1. Community pharmacy flu vaccination services- preparing for 2014/15

2. The national flu programme Jo Yarwood Programme Manager - Immunisation Public Health England

3. Vaccine uptake since 2000 65 and over (under 65 ‘at risk’) YearEngland (%)Scotland (%)Wales (%)Northern Ireland (%) 2000–0165.465.4653968 2001–022001–0267.565595972 2002–0368.6695472.1 (55.8)72.1 (55.8) 2003–042003–0471.071.072.5636373.4 (63.8)73.4 (63.8) 2004–0571.5 (39.9)71.7 (39.3)71.7 (39.3)636372.7 (65.2)72.7 (65.2) 2005–062005–0675.3 (48.0)75.3 (48.0)77.8 (46.3)6876.8 (80.9)76.8 (80.9) 2006–0773.9 (42.1)73.9 (42.1)75.2 (37.8)75.2 (37.8)*75.1 (71.2)75.1 (71.2) 2007–082007–0873.5 (45.3)74.3 (44.4)6475.7 (68.3) 2008–092008–0974.1 (47.1)74.1 (47.1)76.3 (47.8)76.3 (47.8)60 (41)60 (41)76.8 (74.0)76.8 (74.0) 2009–102009–1072.4 (51.6)72.4 (51.6)75.0 (53.4)64 (49)64 (49)77.0 (80.0) 2010–1172.8 (50.4)72.8 (50.4)75.3 (56.1)75.3 (56.1)65.8 (48.6)65.8 (48.6)74.9 (78.7) 2011-122011-1274.0 (51.6)74.0 (51.6)76.6 (59.7)**67.7 (50.0)77.0 (81.7) 2012-132012-1373.4 (51.3)73.4 (51.3)76.5 (55.9)67.7 (49.7)75.0 (80.2) 3

4. Flu uptake Year2012/132013/14 65 and over73.4%73.2% Under 65 at risk51.3%52.3% Pregnant women40.3%39.8% All 2 year oldsn/a42.6% All 3 year oldsn/a39.6% HCW45.9%54.8% 4

5. Getting vaccinated in pharmacies 89K people got the jab at Boots just over 20% of these were in a risk group they could therefore have got a free NHS jab. processes should be in place for GP records to be updated do these immunisations go unrecorded on GP systems? it may be that the official vaccine uptake figures produced, particularly for the under 65 at risks who are more likely to be in employment and less likely to see their GP, underestimate the true vaccine uptake figures. http://www.pjonline.com/news/research_highlights_opportunity_for_pharmacy_to_fill_gap_in_flu_vaccinations? 5

6. The risk of the risk groups Number of fatal flu cases (%) Mortality rate per 100,000 population Age-adjusted relative risk* In a risk group213(59.8)213(59.8) 4.011.3 (9.1-14.0) Not in any risk group143 (40.2) 0.4Baseline Chronic renal disease19 (5.3) 4.818.5 Chronic heart disease32 (9.0)3.710.7 (7.3-15.7) Chronic respiratory disease 59 (16.6) 2.47.4 (5.5-10.0) Chronic liver disease32 (9.0) 15.848.2 (32.8-70.6) Diabetes26 (7.3) 2.25.8 (3.8-8.9) Immunosuppression71 (19.9) 20.047.3 (35.5-63.1) Chronic neurological disease (excluding stroke/transient ischaemic attack) 42 (11.8) 14.740.4 (28.7-56.8) Total (including 22 cases with no information on clinical risk factors) 3780.8 6

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9. Vaccine uptake in all pregnant women YearEngland (%)Scotland (%) Wales (%)Northern Ireland (%) 2010-1138.065.6*39.639.6N/A 2011-122011-1227.427.441.131.731.758.458.4 2012-132012-1340.340.354.061.661.664.6 9

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11. So, what’s new? 11

12. Flu programme extension Aim to offer annual vaccination for all children age 2-16 2013/14Routine 2 and 3 yr oldsPilot yrs 0 - 6 Potential plan for next three years – 2014/15Routine 2,3 and 4 yr oldsPilot yrs 0 – 6 & 7 & 8 2015/16Extend where indicated 2016/17Extend where indicated and then ?JCVI assessment 12

13. Pilot sites and uptake SiteCohortVaccinated% Uptake Bury 167731052862.8 Cumbria 362891352837.3 Gateshead 14895778452.3 Havering 205451340865.3 Leicester 549662860052.0 Newham 307301420746.2 SE Essex 247231750970.8 Total 19892110556453.1

14. What went well? Well accepted by children Well accepted by parents Schools collaborated well Nurses enjoyed working with the children Pharmacists as joint providers Self administration 14

15. What was hard? Administrative burden (consent, screening for high risk etc.) Generally hard work Workforce capacity Working across boundaries Porcine gelatine 15

16. What vaccine should be used? Vaccine typeAuthorised age indication Dose Live attenuated intranasal vaccine - Fluenz® Children aged two to under 18 years (see precautions and 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. Inactivated intramuscular vaccine (number of different brands) Children aged six months and older and adults, although some of the vaccines are not authorised for young children – see table 19.6 Single injection of 0.5ml (see note above) 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. 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 16

17. 17 Acknowledge - EVERYBODY