The national childhood flu
immunisation programme
2015/16
Training for healthcare practitioners
Key messages
2
•
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
The national childhood flu immunisation programme 2015/16
Aims of resource
This purpose of this training resource is to:
3
•
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®
The national childhood flu immunisation programme 2015/16
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
4
The national childhood flu immunisation programme 2015/16
Key roles of healthcare practitioners
Key roles of healthcare practitioners in relation to the childhood flu programme
are as follows:
•
•
•
•
5
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
The national childhood flu immunisation programme 2015/16
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
The national childhood flu immunisation programme 2014/15
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The national childhood flu immunisation programme 2015/16
Influenza viruses
There 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
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The national childhood flu immunisation programme 2014/15
Flu A virus
Genetic material (RNA) in the centre
Two surface antigens:
• Haemagglutinin (H)
• Neuraminidase (N)
There are 16 different types of H
and 9 different types of N
8
The blue protuberances represent
haemagglutinin and the red spikes
neuraminidase
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
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The national childhood flu immunisation programme 2015/16
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
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The national childhood flu immunisation programme 2015/16
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
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The national childhood flu immunisation programme 2015/16
Flu epidemiology (all ages)
• 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
Rate of influenza/influenza-like illness episodes in England (weekly returns to Royal College of General
Practitioners), 2008–09 to 2014–15
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The national childhood flu immunisation programme 2015/16
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
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The national childhood flu immunisation programme 2015/16
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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The national childhood flu immunisation programme 2015/16
Why has the seasonal flu vaccination
programme been extended to include
children (between 2 years and less than 17
years of age)?
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The national childhood flu immunisation programme 2015/16
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
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The national childhood flu immunisation programme 2015/16
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
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The national childhood flu immunisation programme 2015/16
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
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The national childhood flu immunisation programme 2015/16
2014/15 childhood flu uptake and pilots
19
•
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
The national childhood flu immunisation programme 2015/16
Impact of 2013/14 childhood flu pilots
In 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
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The national childhood flu immunisation programme 2015/16
Vaccine uptake for children in a clinical risk
group
• 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.
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The national childhood flu immunisation programme 2015/16
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
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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The national childhood flu immunisation programme 2015/16
Which flu vaccine should be used?
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The national childhood flu immunisation programme 2015/16
Types of flu vaccines
Two 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
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The national childhood flu immunisation programme 2015/16
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
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The national childhood flu immunisation programme 2015/16
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)
The national childhood flu immunisation programme 2014/15
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The national childhood flu immunisation programme 2015/16
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)
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The national childhood flu immunisation programme 2015/16
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
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The national childhood flu immunisation programme 2015/16
Fluenz Tetra® composition 2015/16
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:
Sucrose
Dibasic potassium phosphate
Monobasic potassium phosphate
Gelatin (porcine type A)
Arginine hydrochloride
Monosodium glutamate monohydrate
Water for injection
Residues:
Egg proteins (e.g. ovalbumin)
Gentamicin
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The national childhood flu immunisation programme 2015/16
Image courtesy of AstraZeneca
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)
Image courtesy of AstraZeneca
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The national childhood flu immunisation programme 2015/16
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
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The national childhood flu immunisation programme 2015/16
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
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The national childhood flu immunisation programme 2015/16
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
Image courtesy of AstraZeneca
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The national childhood flu immunisation programme 2015/16
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
A PGD template “The national influenza (Fluenz Tetra®) vaccination
programme: September 2015 to August 2016” is available on the PHE
website
https://www.gov.uk/government/collections/immunisation-patient-group-direction-pgd
N.B Local authorisation is required before PHE PGD templates can be used
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The national childhood flu immunisation programme 2015/16
Fluenz Tetra® Applicator
Image taken from Fluenz Tetra® SPC 2014
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The national childhood flu immunisation programme 2015/16
Administration of Fluenz Tetra®
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The national childhood flu immunisation programme 2015/16
Administration of Fluenz Tetra®
Images taken from Fluenz Tetra® SPC 2014
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The national childhood flu immunisation programme 2015/16
Administration video
A 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/edu
cation-and-training/by-themeinitiative/public-health/healthprotection/seasonal-flu.aspx
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The national childhood flu immunisation programme 2015/16
Contraindications to Fluenz Tetra®
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
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The national childhood flu immunisation programme 2015/16
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
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2014/15
Severe asthma or active wheezing
•
Live flu vaccine not recommended for children and adolescents with severe
asthma or active wheezing, e.g. those who are currently taking or have
been prescribed oral steroids for respiratory disease 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
•
41
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
The national flu immunisation programme 2015/16
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
•
LAIV is not otherwise contraindicated in children with egg allergy. Eggallergic children with asthma can receive LAIV if their asthma is wellcontrolled (see previous slide on severe asthma)
*Children in a clinical risk group and aged under nine years who have not been previously vaccinated
against influenza will require a second dose whether given LAIV or inactivated vaccine
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The national flu immunisation programme 2015/16
Precautions to Fluenz Tetra®
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
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The national childhood flu immunisation programme 2015/16
Inadvertent administration of Fluenz Tetra®
44
•
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)
The national childhood flu immunisation programme 2015/16
Risk of transmission of vaccine virus
45
•
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
The national childhood flu immunisation programme 2015/16
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
The national flu immunisation programme 2014/15
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The national childhood flu immunisation programme 2015/16
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 a rigid yellow sharps container with yellow lid
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The national childhood flu immunisation programme 2015/16
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
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The national childhood flu immunisation programme 2015/16
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;
49
•
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
The national childhood flu immunisation programme 2015/16
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)
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The national childhood flu immunisation programme 2015/16
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®
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The national childhood flu immunisation programme 2015/16
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
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The national childhood flu immunisation programme 2015/16
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
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The national childhood flu immunisation programme 2015/16
Recording of flu vaccine given to children
The following information should be recorded:
●
vaccine name, product name, batch number and expiry date
●
dose administered
●
route/site used
●
date immunisation given
●
name and signature of vaccinator
This information should be recorded in:
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●
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
The national childhood flu immunisation programme 2015/16
Data collection
55
•
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
The national childhood flu immunisation programme 2015/16
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
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The national childhood flu immunisation programme 2015/16
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
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The national childhood flu immunisation programme 2015/16
Key messages
58
•
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
The national childhood flu immunisation programme 2015/16
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 August 2015. Available at:
https://www.gov.uk/government/organisations/public-health-england/series/immunisationagainst-infectious-disease-the-green-book
•
Flu immunisation: toolkit for programme extension to children Available at:
https://www.gov.uk/government/publications/flu-immunisation-toolkit-for-programmeextension-to-children
•
Leaflets and posters prepared specifically for the childhood flu programme. Available at:
https://www.gov.uk/government/organisations/public-health-england/series/annual-fluprogramme
•
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/bytheme-initiative/public-health/health-protection/seasonal-flu.aspx
•
Fluenz Tetra® Summary of Product Characteristics (SPC) Available at:
https://www.medicines.org.uk/emc/medicine/29112
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The national childhood flu immunisation programme 2015/16