LONDON CHILDHOOD IMMUNISATION
CO-ORDINATORS’ NETWORKING MEETING
Monday 11 October 2010 at 1330 to 1600
CSL, Stephenson House, 75 Hampstead Road, London NW1 2PL
MINUTES
Attendees:
Name
NHS/Organisation
Helen Donovan
Funmi Opemuyi
Shona Ash
Jyotsna Abhyankar
Sharon Milne
Patricia Stephens
Philippa Kemsley
Joanna Yarwood
Padma Mudalige
Amanda Williams
Veena Bhumvra
Mary Akuffo
Joanna Ekladious
Stefania Costa-Zaccarelli
Elizabeth Hunt
Catherine Heffernan
Khalida Aziz
Laura Craig
Rebecca Cordery
Barry Walsh
Rachel Heathcock
David Elliman
Christine Ogundele
Nicola Pratelli
Serena Tung
Jean Young
John Licorish
Luise Dawson
Christine Sloczynska
Ravikumar Balakrishnan
Dr Helen McShane
Penelope Toff
Melanie Ashdown
Ali Lawrence
Haringey (Chair)
Barking and Dagenham
Barnet
Bexley
Camden
Camden
City & Hackney
DH
Hounslow
Enfield
Hammersmith & Fulham
Harrow
Hillingdon
Hillingdon
Hillingdon Community Health
Hounslow
Hounslow
HPA
HPA – NE & Central HPU
HPA – SW London HPU
HPU
Islington
Islington
Kingston
Lambeth
Southwark
Sutton & Merton
Tower Hamlets
Waltham Forest
Wandsworth
Jenner Institute of Oxford University
NHS Brent
Commissioning Support for London
Commissioning Support for London (Minutes)
Item
Minute
1
HD welcomed everyone and introductions were made.
Action
Item
Minute
Action
2
Review of Minutes
AL
It was pointed out that Joanna Yarwood’s first name had been
incorrectly spelt with a Y. Otherwise the minutes and actions were
agreed.
3
The paper ‘Guidance for the Management of Human Bite Injuries’
produced by Haringey, was ratified, and will be uploaded onto the
Immunisation website.
Link:
http://www.csl.nhs.uk/service_design/staying_healthy/Imms_and_vacc
s/Pages/Immunisationco-ordinatorgroup.aspx
4
Consent
There were no comments on the Consent document. This item will be
added to the agenda of the next meeting.
5
AL
BCG vaccination and development of new vaccines.
A presentation was given by Dr Helen McShane, Consultant
Physician, Reader in Vaccinology, Senior Clinical Fellow and
Honorary Consultant in HIV and Genito-Urinary Medicine, Jenner
Institute of Oxford University.
Helen discussed current ongoing research projects during the session.
As the slides contain unpublished data she has asked that they are
not used for onward circulation but for information and interest only.
As a result the presentation will not be uploaded but are being
circulated with these minutes.
6
Response to the White Paper.
HD had collated input from the group and a response to the White
paper had been submitted the week prior this meeting. The HPA had
also submitted a response.
7
MMR Post Natal Leaflet
Members of the network worked to redraft this with the antenatal
screening group after concerns were raised on the accuracy. The final
version of the leaflet has now been agreed and will be distributed to
women postnatally with advice to attend for the second vaccination.
As soon as it is available the Network will be informed and advised on
HD
Item
Minute
Action
how to access it.
8
Feedback on HPV catch-up campaign
In the main the HPV catch up campaign ended in August 2010
although Haringey and some others nationally are still completing for
school years 11 and 12. Discussion about PCTs offering catch up for
those who missed the vaccine in previous years. DH green book
advice to vaccinate those up to the age of18; i.e. those in school or
could still be in school. Some expressed concern that some may miss
out. Mixed feedback from efficacy of GP campaigns. In general uptake
lower last year. Plans in place now to focus on Year 8.
9
Immunisation Guidance document
This document has been published to the CSL website. This is in two
parts:
Part A Childhood Immunisations: The London Context.
This part provides background information and quantitative data
regarding immunisation services in London for directors or interested
people not necessarily involved in the direct provision of these
services. It includes key messages regarding behaviours and
attitudes to immunisation
Part B Childhood Immunisations Guidance
This part aims to provide commissioners and providers of childhood
immunisation services with detailed information regarding
commissioning of good immunisation services. The guide may be
used by immunisation leads and people at the front line of
immunisation provision. It outlines effective immunisation
programmes and practical examples of what community service
providers should work towards.
The guide has been circulated to all PCTs via the CSL Bulletin.
Additionally, it will be available at the DH NST workshops.
10
The 4 National Support Team (NST) Workshop days:
There are 4 NST workshop dates:
12th November
16th December
14th January
8th February
All at Skipton House
JY
Item
Minute
Action
It was felt that 4 full days is too much and that 4 half days would have
been better. Joanne Yarwood to feed back
11
Social Marketing and staff need for training.
At the Steering Group meeting last week the topic of developing a
collective London approach to immunisation training was discussed.
Issues raised were regarding access to resources and also the
possibility of a move back to the “train the trainer” approach. The HPA
are encouraging the ‘train the trainer model’. The Immunisation Coordinators were in support and this will be fed back to the Steering
Group.
HD
NCL have guidance for immunisation training and it was suggested
that this document could be shared and that it could be a topic for
discussion at the NST meeting.
David Elliman said that there were lots of resources around i.e. the
HPA slide set for trainers to use although it may need some updating.
There are two e-learning packages under development to cover the
whole curriculum, but there is recognition that individuals still need
face to face and localised training.
Difficulties include access to material and people who can deliver
sessions. Another difficulty is the lack of administrative resources, i.e.
PCTs are struggling with support with booking rooms and delegates
and chasing responses etc.
It was felt that joint delivery would be more cost effective on condition
that the right people are doing the training.
12
Seasonal Flu Vaccine
Feedback from Barnet is that H1N1 is in the seasonal flu vaccine but
that some patients are declining it because of this.
HD stated that she advises that seasonal flu vaccine has always
contained the 3 main strains likely to be circulating every year and this
is the message to promote.
JY suggested that we recommend that patients read the patient leaflet
(rather than the newspapers). Good communication between staff
and patients/public was essential.
13
Immunisation Leaflet
JY reported that stocks of the teenage immunisation leaflets had run
out. The DH is reprinting but have had to batch print. There is
currently a freeze on communication expenditure. This raises concern
for cost implications for PCTs. JY has shared these concerns with
ALL
Item
Minute
Action
senior colleagues.
JY confirmed that back orders will be fulfilled.
14
MMR doses
A query was raised regarding the gap between the two doses of MMR
where the 2 doses are not given at the usual scheduled times and
concern that children could potentially miss out on vaccinations. There
was confusion on what the Green book says.
Post meeting clarification was sought on the issues discussed with
consultation from DH and HPA.
-
-
-
-
-
15
The second dose of MMR is normally given before school entry
but can be given routinely at any time from three months after
the first dose (p217 GB). Allowing three months between
doses is likely to maximise the response rate, particularly in
young children under the age of 18 months where maternal
antibodies may reduce the response to vaccination
Where protection against measles is urgently required (e.g.
outbreak or travel), the second dose can be given one month
after the first
If the second dose is given less than three months after the
first dose to a child under 18 months of age, then a third dose
should be given (usually pre-school) to ensure full protection
If the first dose is given under one year of age, i.e. in the case
of an outbreak or because of travel, it should not be counted
and two further doses of MMR vaccine should be given - one
once the child is over 1 year of age and another pre-school as
per the schedule or the above recommendations.
It is vital in any case for the immunisation history to be checked
at every contact. Where previous doses of MMR have been
given, health care professionals should always check to make
sure the 2 doses have been given according to the above
guidance when the child attends for their pre school booster.
Vaccine Cold Storage
Vaccine Efficiency Savings Programme Audit (VESPA) was discussed
in relation to the cold chain process and vaccine safety. This
programme of the DH aims to provide guidelines to NHS staff on the
correct ordering, storing and handling of vaccines, and to provide
information at SHA/GP level on the amount of vaccines needed,
ordered and the value of the vaccines.
The DH believes there is great wastage and that approx £5m vaccines
are sitting in fridges potentially waiting for fridge failure or expiration
because of badly managed ordering and storage.
Item
Minute
Action
There have been changes made to the vaccine ordering pages of
ImmForm to highlight the value of vaccines and encourage staff to
treat them as valuable commodities.
A set of 15 slides are available on the DH website. Link:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publica
tionsPolicyAndGuidance/DH_120010
JY asked for all to encourage colleagues to use ImmForm as it
provides a more flexible, robust method of processing and one that the
DH can track.
16
Green Book and Quadravalent meningitis
A query was raised regarding the administration of unlicensed drugs
such as quadravalent meningitis. JY said that where there is
uncertainty the Green Book will take precedence. If any attendees
have queries regarding this issue they should please forward these to
AL who will collate and send to JY.
For clarity this is the quote from the NELM web site:
‘Off label use of medicines is permitted under a PGD provided use is
exceptional, justified by current best clinical practice and the PGD
clearly describes the status of the product’.
http://www.nelm.nhs.uk/en/Communities/NeLM/PGDs/FAQs/Question
s-about-Medicines-Act-exemptions/?query=off+label&rank=100
17
All /
AL
HD
NEXT MEETING:
Wednesday 26 January 2- 4.0pm at NHS London, Southside, 105
Victoria Street, London SW1E 6QT, Rooms 402 and 403.
Speaker Nick Andrews
Deputy Head of the Statistics Unit at the Centre for Infections, Health
Projection Agency.
‘Monitoring and assessment of adverse events following vaccination’.
Link to CSL Website:
http://www.csl.nhs.uk/service_design/staying_healthy/Imms_and_vaccs/Pages/
Immunisationco-ordinatorgroup.aspx