0.12 μg/ml)

• Children with a history of severe anaphylaxis to egg which has previously required intensive care, should be referred to specialists for immunisation in hospital

• For children with egg allergy and asthma, follow recommendations for severe asthma (previous slide)


Acute severe febrile illness:• defer until recovered

Heavy nasal congestion:• defer until resolved or consider inactivated flu vaccine

Use with antiviral agents against flu:

• Fluenz Tetra® should not be administered at the same time or within 48 hours of cessation of treatment with flu antiviral agents

• Administration of flu antiviral agents within two weeks of administration of Fluenz Tetra® may adversely affect the effectiveness of the vaccine


Precautions to Fluenz Tetra®

Inadvertent administration of Fluenz Tetra®

• If an immunocompromised individual receives LAIV, the degree of immunosuppression should be assessed

• If patient is severely immunocompromised, antiviral prophylaxis should be considered

• Otherwise they should be advised to seek medical advice if they develop flu-like symptoms in the 4 days following administration of the vaccine

• If antivirals are used for prophylaxis or treatment, patient should also be offered inactivated flu vaccine in order to maximise their protection in the forthcoming flu season (this can be given straight away)


• Theoretical potential for transmission of live attenuated virus to immunocompromised contacts

• Risk is for one to two weeks following vaccination

• Extensive use of the live attenuated flu vaccine in United States - no reported instances of illness or infections from the vaccine virus among immunocompromised patients inadvertently exposed to vaccinated children

• However, where close contact with very severely immunocompromised patients (e.g. bone marrow transplant patients requiring isolation) is likely or unavoidable (e.g. household members) consider an appropriate inactivated flu vaccine instead


Risk of transmission of vaccine virus

Exposure of healthcare professionals to live attenuated influenza vaccine viruses

• There may be some low level exposure to the vaccine viruses for those administering LAIV and/or from recently vaccinated patients

• In the US, where there has been extensive use of LAIV, no reported instances of illness or infections from the vaccine virus among HCPs inadvertently exposed

• Risk of acquiring vaccine viruses from the environment is unknown but probably low

• The vaccine viruses are cold-adapted and attenuated and therefore unlikely to cause symptomatic flu

• As a precaution, very severely immunosuppressed individuals should not administer LAIV

• Other healthcare workers who have less severe immunosuppression or are pregnant, should follow normal clinical practice to avoid inhaling the vaccine and ensure that they themselves are appropriately vaccinated

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The national flu immunisation programme 2014/15


Infection control issues • There are no specific infection control precautions required when

administering Fluenz Tetra®

• Routine hand hygiene procedures should be performed before and after each child contact

• Gloves and aprons are not required

Disposal of clinical waste:

Used, part-used or out of date/wasted Fluenz Tetra® applicators should be disposed of in the waste medicines stream (rigid yellow container with blue lid)


Adverse reactions to Fluenz Tetra®Commonly reported adverse reactions (affects more than 1 in 10 Fluenz Tetra®

recipients):

• Blocked or runny nose

• Headache

• Fever

• Malaise

• Myalgia

• Decreased appetite

Hypersensitivity reactions (including angio-oedema, urticaria and bronchospasm and anaphylaxis) can occur but are very rare



Reporting suspected adverse reactions

As with all vaccines during the earlier stages of their introduction, Fluenz Tetra® carries a black triangle symbol (▼)

This is to encourage reporting of all suspected adverse reactions to the Medicines and Healthcare products Regulatory Agency (MHRA) using the Yellow Card scheme

Yellow card scheme: http://mhra.gov.uk/yellowcard;

• Voluntary reporting system for suspected adverse reaction to medicine/vaccines

• Success depends on early, complete and accurate reporting

• Report even if uncertain about whether vaccine caused condition

• See chapter 8 of Green Book for details

http://mhra.gov.uk/yellowcard

http://mhra.gov.uk/yellowcard

Vaccine ordering• All flu vaccines for children (both live and inactivated) are purchased

centrally by Public Health England (PHE). In 2015/16 this will be for: • All children aged 2, 3 and 4yrs, and of school years 1 & 2 age and • All children in clinical risk groups aged 6 months to 18 years

i.e. PHE will supply Fluenz Tetra® for those who can receive it and inactivated flu vaccine for those children for whom Fluenz Tetra® is contraindicated • The quadrivalent inactivated flu vaccine (Fluarix™ Tetra®) is authorised for children

aged from three years and is preferred because of the additional protection offered.

• Children aged from six months to less than three years should be given inactivated flu vaccine (Split Virion) BP®

• Flu vaccines for children can be ordered through the ImmForm website as for other centrally purchased vaccines (www.immform.dh.gov.uk)


Inactivated Influenza Vaccine (TIV) for children contraindicated to receive Fluenz Tetra®

• Children for whom Fluenz Tetra® is contraindicated should be offered a suitable alternative inactivated flu vaccine

• Some inactivated flu vaccines have been associated with high rates of febrile convulsions in children

• Some inactivated flu vaccines contain too much ovalbumin for egg allergic children

• Check SPC for vaccine suitability before administration

Guidance on which vaccines to use for those children who cannot receive Fluenz Tetra ® can be found in the Green Book influenza chapter

• Fluarix Tetra® is the preferred vaccine for children aged ≥ 3years who cannot receive Fluenz Tetra®

• Children 6m to <3yrs should be given inactivated influenza vaccine (Split Virion) BP®


Beware of product confusion!FluarixTM Tetra is an inactivated vaccine supplied for children aged three

and over who cannot receive the live Fluenz Tetra® vaccine

Care must be taken not to confuse the two ‘Tetra’ brands

One way of remembering which vaccine is which is:

• Fluenz is the nazal flu vaccine

• Fluarix is the arm injected vaccine


Porcine gelatine• Fluenz Tetra® contains a highly purified form of gelatine derived from pork

• Gelatine is used to stabilise live viral vaccines and is commonly used in a range of pharmaceutical products, including many capsules and some vaccines

• Some faith groups do not accept the use of porcine gelatine in medicinal products

• There is no other live attenuated vaccine available that does not contain porcine gelatine. The manufacturer of Fluenz Tetra® tested 40 potential stabilisers – gelatine was chosen because without it, stability was significantly reduced

• PHE & Department of Health’s view is that, for universal vaccination of healthy individuals, there is no suitable alternative to Fluenz Tetra®. The purpose of the childhood programme is to interrupt transmission & therefore indirectly protect whole population. This is best achieved by offering Fluenz Tetra®

• See www.gov.uk/government/news/vaccines-and-gelatine-phe-response for Q&As and more information on vaccines and gelatine


http://www.gov.uk/government/news/vaccines-and-gelatine-phe-response

Recording of flu vaccine given to children

The following information should be recorded:

● vaccine name, product name, batch number and expiry date

● dose administered ● date immunisation given

● route/site used ● name and signature of vaccinator

This information should be recorded in:

● Personal Child Health Record (the ‘Red Book’)

● Child’s GP record (or other patient record, depending on location)

● Child Health Information System

● Practice computer system


Data collection• Flu vaccine uptake data is collected via the web-based ImmForm system (

www.immform.dh.gov.uk) where it is managed and published by PHE

• Over 90% GP practices are able to make automated data returns where the number of their patients vaccinated is directly extracted from their IT system and put into ImmForm

• For data to be accurate and complete, it is critical that any vaccines given outside the surgery e.g. in pharmacies etc. are reported to the patient’s GP

• Uptake data for school years 1 & 2 and pilot areas will be manually submitted by Area Teams onto ImmForm

• Data is collected and published monthly on all the groups for whom flu vaccine is indicated at national level and local NHS England team level to enable performance to be reviewed and time to take action if needed


http://www.immform.dh.gov.uk/

Achieving high uptake (GP Practice checklist)

In order to obtain high vaccine uptake, it is recommended that GP practices:

1. Should have a named individual within the practice who is responsible for the flu vaccination programme

2. Have a register that can identify all pregnant women, patients in the under 65 years at risk groups, those aged 65 years and over and those aged 2 to 4 years

3. Update patient registers throughout the flu season paying particular attention to the inclusion of women who become pregnant during the flu season

4. Submit accurate data on the number of its patients eligible to receive flu vaccine and the flu vaccinations given to its patients on ImmForm

5. Order sufficient flu vaccine taking into account past and planned performance, expected demographic increase, and to ensure that everyone at risk is offered the flu vaccine


Achieving high uptake (GP Practice checklist cont’d)

6. Patients recommended to receive the flu vaccine should be directly contacted (e.g. letter, e-mail, phone call, text or other) inviting them to a flu vaccination clinic or to make an appointment

7. The practice should follow-up patients who do not respond or fail to attend scheduled clinics or appointments

8. Flu vaccination should start as soon as practicable after receipt of the vaccine so maximum number of patients are vaccinated as early as possible to ensure they are protected before flu starts to circulate

9.The GP practice should offer flu vaccination in clinics and opportunistically.

10.The GP practice and/ or CCG should collaborate with other providers such as community or health and social care trusts to identify and offer flu vaccination to residents in care homes, nursing homes and house-bound patients

iDexter LJ et al (2012) Strategies to increase influenza vaccination rates: outcomes of a nationwide cross-sectional survey of UK general practice. bmjopen.bmj.com/content/2/3/e000851.full


Key messages• In 2012 the Joint Committee on Vaccination and Immunisation (JCVI)

recommended that the seasonal influenza (flu) programme should be extended to all children aged between 2 years and less than 17 years

• This extension to the flu vaccination programme should reduce the impact of seasonal flu on children and reduce transmission of flu within the community

• The phased introduction of the childhood flu programme began in 2013 with flu vaccine being offered to all 2 & 3year olds and to some primary school-aged children in pilot areas. Each year, more age groups are being added to the programme

• From 1st September 2015, all 2,3 & 4 year old children, children of school year 1 and 2 age & primary school-aged children in areas that participated in pilots last year will be offered flu vaccine

• Once fully implemented, the children’s flu programme will ultimately avert many cases of severe flu and flu-related deaths in older adults and people in clinical risk groups



Resources

• Flu Plan and Supporting Letter detailing 2015/16 flu programme: Department of Health, Public Health England, NHS England. Published 27 March 2015. Available at: https://www.gov.uk/government/publications/flu-plan-2015-to-2016

• Green Book updated Influenza chapter May 2015. Available at: https://www.gov.uk/government/organisations/public-health-england/series/immunisation-against-infectious-disease-the-green-book

• A leaflet and a poster have been prepared specifically for the childhood flu programme. Available at: https://www.gov.uk/government/organisations/public-health-england/series/annual-flu-programme

• A video for health professionals on how to administer the vaccine produced by NHS Education for Scotland is available at http://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/public-health/health-protection/seasonal-flu.aspx

• Fluenz Tetra® Summary of Product Characteristics (SPC) available at http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002617/WC500158412.pdf

https://www.gov.uk/government/organisations/public-health-england/series/immunisation-against-infectious-disease-the-green-book




https://www.gov.uk/government/organisations/public-health-england/series/annual-flu-programme






http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002617/WC500158412.pdf

http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002617/WC500158412.pdf

Documents

The national childhood flu immunisation programme 2015/16 Training for healthcare practitioners