Flu vaccination in school 2017 Insert Date here © Public Health Wales Flu vaccination in school 2017 Insert Name

What is influenza (flu) Symptoms include: headache extreme tiredness high temperature aching muscles cough and cold symptoms feeling really unwell Flu is caused by a virus Spreads easily through coughs and sneezes Anyone can get flu, but rates of infection are highest among children Notes: People of any age can get flu, from the very young to the very old. Flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby, or be inhaled by them in the air. Less often, a person might also get flu by touching a surface or object such as a toy that has flu virus on it and then touching their own mouth, eyes or possibly their nose.   In Wales last winter (2016/17) 7,000 people were diagnosed with flu by their GP and many more will have had flu but didn’t visit their GP. Flu vaccination in school

Did you know that? Up to 1 in 10 children get flu every year Flu can result in: Absence from school Doctors appointments Some children are so poorly they are admitted to hospital A small number are treated in intensive care units Image © Leah Millinship Flu vaccination in school

Why vaccinate your child against flu? To protect your child against flu To protect your family and others from catching flu from your child When children get flu parents need to take time off work or ask relatives to look after their sick child/children. Children are ‘super spreaders’ of flu and other illnesses Parents may catch flu from their children and then need to take time off work unwell Children may also spread the flu virus to elderly relatives or relatives and friends with health conditions that put them more at risk from the complications of flu Flu vaccines are not suitable for children under six months of age Image © Leah Millinship Flu vaccination in school

Nasal spray flu vaccine The flu vaccine given in school is a nasal spray It is the recommended flu vaccine for children aged 2 and over Nasal spray flu vaccine has been widely used in the UK for four years It has a good safety record © Public Health Wales Flu viruses can change every year so the vaccine is changed every year to make sure the best protection is offered. The vaccine has been widely used in the UK since 2013 when the children’s flu vaccination programme was introduced Flu vaccination in school

How effective is nasal spray flu vaccine? The vaccine contains four strains of flu virus (two A and two B strains) The strains of flu virus included in the vaccine alter each year to match the WHO (World Health Organisation) recommendations Flu vaccines are usually well matched and provide good protection against flu In 2016/17 nasal spray flu vaccine was 66% effective in preventing flu infection in children aged 2–17 years in the UK End of season vaccine efficacy studies showed that nasal spray flu vaccine had been 65.8% effective in preventing flu infection among children aged 2 – 17 years in 2016/17. Overall adjusted end-of-season flu vaccine effectiveness (VE) for all types of flu vaccine was 39.8% in all age groups in 2016/17 . Reference: www.gov.uk/government/publications/influenza-vaccine-effectiveness-2016-to-2017-estimates Flu vaccination in school

The vaccination Nasal spray flu vaccine: NO NEEDLE involved - does not hurt small amount of spray up each nostril no need to sniff or breathe in © Public Health Wales no need to repeat if sneeze or runny nose nose may feel a little runny or blocked afterwards can use tissue to wipe nose afterwards if needed Children often say “it tickles” Flu vaccination in school

Are there any side effects? Most children feel fine afterwards and don’t experience any side effects Any side effects are usually mild and only last a day or two but may include: A stuffy or runny nose Headache Aching muscles Slight temperature Reduced appetite Tiredness © Public Health Wales Flu vaccination in school

Are there any children who shouldn’t have the nasal spray flu vaccine? Most children can safely have the nasal spray flu vaccine It is not recommended for a small number of children and the exclusions are outlined in the children’s flu vaccine leaflet These children will be offered an injection at their GP surgery Speak to your school nurse if you are unsure or need advice Parents of these children, who’ve consented for their child to have nasal spray flu vaccine in school, will receive a letter from the school nursing team asking them to make an appointment for their child to have a flu vaccine injection at their GP surgery. Flu vaccination in school

Who will be offered nasal spray flu vaccine in school in 2017/18 All children in reception class and school years 1, 2, 3 and 4 Children in these school years will be offered flu vaccination regardless of their date of birth Where consent for the vaccination has been received but the child is unable to attend the arranged school vaccination session, a letter will be provided by the school nursing service advising that a flu vaccination appointment may be made with their GP. Where no consent has been received, the option to have the vaccine at the GP will not be offered. Flu vaccination in school

Are younger children eligible? Children aged 2 or 3 years (age on 31st August 2017) will have their nasal flu vaccine at their GP surgery (Dates of birth from 1st September 2013 to 31 August 2015 inclusive) Flu vaccination in school

What about other children? Children aged six months and older at increased risk of becoming very ill from flu, such as those with health conditions like diabetes, heart or lung conditions should have a flu vaccine each year Children in school year 5 and above who are in a ‘risk group’ for flu should contact their GP surgery to arrange their flu vaccine Children aged 6 months to 23 months are only eligible for a flu vaccine if they have a medical condition that increases the risk of complications from flu. These children would have their flu vaccine by injection as the nasal spray isn’t suitable for this age group. There aren’t any flu vaccines suitable for babies under 6 months, which is why it’s important to have a flu vaccine during each pregnancy to protect baby in the first few months of life as well as the mum. Flu vaccination in school

Before vaccination A letter, consent form and information will be sent home with your child If you have any questions contact your school nurse The completed consent form should be returned to school as soon as possible © Public Health Wales Flu vaccination in school

Day of the vaccination Make sure you have returned your child’s consent form to school Minor illness such as a cough or cold is not a reason for your child to miss their flu vaccination The nurse will assess your child on the day and will send a letter home if they are unable to have the vaccine in school The vaccine may not work so well in children with a heavily blocked or runny nose and children who are acutely unwell or have a fever. The nurse will assess each child on the day of the vaccination in school and if this applies to your child a letter will be sent home, with your child, to enable you to obtain their flu vaccine from your GP surgery when they are well. Flu vaccination in school

On the vaccination day tell the nurse if your child…… has had their asthma treatment altered since you completed their consent form is wheezy or has been in the last 3 days is feeling unwell or has been ill recently If this applies please leave a telephone number where you can be contacted as a nurse may telephone you Flu vaccination in school

How will the vaccine be given in school? A team of nurses will visit your child’s school with all the necessary equipment A nurse will give your child the nasal spray vaccine Flu vaccination in school

GP follow up Some children will need to attend their GP for the nasal spray vaccine. These children will receive a letter from the school nurse Children who are increased risk from flu, due to a medical condition or treatment, who have never had a flu vaccination before will need a second flu vaccine not sooner than four weeks after at their GP surgery. Speak to the school nurse if this applies to your child. The vaccine may not work so well in children with a heavily blocked or runny nose and children who are acutely unwell or have a fever. The nurse will assess each child on the day of the vaccination in school and if this applies to your child a letter will be sent home, with your child, to enable you to obtain their flu vaccine from your GP surgery when they are well. Flu vaccination in school

Other information Nasal spray flu vaccine contains small traces of highly purified porcine (pork) gelatine to stabilise the vaccine Nasal spray flu vaccine provides good protection against flu in children aged 2 and over An alternative flu vaccine is not available for children who are not in a ‘risk group’ for flu It is up to an individual parent/guardian to decide if they would like their child vaccinated against flu on the basis of informed consent Gelatine is commonly used in a range of medicines, including many capsules and some other vaccines. For children who are not in an at risk group an alternative vaccine is not available in NHS Wales. Nasal spray flu vaccine is the recommended vaccine for the childhood influenza vaccination programme as it provides the greatest protection for children in the recommended age groups. Following consultation with the Muslim Council of Britain and different stakeholder groups representing views within the Muslim and Jewish communities it is acknowledged that there is diversity of opinion on porcine gelatine in medicines.   The acceptability of medication that contains components that are otherwise forbidden may depend upon a specific interpretation, and many Muslims will accept these products. Most Jewish authorities agree that limitations on medications with porcine components are only an issue with oral administration, and do not apply to injectable medications or nasal spray vaccines. This, with the additional inclusion of nasal medication, is consistent with the advice that Public Health England (PHE) obtained from the Kashrus and Medicines Information Service: ‘It should be noted that according to Jewish laws, there is no problem with porcine or other animal derived ingredients in non-oral products. This includes vaccines, including those administered via the nose, injections, suppositories, creams and ointments.’ Within the British Muslim and Jewish communities, there are some that may consider medicines and vaccines containing any porcine product to be forbidden. In these circumstances, it is likely that the individual would be unable to accept many pharmaceutical products unless there was no suitable alternative and / or the product was considered life-saving. Ultimately the patient or parent has to make a decision about vaccination on the basis of informed consent. It is recommended that eligible patients are given the relevant vaccine in a timely manner to ensure the optimum protection. Welsh Government and Public Health Wales have produced a leaflet ‘Vaccines and porcine gelatine’ for health professionals and the public which provides further information about the porcine content of vaccines. Flu vaccination in school

MMR and other vaccinations Measles is circulating in Europe with a local Welsh outbreak Has your child had two doses of MMR? (Measles, Mumps & Rubella vaccine) Are your child’s other routine vaccinations up to date? If you are unsure ask your school nurse or GP to check your child’s records Prior to October 2017 please use the version located here www.nhsdirect.wales.nhs.uk/pdfs/WGCh.pdf Flu vaccination in school Flu vaccination in school

Further Information Visit www.Beatflu.org You can speak to your School Nurse or GP NHS Direct Wales - Flu vaccine for children www.nhsdirect.wales.nhs.uk/immunisations Phone NHS Direct Wales on 0845 46 47 Flu vaccination in school

Any questions?

Template side set produced by the Vaccine Preventable Disease Programme, Public Health Wales, August 2017

Optional slides Flu vaccination in school The following two slides are optional Flu vaccination in school

Flu vaccine during pregnancy Flu vaccine is advised during pregnancy to protect mum and baby This will also help protect baby from flu during their first six months of life Flu vaccine can be given at any stage of the pregnancy Having a flu vaccine during pregnancy is very safe It is important that mothers are vaccinated against flu in each pregnancy to protect them and their baby. Flu vaccines are not available for children under the age of six months therefore it is important they receive protection against flu before birth. Whooping cough vaccine is also recommended from 16 weeks of pregnancy to protect the baby before their first vaccinations.

Are there any children who shouldn’t have the nasal spray flu vaccine? Most children can safely have the nasal spray flu vaccine It is not recommended for the small number of children who: have had a serious allergic reaction to the vaccine or any part of it are on long-term aspirin (salicylate) treatment have needed intensive care following a severe allergic reaction to eggs or egg products have severe asthma that is being treated with high dose inhaled steroids or have had oral steroids in the past 14 days are wheezy or have been wheezy in the last 3 days have increased the use of their reliever inhaler in the last 3 days have a condition that weakens their immune system are in close contact with someone who has a very weakened immune system and needs to be isolated (e.g. after a bone marrow transplant) These children will be offered an injection at their GP surgery Parents of these children (who’ve consented for their child to have nasal spray flu vaccine in school) will receive a letter from the school nursing team asking them to make an appointment for their child to have a flu vaccine injection at their GP surgery. Flu vaccination in school