Transcript Slide 1

The national flu immunisation
programme 2014/15
Training for healthcare practitioners
Key messages
• Flu immunisation is one of the most effective interventions immunisers can
provide to reduce harm from flu and pressures on health and social care
services during the winter
•
Increasing flu vaccine uptake in clinical risk groups is important because of
increased risk of death and serious illness if people in these groups catch flu
•
For a number of years only around half of patients aged six months to under
65 years in clinical risk groups have been vaccinated
•
Influenza during pregnancy may be associated with perinatal mortality,
prematurity, smaller neonatal size, lower birth weight and increased risk of
complications for the mother
• Vaccination of health and social care workers protects them & reduces risk of
spreading flu to their patients, service users, colleagues and family members
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The national flu immunisation programme 2014/15
Aims of resource
This training resource aims to:
3
•
Develop the knowledge base of healthcare practitioners regarding the
2014/15 seasonal flu vaccination programme
•
Support healthcare practitioners involved in discussing flu vaccination with
those eligible by providing evidence based information
•
Promote high uptake of flu vaccination in those eligible by increasing the
knowledge of those involved in delivering the vaccination programme
•
Provide information on the administration of flu vaccines
The national flu immunisation programme 2014/15
Learning Outcomes
On completion of this resource healthcare practitioners will be able to:
• Describe the cause of flu
• Understand how flu is transmitted and the possible effects of flu
• Understand the evidence base for the administration of flu vaccination to those
aged 65 years and over and those in clinical risk groups
• Explain which vaccines will be used and the precautions and contraindications
to the administration of flu vaccines
• Explain the sequence of steps in flu vaccine administration
• Explain the possible side effects from flu vaccines
• Understand the importance of their role in promoting and providing evidence
based information about flu vaccination to patients
• Identify sources of additional information
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The national flu immunisation programme 2014/15
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 flu immunisation programme 2014/15
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The national flu immunisation programme 2014/15
Influenza (flu) viruses
There are 3 types of influenza (flu) 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 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
The blue protuberances represent
haemagglutinin and the red spikes
neuraminidase.
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The national flu immunisation programme 2014/15
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 which tend to occur from season to season
•
Antigenic shift: major changes and the emergence of new subtype.
Immunity from previous virus may not protect against new subtype thus leading to
widespread epidemic or pandemic in a non-immune population
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 influenza vaccine developed each year
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The national flu immunisation programme 2014/15
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, myalgia & 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 flu immunisation programme 2014/15
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, chronic neurological conditions or immunosuppression
Influenza during pregnancy may be associated with perinatal mortality, prematurity,
smaller neonatal size and lower birth weight
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The national flu immunisation programme 2014/15
Flu epidemiology
• Flu activity usually
between weeks 37
and 15 (September
to March)
• Impact of flu varies
from year to year
• 2013/14 saw low
levels of circulating
flu
• Estimated 11,000
deaths attributable
to flu in the 2012/13
season
Rate of influenza/influenza-like illness episodes in England (weekly returns to Royal College of General Practitioners), 2008–09 to 2013–14
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Flu vaccination programme
• Late 1960s: annual flu immunisation recommended in the UK with the aim of
directly protecting those in clinical risk groups who are at a higher risk of
influenza 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 influenza
immunisation
• 2013: phased introduction of an extension to offer annual flu vaccination to all
children aged 2-17y began with the inclusion of children aged 2 and 3 years
in the routine programme and 7 geographical pilots of primary school aged
children
• 2014: phased introduction of childhood flu vaccination programme continues
with the vaccine to be offered to all children aged 2, 3 and 4 years and
geographical pilots in primary and secondary school aged children
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The national flu immunisation programme 2014/15
Flu vaccine eligibility 2014/15
For the 2014/15 flu season, the following people are eligible for flu vaccination:
•
those aged 65 years and over on or before 31 March 2015
(born on or before 31 March 1950)
•
those aged six months to under 65 years in clinical risk groups
•
pregnant women at any stage of pregnancy
•
all children aged two, three and four years on or before 1 Sept 2014
(DOB on or after 2/9/09 and on or before 1/9/12)
•
school-aged children in pilot areas
•
those in long-stay residential care homes
•
carers
Health and social care workers who are in direct contact with patients or service
users should be offered flu vaccination by their employer
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The national flu immunisation programme 2014/15
Clinical risk groups who should
receive flu vaccine
Clinical risk category
Chronic respiratory disease
Examples (this list is not exhaustive and decisions should be based on clinical
judgement)
Asthma that requires continuous or repeated use of inhaled or systemic steroids or with
previous exacerbations requiring hospital admission.
Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and
emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and
bronchopulmonary dysplasia (BPD).
Children who have previously been admitted to hospital for lower respiratory tract
disease.
Chronic heart disease
Chronic kidney disease
Chronic liver disease
Chronic neurological disease
(included in the DES directions for
Wales)
Diabetes
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see precautions section on live attenuated influenza vaccine
Congenital heart disease, hypertension with cardiac complications, chronic heart failure,
individuals requiring regular medication and/or follow-up for ischaemic heart disease.
Chronic kidney disease at stage 3, 4 or 5, chronic kidney failure, nephrotic syndrome,
kidney transplantation.
Cirrhosis, biliary atresia, chronic hepatitis
Stroke, transient ischaemic attack (TIA). Conditions in which respiratory function may be
compromised due to neurological disease (e.g. polio syndrome sufferers).
Clinicians should offer immunisation, based on individual assessment, to clinically
vulnerable individuals including those with cerebral palsy, learning difficulties, multiple
sclerosis and related or similar conditions; or hereditary and degenerative disease of the
nervous system or muscles; or severe neurological disability
Type 1 diabetes, type 2 diabetes requiring insulin or oral hypoglycaemic drugs, diet
controlled diabetes.
The national flu immunisation programme 2014/15
Clinical risk groups who should
receive flu vaccine (cont)
Clinical risk category
Immunosuppression (see
contraindications and
precautions section on live
attenuated influenza
vaccine)
Examples (this list is not exhaustive and decisions should be based on
clinical judgement)
Immunosuppression due to disease or treatment, including patients
undergoing chemotherapy leading to immunosuppression, bone marrow
transplant, HIV infection at all stages, multiple myeloma or genetic
disorders affecting the immune system (e.g. IRAK-4, NEMO, complement
disorders)
Individuals treated with or likely to be treated with systemic steroids for
more than a month at a dose equivalent to prednisolone at 20mg or more
per day (any age), or for children under 20kg, a dose of 1mg or more per kg
per day.
It is difficult to define at what level of immunosuppression a patient could
be considered to be at a greater risk of the serious consequences of
influenza and should be offered influenza vaccination. This decision is best
made on an individual basis and left to the patient’s clinician.
Some immunocompromised patients may have a suboptimal immunological
response to the vaccine.
Asplenia or dysfunction of the This also includes conditions such as homozygous sickle cell disease and
spleen
coeliac syndrome that may lead to splenic dysfunction.
Pregnant women
Pregnant women at anystage of pregnancy (first, second orthirdtrimesters).
see precautions section on live attenuated influenza vaccine
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The national flu immunisation programme 2014/15
Flu immunisation should also be offered to:
•
Those living in long-stay residential care homes or other long-stay
care facilities where rapid spread is likely to follow introduction of infection
and cause high morbidity and mortality
(this does not include prisons, young offender institutions, university halls of
residence etc.)
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•
Those who are in receipt of a carer’s allowance, or those who are the
main carer of an elderly or disabled person whose welfare may be at risk if
the carer falls ill
•
Health and social care staff in direct contact with patients/service users
(they should be vaccinated by their employer as part of an OH programme)
The national flu immunisation programme 2014/15
Other groups who should receive flu vaccine
•
The list of clinical risk groups is not exhaustive
•
Healthcare practitioners should apply clinical judgement to take into account
the risk of flu exacerbating any underlying disease that a patient may have, as
well as the risk of serious illness from flu itself
•
Flu vaccine should be offered to such patients even if the individual is not in
the clinical risk groups specified in the risk groups list
•
Consideration should also be given to the vaccination of household contacts
or carers of immunocompromised individuals
i.e. individuals who expect to share living accommodation on most days over the winter and therefore
for whom continuing close contact is unavoidable
•
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Child contacts of very severely immunocompromised individuals should be
given inactivated vaccine
The national flu immunisation programme 2014/15
Why vaccinate these risk groups?
Influenza-related population mortality rates and relative risk of death among those aged six months to
under 65 years by clinical risk group in England, September 2010 – May 2011
Number of fatal flu cases
(%)
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Age-adjusted relative risk
In a risk group
213 (59.8)
Mortality rate per 100,000
population
4.0
Not in any risk group
143 (40.2)
0.4
Baseline
Chronic renal disease
19 (5.3)
4.8
18.5
Chronic heart disease
32 (9.0)
3.7
10.7 (7.3-15.7)
Chronic respiratory disease
59 (16.6)
2.4
7.4 (5.5-10.0)
Chronic liver disease
32 (9.0)
15.8
48.2 (32.8-70.6)
Diabetes
26 (7.3)
2.2
5.8 (3.8-8.9)
Immunosuppression
71 (19.9)
20.0
47.3 (35.5-63.1)
Chronic neurological disease
(excluding stroke/transient
ischaemic attack)
42 (11.8)
14.7
40.4 (28.7-56.8)
Total
378
0.8
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11.3 (9.1-14.0)
Vaccination of clinical risk groups
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•
Increasing flu vaccine uptake in clinical risk groups important because of
increased risk of death and serious illness if people in these groups catch
flu
•
For a number of years only around half of patients aged six months to under
65 in clinical risk groups have been vaccinated
•
Despite those with liver disease and chronic neurological disease having
some of the highest mortality rates, they have the lowest flu vaccine uptake
rate amongst those in clinical risk groups
•
2014/15: request to prioritise the improvement of vaccine uptake in those
with chronic liver and neurological disease, including those with learning
disabilities
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Flu vaccine uptake by clinical risk group in
2012/13
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Flu vaccine uptake rates 2011/12 – 2013/14
2014/15 aim: all eligible individuals offered flu vaccine and a minimum 75%
uptake for those aged 65 years and over and for health and social care workers
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Pregnant women
•
Pregnant women at increased risk from complications if they contract flu
•
Having flu during pregnancy may be associated with premature birth and
smaller birth size and weight
•
Flu vaccination during pregnancy provides passive immunity against flu to
infants in the first few months of life
•
Studies on safety of flu vaccine in pregnancy show that inactivated flu
vaccine can be safely and effectively administered during any trimester of
pregnancy
•
No study to date has demonstrated an increased risk of either maternal
complications or adverse fetal outcomes associated with inactivated flu
vaccine
All pregnant women are recommended to receive the inactivated flu
vaccine irrespective of their stage of pregnancy
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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:
• Child to child
• Child to adult
• Child 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
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Health and social care workers
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•
Frontline health and social care workers have a duty of care to protect their
patients and service users from infection.
•
Vaccination of health and social care workers protects them & reduces risk of
spreading flu to their patients, service users, colleagues and family members
•
Evidence that it significantly lowers rates of flu-like illness, hospitalisation and
mortality in older people in healthcare settings
•
Reduces transmission of flu to vulnerable patients, some of whom may have
impaired immunity that may not respond well to immunisation
•
Vaccination of health and social care workers can also help reduce sickness
absences and contributes to keeping the NHS and care services running
through winter pressures
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Health and social care workers (cont)
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•
NHS and social care bodies have responsibility to ensure, as far as is
reasonably practicable, that health and social care workers are free of, and are
protected from exposure to infections that can be caught at work
•
Responsibility for funding and administering seasonal flu vaccine to staff lies
with employers
•
Trusts/ employers should ensure that health and social care staff directly
involved in delivering care are encouraged to be immunised and that processes
are in place to facilitate this
•
2013/14: marked improvement in flu vaccination of health care workers with
final overall uptake rate 54.8% compared to 45.6% previous year.
•
However, overall level of uptake is still below the 75% aspiration
•
See NHS Employers flu fighter campaign www.nhsemployers.org/flu
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When to vaccinate
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•
As early as possible between September and early November before flu
starts circulating in the community
•
Flu can circulate considerably later than this however so clinical judgement
should be applied to assess needs of individual patients for vaccination
beyond this time period
•
This should take into account level of flu-like illness in community and fact that
the immune response following flu vaccination takes about two weeks to
develop fully
•
Protection afforded by the vaccine thought to last at least one influenza
season
•
However, as antibody levels likely to reduce in subsequent seasons and may
be changes to circulating strains from one season to next, annual
revaccination is important
The national flu immunisation programme 2014/15
Which flu vaccine should be used?
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Types of flu vaccines
Two main types of vaccine available:
• Inactivated – by injection
• Live - by nasal application
None of the influenza vaccines can cause clinical influenza in those that
can be vaccinated
Trivalent: most inactivated flu vaccines contain two subtypes of Influenza A and
one type B virus
Quadrivalent: an inactivated vaccine containing 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,
a quadrivalent live intranasal vaccine will be offered to children aged
2yrs and over in the 2014/15 flu season
*Quadrivalent inactivated influenza vaccine only authorised for children aged 3 years and older
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Live attenuated influenza vaccine (LAIV)
•
A live attenuated intranasal spray called Fluenz Tetra® is the recommended
vaccine for the childhood flu programme
•
The live attenuated influenza vaccine (LAIV) has been shown to be more
effective in children compared with inactivated influenza vaccines
•
It may offer some protection against strains not contained in the vaccine as well as
to those that are
•
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 and a
very similar trivalent vaccine has an established history of use in the United States
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Inactivated flu vaccines
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•
A number of different manufacturers produce flu vaccines Those available for
2014/15 season are listed in Green Book Influenza chapter 19
•
Most of the inactivated vaccines are administered by intramuscular injection,
although one vaccine (Intanza®) is administered by the intradermal route
•
Most flu vaccines are prepared from viruses grown in embryonated hens eggs
– details of ovalbumin content available in Green Book and product SPC
•
Some flu vaccines are restricted for use in particular age groups. The SPC for
individual products should always be referred to when ordering vaccines
for particular patients
The national flu immunisation programme 2014/15
Storage of flu vaccine
Efficacy, safety and quality may be adversely affected if vaccines are not
stored at the temperatures specified in the licence
Flu vaccines 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 highly likely that all the Fluenz Tetra® supplied centrally will have
expired by February 2015. It is therefore important to ensure that efforts
are made to vaccinate children before the Christmas holidays
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How many doses?
Vaccine type
Authorised age indication Dose
Live attenuated intranasal
vaccine - Fluenz Tetra®
Children aged two to under 18
years (if no contraindications)
Single application in each nostril of 0.1ml
Children NOT in clinical risk groups only
require one dose of this vaccine.
Children in clinical risk groups aged two to
under nine years who have not received
influenza vaccine before should receive a
second dose of vaccine at least four weeks
later.
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N.B Follow Green Book not SPC
Single injection of 0.5ml
Inactivated intramuscular
vaccine (number of different
brands)
Children aged six months and
older and adults
Inactivated intradermal
vaccine - Intanza® 9µg
Adults aged 18 years to 59
years
Single injection of 0.1ml
Inactivated intradermal
vaccine - Intanza® 15µg
Adults aged 60 years and older
Single injection of 0.1ml
(N.B some of the vaccines are
not authorised for young
children)
The national flu immunisation programme 2014/15
Children aged six months to under nine
years who have not received influenza
vaccine before should receive a second
dose of vaccine at least four weeks later.
Flu vaccine composition 2014/15
Trivalent vaccines will contain the following three viruses:
A/California/7/2009 (H1N1)pdm09-like virus
A/Texas/50/2012 (H3N2)-like virus
B/Massachusetts/2/2012-like virus
In addition to the above, the quadrivalent vaccine will also contain:
B/Brisbane/60/2008-like virus
None of the influenza vaccines for the 2014/15 season contain thiomersal as
an added preservative
More detailed information on the characteristics of the available vaccines,
including age indications and ovalbumin (egg) content can be found in the
Influenza chapter of the Green Book
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Flu vaccine presentation and dosage
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•
Inactivated flu vaccines for intramuscular (IM) administration supplied as
suspensions in pre-filled syringes.
•
If SPC for IM inactivated flu vaccine states young children can be given
either a 0.25ml or a 0.5ml dose, give 0.5ml dose
•
Intanza®, the intradermal vaccine, is supplied in a micro-needle injection
system
•
Fluenz Tetra®, the intranasal vaccine, is supplied as a nasal spray
suspension in a special single use, pre-filled, nasal applicator. No
reconstitution or dilution required. Each applicator contains 0.2ml
(administered as 0.1 ml per nostril)
The national flu immunisation programme 2014/15
Vaccine administration
Intramuscular flu vaccines should be given into the upper arm (or anterolateral
thigh in infants)
Individuals with a bleeding disorder should be given vaccine by deep
subcutaneous injection to reduce the risk of bleeding
Intradermal: Intanza® is supplied in a micro-needle injection system that should
be held at right-angles to the skin. The device allows intradermal vaccination
to be performed without the need for additional training
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•
IM and ID vaccines should be given at separate sites, preferably in a different
limb. If given in the same limb, they should be given at least 2.5cm apart
•
Both inactivated and live flu vaccines can be given at the same time as, or at
any interval before or after, other vaccines
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Administration of Fluenz Tetra®
• Fluenz Tetra® 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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The national flu immunisation programme 2014/15
Administration of flu vaccines
Flu vaccines may only be administered:
• Against a prescription written manually or electronically by a registered
medical practitioner or other authorised prescriber
• Against a Patient Specific Direction
• Against a Patient Group Direction
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Contraindications
There are very few individuals who cannot receive any flu
vaccine
Where there is doubt, expert advice should be sought
promptly so that the period the individual is left
unvaccinated is minimised
For children aged 2-18 years, where live flu vaccine
cannot be given, it is likely that inactivated vaccine
could be given instead
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The national flu immunisation programme 2014/15
Contraindications to flu vaccines
• Confirmed anaphylactic reaction to a previous dose of flu vaccine
• Confirmed anaphylactic reaction to any component of the vaccine
The live attenuated flu vaccine should not be given to children who are:
• Severely immunodeficient due to conditions or immunosuppressive
therapy:





Acute and chronic leukaemias
Lymphoma
HIV positive patient not on highly active antiretroviral therapy
Cellular immune deficiencies
High dose steroids
• Receiving salicylate therapy
• Known to have egg allergy
• Known to be pregnant
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Precautions to flu vaccines
Acute severe febrile illness:
•
defer until recovered
Heavy nasal congestion:
•
defer live intranasal vaccine until resolved or consider inactivated flu vaccine
Use with antiviral agents against flu:
• The live intranasal vaccine (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 flu immunisation programme 2014/15
Severe asthma or active wheezing
The live attenuated influenza vaccine (Fluenz Tetra®) is not recommended for
those children:
•
with a history of active wheezing at the time of vaccination (until at least 7
days after wheezing has stopped) or
•
who are currently taking or have been prescribed oral steroids in the last 14
days or
•
who are currently taking a high dose inhaled steroid - Budesonide >800
mcg/day or equivalent* (e.g. Fluticasone > 500 mcgs/day) because of
limited safety data in these groups
* In children aged 5-12 years, the definition of severe asthma corresponds to the British Thoracic
Society BTS Sign Step 5
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Egg allergy
•
Most flu vaccines are prepared from flu viruses grown in embryonated hens eggs
and the final vaccine products contains varying amounts of egg (as ovalbumin)
•
Fluenz Tetra® contains traces of egg and is therefore not suitable for children with
any degree of egg allergy
•
Patients with egg allergy should be immunised in primary care using either
 an egg-free flu vaccine (licensed from 18yrs of age) or
 an inactivated flu vaccine with an ovalbumin content less than 0.12 µg/ml (equivalent to
0.06 µg for 0.5 mL dose)
•
Vaccines with ovalbumin content more than 0.12 µg/ml or where content is not
stated should not be used in egg-allergic individuals
•
Ovalbumin content of flu vaccines is given in the Green Book Influenza chapter
•
Patients with either confirmed anaphylaxis to egg or egg allergy and severe
uncontrolled asthma should be referred to specialists for immunisation in hospital
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Risk of transmission of vaccine virus
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•
Theoretical potential for transmission of live attenuated virus to very
severely immunocompromised contacts (e.g. bone marrow transplant
patients requiring isolation)
•
Risk is for one to two weeks following vaccination
•
Extensive use of the live attenuated influenza 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
individuals is likely or unavoidable (e.g. household members) consider an
appropriate inactivated flu vaccine instead
The national flu immunisation programme 2014/15
Exposure of healthcare professionals to live
attenuated influenza vaccine (LAIV)
•
There may be some low level exposure to the vaccine viruses for those administering
LAIV
•
In the US, where there has been extensive use of LAIV, no reported instances of illness
or infections from the vaccine virus among HCPs or immunocompromised patients
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 influenza
•
As a precaution, very severely immunosuppressed individuals should not
administer LAIV
•
Other healthcare workers who have less severe immunosuppression or are pregnant,
should take reasonable precautions to avoid inhaling the vaccine and ensure that they
themselves are appropriately vaccinated
The national flu immunisation programme 2014/15
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Commonly reported adverse reactions
Following inactivated flu vaccine:
•
Pain, swelling or redness at the injection site, low grade fever, malaise,
shivering, fatigue, headache, myalgia and arthralgia
•
A small painless nodule (induration) may also form at the injection site
•
These symptoms usually disappear within one to two days without
treatment
Following live attenuated flu vaccine:
•
Nasal congestion/rhinorrhoea, reduced appetite, weakness and headache
Rarely, after live or inactivated vaccine, immediate reactions such as urticaria,
angio-oedema, bronchospasm and anaphylaxis can occur
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Reporting suspected adverse reactions
All serious suspected reactions following flu vaccination should be reported to
the Medicines and Healthcare products Regulatory Agency using the Yellow
Card scheme at http://yellowcard.mhra.gov.uk/.
Fluenz Tetra® and Fluarix™Tetra carry a black triangle symbol (▼) (as do all
vaccines during the earlier stages of their introduction)
This is to encourage reporting of all suspected adverse reactions
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Vaccine ordering
• General Practices are responsible for ordering sufficient flu vaccine for
eligible patients aged 18 years and older directly from manufacturers
• Ordering from more than one supplier is recommended in case of
supplier delays or difficulties in delivery of the vaccine
• PHE has centrally procured both live and inactivated flu vaccine for all
children aged from 6 months to less than 18 years old
• for children who are part of the extension of the programme (2,3,4yrs and pilots) and
• those children in clinical risk groups who are not part of the extension
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
• 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 flu immunisation programme 2014/15
Inactivated Influenza Vaccine (TIV) for children
contraindicated to receive Fluenz Tetra®
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•
Children for whom Fluenz Tetra® is contraindicated should be offered a
suitable alternative influenza 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 FluenzTetra ® can be found in the Green Book influenza chapter
•
Fluarix Tetra® is the preferred vaccine for children aged three years and over
who cannot receive Fluenz Tetra®
The national flu immunisation programme 2014/15
Beware of product confusion!
Fluarix Tetra® is an inactivated vaccine licensed from three years of age
that can be purchased for children who cannot receive the live
intranasal flu vaccine, the 65 and overs, the under 65s at risk, pregnant
women and healthcare workers
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 flu immunisation programme 2014/15
Recording of flu vaccine given
As a wide variety of influenza vaccines are on the UK market each year, it is
especially important that the following information 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:
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•
Patient's GP record (or other patient record, depending on location)
•
Personal Child Health Record (the ‘Red Book’) if a child
•
Practice computer system
•
Child Health Information System
The national flu immunisation programme 2014/15
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 flu immunisation programme 2014/15
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 in
the practice so maximum number of patients are vaccinated as early as possible
prior to the flu season (ie by the end of October), to ensure they are protected
before flu starts to circulate
9. The GP practice should collaborate with midwives to offer and provide flu
vaccination to pregnant women and to identify, offer and provide to newly pregnant
women as the flu season progresses
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The national flu immunisation programme 2014/15
Achieving high uptake (GP Practice checklist cont’d )
10.The GP practice should offer flu vaccination in clinics and opportunistically.
11.The GP practice and/ or CCG should collaborate with other providers such as
Foundation Trusts to identify and offer flu vaccination to residents in care
homes, nursing homes and house-bound patients
The GP practice checklist highlights good practice
• It is based upon the findings from a study examining the factors associated with
higher vaccine uptake in general practicei
• GP practices are encouraged to review their systems in the light of the checklist
• Some recommendations will apply to other areas where flu vaccine is given
iDexter
L 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 flu immunisation programme 2014/15
Key messages
• Flu immunisation is one of the most effective interventions immunisers can
provide to reduce harm from flu and pressures on health and social care
services during the winter
•
Increasing flu vaccine uptake in clinical risk groups is important because of
increased risk of death and serious illness if people in these groups catch flu
•
For a number of years only around half of patients aged six months to under
65 years in clinical risk groups have been vaccinated
•
Influenza during pregnancy may be associated with perinatal mortality,
prematurity, smaller neonatal size, lower birth weight and increased risk of
complications for mother
• Vaccination of health and social care workers protects them & reduces risk of
spreading flu to their patients, service users, colleagues and family members
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The national flu immunisation programme 2014/15
Resources
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•
Letter detailing 2014/15 flu programme: Department of Health, Public Health England,
NHS England. The national flu immunisation programme 2014/15. 28 April 2014.
Available at: https://www.gov.uk/government/publications/flu-immunisation-programme2014-to-2015
•
Green Book Influenza chapter updated July 2014. Available at:
https://www.gov.uk/government/collections/immunisation-against-infectious-disease-thegreen-book
•
Leaflets, posters, Q&As and other resources to support the annual flu programme
Available at: https://www.gov.uk/government/collections/annual-flu-programme
•
A video for health professionals on how to administer the Fluenz Tetra® vaccine
produced by NHS Education for Scotland is available at
http://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/publichealth/health-protection/seasonal-flu.aspx
•
Summary of Product Characteristics (SPC) for flu vaccines are available at
http://www.medicines.org.uk/emc/
The national flu immunisation programme 2014/15