1. Immunisation Update September 2014
Dr Karen Lake
Screening and Immunisation Team
PHE

2. Contents Aim and Learning objectives Aim of immunisation programmes
Objectives of surveillance
COVER and Immform data
National schedule and updates
Influenza and child flu pilot
Cold Chain
Contacts/resources
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3. Aim
To increase knowledge and awareness of immunisation programmes and recent changes in schedule
To increase knowledge and awareness of vaccine surveillance and data
Support health care practitioners involved in discussing immunisation by providing evidence base information
Promote high uptake of immunisation by increasing knowledge and awareness
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4. Learning Objectives
Describe how immunisation programmes are monitored through the use of surveillance, the COVER programme and Immform
Describe the current UK vaccine schedule including selective vaccination and new programmes and deal with variations to the schedule
Describe the Influenza vaccine campaign for 2014/5
Define how to maintain the Vaccine Cold Chain
Identify sources of information
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5. Aim of Immunisation programmes
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6. Public health
The two public health interventions with the greatest impact are clean water and vaccination
Vaccination is the most effective medical intervention in the world
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7. Aim of Immunisation Programmes
Need to decide overall aim:
To protect those at highest risk
(selective immunisation strategy) or
To eradicate, eliminate or contain disease
(mass immunisation strategy)
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8. Selective vaccination
Sometimes vaccines do not need to be given to all, only to those at increased risk of disease:
Travel
e.g. Japanese B encephalitis
Outbreak control
e.g. Hepatitis A
High risk groups
e.g. Hepatitis B for neonates
Occupational risk Outbreak control
e.g. Anthrax
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9. Mass vaccination Either:
Eradication Disease and its causal agent have been removed worldwide e.g. smallpox
Elimination
Disease has disappeared from one WHO Region but remains elsewhere e.g. polio
Containment
The point at which the disease no longer constitutes a ‘significant public health problem’ e.g. Hib
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10. Health Professionals role…..
You are a vital part of the world wide delivery of one of the most important public health interventions
You are the front line
You ensure protection for children, some of which will last them throughout their lives
You continue to protect young people as they travel and take up an occupation
You protect those who are vulnerable as they are unable to have, or respond to immunisations
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11. Objective of Surveillance
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12. Objectives of Surveillance
Surveillance needs to be carried out both before and after a vaccine programme is introduced:
Pre-implementation of vaccine
To estimate burden of disease
To decide vaccination strategy
Post implementation of vaccine
To monitor effectiveness of vaccine strategy
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13. Surveillance for Vaccine Programmes
Disease incidence
Reports of disease from a variety of sources are collated by the Centre for Infections (CfI)
Susceptibility
Residual blood samples used for serological surveillance
Vaccine Coverage
Vaccine uptake monitored across the country, collated by CfI from local Child Health Computers
Monitoring adverse events and vaccine safety
Collated by Medicines and Healthcare products Regulatory Agency (MHRA) Yellow Card scheme
Investigated by CfI and immunisation experts worldwide
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14. Disease incidence Main sources of data: - Statutory notification
Laboratory reporting
Death notification
Other sources
- Hospital episodes
- Sentinel physician reporting
- Paediatric surveillance
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15. COVER and Immform
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16. Vaccination Coverage COVER (Cover of Vaccination Evaluated Rapidly)
It is important to know what proportion of any targeted population has received each vaccine
Since 1988 computerised child health systems across the country have held vaccination details for all children resident in the area
Every 3 months, information collected by CfI from each child health computer as to number of children who have completed scheduled vaccine courses at 1, 2 & 5y of age
This information used to evaluate and improve immunisation coverage by regular feedback to local areas
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17. COVER (cont) Additionally, COVER data can be used to:
detect change rapidly and monitor trends in uptake
provide information on impact of media stories
look for pockets of poor coverage
estimate vaccine efficacy
measure impact and success of a vaccination campaign
It is thus vital than anyone who gives an immunisation, records and reports that immunisation to the child’s local Child Health System [CHIS]
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18. COVER data at 24 months: Q4 2013/4
DTaP/IPV/Hib
PCV B
Hib/Men C
MMR 1
P’boro
97.3
93.5
93.1
Cambs
95.1
92.2
92.6
96.6
EOE
97.2
95.0
95.4
94.4
England
96.1
92.5
92.7
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19. COVER data at age 5 years: Q4 2013-4
DTaP/IPV
DTaP/IPV B
MMR 1
MMR 2
Hib/MenC B
P’boro
95.3
84.1
92.8
83.1
87.3
Cambs
94.5
88.0
92.3
86.6
91.7
EOE
96.1
91.6
94.3
90.1
94.0
England
95.7
88.5
94.2
88.2
92.1
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20. MMR 2 at 5 yrs
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21. Coverage of measles vaccination and measles notifications from 1950 to 2004
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22. Immform data: Rotavirus vaccine uptake: East Anglia April-August 2014 [dose 2]
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23. Immform: Prenatal Pertussis East Anglia 2014 April-July
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24. UK Vaccine Policy published in:
Immunisation against Infectious Disease (the ‘Green Book’)
Currently available on Department Health website
Chapters can be individually downloaded from the website and printed off - updated chapters will replace previous versions as they become available
Chief Medical Officer Updates, Letters, Publications and Urgent Communications
These detail any changes to vaccine policy and recommendations
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25. National Immunisation Schedule

26. National immunisation schedule

27. National immunisation schedule: over 65yrs
When
Diseases protected
Vaccine given
65 yrs old
Pneumococcal disease
PPV pneumococcal polysaccharide vaccine (pneumovax 11)
65 yrs and older
Influenza
Flu injection
70 yrs, 78 yrs, 79 yrs
Shingles
Zostavax (Shingles)
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28. Other selective vaccination (1) (not for travel)
Hepatitis A
Used to protect contacts of cases
Used occupationally e.g. sewage workers, lab staff
Hepatitis B
Given to specific risk groups either because of their lifestyle or health
Used to protect babies born to Hep B positive mothers
Used occupationally e.g. healthcare workers
Influenza (seasonal)
Over 65s and at risk groups
Pneumococcal
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29. Other selective vaccination (2) (not for travel)
Prenatal Pertussis
Temporary programme to provide Pertussis vaccine to women who are between weeks pregnant [from 1st July Boostrix IPV vaccine]
Rabies
Used for post-exposure prophylaxis
Used occupationally e.g. bat handlers, animal quarantine centres
TB (BCG)
< 16yr olds depending on incidence of TB where they live and/or where they originate from
Occupational risk if < 35 yrs
Varicella
Contacts of immunocompromised patients
Used occupationally e.g. health care workers, lab staff
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30. Planning schedules for individuals of uncertain or incomplete immunisation status
Transfer individual onto UK schedule if come from abroad
No need to restart schedule if evidence of previous immunisation or longer than recommended intervals between vaccine doses – restart schedule where left off [if MMR given before 12months disregard dose]
Plan catch-up immunisation schedule with minimum number of visits and minimum possible timescale
Aim to protect individual in shortest time possible
Consider vaccines that may not have been given to children coming from abroad e.g. MenC, Hib, PCV
Use PHE algorithm to help plan schedule according to age of individual
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31. Immunisations

32. Flu programme
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33. Influenza campaign
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34. Immunisations

35. 2013/4 Influenza uptakes by clinical risk group
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36. Influenza
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37. Influenza vaccine
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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38. Influenza vaccine campaign 2014-15
Over 65 yrs
Pregnant
those aged from six months in clinical risk groups
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 [yr 7 & 8] in pilot areas
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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39. Child influenza
Average influenza season: estimated 0.3% to 9.8% of 0-14 year old children present to a GP with influenza
Incidence rates can be markedly higher in the younger age groups
Influenza associated hospitalisation rates:
- 83-1,038/ 100,000 children 0-59 months old (highest in <6m) /100,000 children 5-17 years
Children more vulnerable to infection than adults when exposed
Children with influenza contribute to the burden of influenza in all age groups because they are more likely to pass on the infection than adults
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40. Extended flu programme for children
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41. Child Influenza vaccine Pilot
East Anglia participating in child flu pilot programme
School nursing/imms teams commissioned to deliver programme
School yr 7 & 8
Cambs provider: Cambridge Community Services [CCS]
P’boro provider: Cambridge and Peterborough Foundation Trust [CPFT]
Starting in Autumn Term 2014
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42. Influenza vaccine Two main types of vaccine available:
Inactivated - by intramuscular injection
Live - by nasal application
None of the influenza vaccines can cause clinical influenza in those that can be vaccinated
Most inactivated flu vaccines are trivalent, containing two subtypes of Influenza A and one type B virus
A quadrivalent live intranasal vaccine will be offered to children aged 2yrs and over in the 2014/15 flu season Fluenz Tetra® is the recommended vaccine for the childhood flu programme
*Quadrivalent inactivated influenza vaccine is only authorised for children aged three years and older
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43. Fluenz vaccine
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44. Contraindications
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45. Cold Chain
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46. Cold Chain
The ‘cold chain’ is a term used to describe the cold temperature conditions in which certain products need to be kept during storage and distribution.
Maintaining the cold chain ensures that vaccines are transported and stored according to the manufacturer’s recommended temperature range of +2˚C to +8˚C until the point of administration.
[see Green Book Chapter 3, for more details]
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47. Cold Chain
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48. Cold Chain
On receipt of vaccines, staff should check them against the order for discrepancies and leakage or damage before accepting and signing for them.
Pharmaceutical distributors and manufacturers will not accept any vaccine for return once it has left their control.
Vaccines must be refrigerated immediately and must not be left at room temperature.
The receipt of vaccines should be recorded on a stock inventory It is the responsibility of the named individuals to ensure there is adequate recording of stock ordering and receipt of vaccines.
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49. Refrigerators
Specialised refrigerators are available for the storage of pharmaceutical products and must be used for vaccines and diluents.
Ordinary domestic refrigerators must not be used. Food, drink and clinical specimens must never be stored in the same refrigerator as vaccines. Opening of the refrigerator door should be kept to a minimum in order to maintain a constant temperature. The fridge temperature gauge should be clearly visible to read without needing to open the fridge door.
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50. Read, Record, Reset, React
Read: daily reading of the thermometer’s maximum, minimum and current temperatures at the same time every day during the working week Record: recording temperatures in a standard fashion and on a standard form, including signing each entry on the recording sheet Reset: resetting the thermometer after each reading. The thermometers should also be reset when temperatures have stabilized after periods of high activity React: the person making the recording should take action if the temperature falls outside +2˚C to +8˚C and document this action.
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51. To improve uptake YOU need to….
Keep up to date with changes to policy
Ensure you have access to current vaccine policy and PGD’s
Ensure you know who to contact when you need further advice or information
Attend regular training updates
Make time to discuss parental concerns about immunisation
Make EVERY effort to vaccinate individuals, as necessary
No opportunity to vaccinate should be missed
BE KNOWLEDGABLE AND CONFIDENT
PROMOTE VACCINATION
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52. Health Protection Team Contacts
Anglia Health Protection Team
Tel option 1
Fax
Generic
Secure
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53. East Anglia SIT Contacts
Dr. Shylaja Thomas Screening and Immunisation Lead: For Cambridge and Peterborough: Dr. Colin Uju Screening and Immunisation Manager: Dr. Karen Lake Screening and Immunisation Co ordinator: For Suffolk Hossein Khaled Screening and Immunisation Manager: For Norfolk Sarah Mossop Screening and Immunisation Manager: Dr. Jamie Scott Screening and Immunisation Co ordinator:
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54. Thank you for listening
Any Questions?
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55. Resources
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56. Immunisations

57. Resources
The Green Book against-infectious-disease-the-green-book Letter detailing childhood programme: Department of Health, Public Health England, NHS England. The national flu immunisation programme 2014/ April Available at: immunisation-programme-2014-to-2015 A leaflet and a poster have been prepared specifically for the childhood influenza programme. Available at: england/series/annual-flu-programme
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58. Resources
programme PHE website with links to all national training slides: PHE Vaccine updates: Immform:
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