Screening and Immunisation Team North Yorkshire and Humber June 2016 Immunisation Update Training 13th June 2016 Northallerton Wendy Watson and Jill Wass Screening and Immunisation Team North Yorkshire and Humber June 2016

Immunisation Uptake Q3 2015/16 Presentation title - edit in Header and Footer

Lowest %age practice uptake Presentation title - edit in Header and Footer

1st and 2nd Dose MMR up to 5 years old Need to consider improving uptake, what are others approaches? Opportunistic, texting, call from practice nurse, designated follow up within the team of non attenders

Rotavirus Sentinel Uptake 31/05/2016; Immform Data - not verified Generally good, although significant variations, again what are practices doing to encourage https://portal.immform.dh.gov.uk/DataCollections/DataCollections/Current-Surveys/Rotavirus-Data-Collections/Submit-Data.aspx

MenB vaccine coverage estimates https://www.gov.uk/government/collections/vaccine-uptake#menb-vaccine-uptake The table below shows provisional April 2016 %age uptake by CCG Presentation title - edit in Header and Footer Source :https://www.gov.uk/government/publications/meningococcal-b-immunisation-programme-vaccine-coverage-estimates

Shingles Shingles Vaccine Coverage Monitoring Programme, England . Cumulative monthly data from 1 September 2015 to 29 February 2016

HPV 1st & 2nd Dose, LA / England  Local Authority   England Kingston Upon Hull East Riding of Yorkshire North East Lincs North Lincs City of York Council North Yorkshire County Council HPV vaccine uptake % 89.4 79.5 88.5 93.9 83.3 90.1 97.4  Local Authority  Local Authority https://www.gov.uk/government/statistics/annual-hpv-vaccine-coverage-2014-to-2015-by-local-authority-and-area-team

Latest prenatal pertussis coverage Pertussis Vaccination Programme for Pregnant Women: vaccine coverage estimates in England, January to March 2016 Source : https://www.gov.uk/government/publications/pertussis-immunisation-in-pregnancy-vaccine-coverage-estimates-in-england-october-2013-to-march-2014 Presentation title - edit in Header and Footer

Vaccination in pregnancy Q1 2016 (Immform) https://portal.immform.dh.gov.uk/DataCollections/DataCollections/Current-Surveys/Flu-Data-Collections/Submit-Data.aspx

Seasonal Flu Vaccine Uptake (GP Patients) 2015/16 - ALL PRACTICES https://portal.immform.dh.gov.uk/DataCollections/DataCollections/Current-Surveys/Flu-Data-Collections/Submit-Data.aspx Report Date : 04/04/2016 11:49:54

School Child Flu Vaccine Uptake - 2015/16 - Primary School delivery (Year 1 and 2) overall % Coverage https://portal.immform.dh.gov.uk/DataCollections/DataCollections/Current-Surveys/Flu-Data-Collections/Submit-Data.aspx Report Date : 04/04/2016 13:57:46

Seasonal Flu Vaccine Uptake (GP Patients) 2015/16 Improvements in uptake for under 65s at risk- team approach follow up, proactive call up https://portal.immform.dh.gov.uk/DataCollections/DataCollections/Current-Surveys/Flu-Data-Collections/Submit-Data.aspx Report Date : 04/04/2016 11:49:54

Healthcare Worker Flu Vaccine Uptake 2015/16 Immform https://portal.immform.dh.gov.uk/DataCollections/DataCollections/Current-Surveys/Flu-Data-Collections/Submit-Data.aspx Report Date : 05/04/2016 14:52:06

Vaccine Preventable Disease Quarterly Report – June 2015 PHE

Disease Prevalence NY&H – Measles, Mumps, Pertussis N Yorkshire and Humber June 2014 Reported Lab confirmed June 2015 Measles 3 1 Mumps 154 49 62 20 Pertussis 243 191 111 77 Source: Yorkshire and the Humber Meningococcal Database

Number of confirmed meningococcal cases by sero-group and year for Yorkshire and the Humber Meningococcal serogroup No (%) 2011 2012 2013 2014 Jan to June 2015 Ungrouped/Unknown 6 1 3 10 7 B 65 79 53 45 28 C 2 W135 5 15 Y 9 Source: Yorkshire and the Humber Meningococcal Database

Total number of laboratory-confirmed pertussis cases per evaluation quarter in England: 2006 -2015 Laboratory confirmed cases of pertussis reported to the enhanced pertussis surveillance programme in England: annual report for 2015 In England there were 4190 laboratory confirmed cases of pertussis Source: Health Protection Report Vol 10 No. 16 – 6 May 2016

Age distribution of laboratory-confirmed cases of pertussis in England: 2015 PHE Infection report / Immunisation vol 10 6/05/2016 From 1 April 2016 the recommended gestational age for vaccination is between 16-32 weeks and for operational reasons vaccine should be offered from around 20 weeks on or after the foetal anomaly scan [3]. The most recent PHE figures report that the proportion of mothers due to give birth between January 2015 and December 2015 who had been immunised with a pertussis containing vaccine in pregnancy in England ranged from 55.1% to 61.6% the incidence of laboratory confirmed cases continued to be highest in infants less than three months, who are at most risk of serious disease and too young to be fully vaccinated. Confirmed pertussis incidence in this age group was 78 per 100,000 in 2015 compared to 59 per 100,000 in 2014, 50 per 100,000 in 2013 and 240 per 100,000 in 2012 (figure 2). Accordingly, the number of confirmed cases in infants <3 months increased by 33% in 2015 (130 cases) compared to 2014 (98 cases), but was 68% lower than 2012 (407 cases) and 21% lower than 2011 (164). In England, 14 deaths were reported in infants with pertussis confirmed in 2012. Following the introduction of pertussis vaccination in pregnancy; three babies died following pertussis confirmed in 2013, seven in 2014 and four in 2015. All cases were <3 months of age and therefore too young to be fully protected by infant vaccination. Only two of the infants born after the introduction of the maternal programme had a mother who had been vaccinated during pregnancy but in both cases too close to delivery to confer optimal passive protection in the infant. Women should, therefore, continue to be encouraged to be immunised against pertussis during pregnancy in order to protect their babies from birth. The advice to offer vaccination earlier in pregnancy should lead to more opportunities for pregnant women to be vaccinated and to have their vaccine status checked. It is anticipated that this will help improve coverage which is particularly important in view of the current increases in pertussis. Source: Health Protection Report Vol 10 No. 16 – 6 May 2016

Incidents and scenarios; Sample taken form the Incident log North Yorkshire and Humber

Cold Chain Fridge temperature dropped to -10 degrees. Vaccines destroyed and fridge decommissioned. New fridge purchased. Double immunisation of pre-school booster Child given pre school booster in September 2014. Immunisation given again in error June 2015. No harm to patient other than potential for more severe local reaction, but reported as an incident. Cold Chain incident Fridge door was left open Maximum temperature reached was 25 degrees, no data logger insitu so unable to establish for how long the vaccines were stored above 8 degrees to a max of 25 degrees. Advised to quarantine all vaccines (all baby vacs) contact manufacturers for vaccine stability Rotarix administered out of schedule Patient was given 1st dose of Rotarix out of schedule aged 19 weeks. 2nd dose can be administered in four weeks if attends under 24 weeks of age to complete Datix Fridge out of temperature at 24 degrees maximum all week end until Monday morning Vaccines destroyed, mainly childhood vaccines. No patients affected. Fridge out of cold chain for 24 hours up to 11 degrees. Vaccines quarantined.

Immunisation: Men B given 4 weeks early. JCVI recommend only two doses required at 2 and 4 months with a booster at 12/13 months. Notes recorded not to administer Men B at 4 months. Mum aware. Reported onto Datix. Cold Chain Fridge 1 out of cold chain to 10 degrees for ten minutes, Decanted vaccines into fridge 2, this reached 12 degrees overnight. Vaccines quarantined, manufacturers to be contacted, Flu vaccine administered twice to patient in one week. Administered a second flu vaccine to a patient a week after the first one was given in the Practice. Patient informed and no adverse effects reported. Reported internally and on Datix. Cold Chain/Fridge Failure Fridge had been out of range up to 13 degrees for 3 and 4 consecutive days on two separate occasions between 23.09.15 and 22.10.15. Double Shingles immunisation Administered a second shingles vaccine to a patient; First one was given two years ago. Double Flu immunisation: Pharmacy then GP practice HCA administered a second flu vaccine following one administered in a pharmacy two weeks previously.

Imms Delay Parent contacted SIC as child had not had immunisations at 8 weeks old, practice cancelled, Practice have staff off sick. Update at 10.12.15: Locum PN now available to catch up with baby immunisations. Cold Chain (Fridge Failure) Fridge found to be at 42 degrees on Monday morning 7.12.15. Engineer out previously on two occasions in the last few months. Vaccines disposed of and new fridge purchased vaccine given wrong route Administered the Men C vaccine orally thinking it was the Rotarix vaccine. Parents reassured. Reported internally as an SI and put on Datix system. Baby to return for oral Rotarix and IM Men C. Wrong time interval between vaccines MMR and Yellow fever vaccination given with only 1 week between vaccinations. Advised to contact NaTHNaC but Green Book guidance on administration of more than one live vaccine (Attached), implies the patient will not come to harm. Advised to report and investigate as an incident internally and confirm with SIT Immunisation update training status of immunisers within the practice.

Links to Useful Resources Guidance on giving multiple live vaccines https://www.gov.uk/government/publications/revised-recommendations-for- administering-more-than-1-live-vaccine Routine Childhood Immunisation Schedule: https://www.gov.uk/government/publications/routine-childhood-immunisation- schedule Off Label Vaccine Leaflets for Patients and Healthcare Professionals https://www.gov.uk/government/publications/off-label-vaccine-leaflets Assess your knowledge of UK immunisation policy and practice at http://immunologyquiz.phe.org.uk/ Presentation title - edit in Header and Footer

Documents and Guidelines in event of cold chain incidents

Incomplete vaccination status Also Guidance The complete routine immunisation schedule from Spring 2016 The complete immunisation schedule reflects changes in pertussis immunisation for pregnant women, which is now available from 20 weeks https://www.gov.uk/government/publications/the-complete-routine-immunisation-schedule

Vaccine Update: https://www.gov.uk/government/collections/immunisation https://www.gov.uk/government/collections/vaccine-update https://public.govdelivery.com/accounts/UKHPA/subscribers/new?preferences=true

Thank you for your kind attention today Any Questions?