GP PLT: Community Paediatrics 18th September 2012

Public Health Update: Flu Vaccination in Children Dr Caroline Hird Locum Consultant in Public Health

Latest vaccination rates Routine childhood vaccinations Q1 Highest rates ever Flu vaccination in high risk children 17.6% in 6 months – 2 years 35.9% in 2 – 16 years Flu vaccination in pregnant women 23.1% The 2012-13 Quarter 1 childhood immunisation data was published at the end of August 2012. This shows a continuing and sustained improvement in the uptake of childhood immunisations in Nottingham City. We receive information on 18 measure points at age 1, 2 and 5 years of age, across the 10 different vaccines. 16/18 of these measure points are up when compared to 2011-12 Q4 data by between 0.1% & 3.4% The 2 declines are by 0.6% & 0.7%. This information will be shared with practices individually as well as including it in the Immunisation Bulletin that is will be issued to practices this autumn. In the city the uptake for all pregnant women last year was 23.1% down from 34.4% the year before/ For at risk – 52.7% - up from 51.2% Not at risk – 20.8% down from 38.6% Target for all at risk is 70%

High risk groups Chronic respiratory disease Asthma requiring steroids or previous admissions (including inhaled steriods) Cystic fibrosis Children who have previously been admitted to hospital for lower respiratory tract disease Nine high risk groups but list is not exhaustive, clinical judgement to take into account the risk of influenza exacerbating any underlying illness as well as the risk of serious illness from influenza itself Copd: including chronic bronchitis and emphysema, bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia

High risk groups Chronic heart disease Chronic neurological disease Congenital heart disease Chronic neurological disease Conditions in which respiratory function may be compromised due to neurological disease Consider on individual basis clinical needs of patients with cerebral palsy

High risk groups Chronic kidney disease Chronic liver disease Diabetes Immune suppression Pregnancy List is not exhaustive, clinical judgement to take into account the risk of influenza exacerbating any underlying illness as well as the risk of serious illness from influenza itself Age 6 months onwards.

Vaccines 2012/13 All inactivated except intranasal (Fluenz®) 2 doses 4 weeks apart if <9 years and no previous vaccination Enzira® - not under 9’s Viroflu® and Inflexal® – not under 5’s – an A/California/7/2009 (H1N1)pdm09-like virus; – an A/Victoria/361/2011 (H3N2)-like virus; – a B/Wisconsin/1/2010-like virus.

What to do Identify children in risk groups Inform of need to vaccinate Staff member responsible for FU?

Future National children’s flu vaccination programme Details awaited From 2014 Using intranasal vaccine, live attenuated Who will deliver vaccine has not been agreed Children transmit virus to susceptible population and act as reservior