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Make sure you’re ready for this year’s flu immunisation programme

Healthcare practitioners involved with the campaign should be prepared to ensure administration of age-appropriate vaccinations

Healthcare practitioners involved with the campaign should be prepared to ensure administration of age-appropriate vaccinations


Picture: iStock

In March a widely distributed letter from the Department of Health and Social Care (DH) and Public Health England (PHE) (2018) outlined eligibility, priorities, types of vaccine and vaccine uptake ambitions for the 2018-19 influenza immunisation programme. 

Apart from the extension of the children’s influenza programme to school children in year five, there were no major changes to eligibility for those with long-term conditions, or those who are well but in eligible age groups. The main change was to which vaccines are recommended to different age groups. 

For a number of years there has been an awareness of the poor efficacy of the standard trivalent inactivated vaccine (TIV) in our oldest members of the population due to immunosensence (the weakening immune system of the older adult). This year, those age 65 years and over (and that will include the ‘rising 65’ – those who will be 65 by 31 March 2019) will receive the adjuvanted trivalent inactivated vaccine (aTIV). Do not forget that this applies to your staff who may be in the ‘mature’ category. 

Introducing the live attenuated influenza vaccine (LAIV), given via the nasal route to younger people, is designed to protect the older adult and the vulnerable at-risk patient, particularly knowing that children are considered the ‘super spreaders’. 

Be informed

If you are a healthcare practitioner involved in the 2018-19 flu campaign, then you need to familiarise yourself with the programme and changes to ensure administration of age-appropriate vaccinations. 

The best starting point would be to look at the information provided by PHE.

PHE has produced two free slide sets available to download for the national flu immunisation programme 2018-19, with one specifically focussing on the child immunisation campaign (PHE 2018a, 2018b). Documents specifically about the inactivated vaccines for this year (PHE 2018c) and the childhood vaccine (PHE 2018d) are also available.

Main points

Having read the literature I have summarised what I believe are the main points for practice outside the categories:

  • A large sign saying: ‘age appropriate flu vaccine’ on your fridges around the building to remind everyone to think before they give. Pharmacies will also be required to administer age appropriate vaccine.
  • The patient specific direction (PSD) for anyone vaccinating, who does not prescribe in their own right or for those who cannot work to a patient group direction, for instance, healthcare support workers and physicians’ assistants, will need to contain specific direction about which vaccine is to be administered as one size no longer fits all. They cannot be expected to make the decision of which vaccine to administer. The person signing the PSD is signing to say they have seen and assessed the individual named patient for suitability of the vaccine.   
  • Check the quadrivalent inactivated vaccine (QAIV) you have ordered as one of the brands is only licensed for aged 18 and over, therefore cannot be used for patients aged between six months and two years at risk, or patients aged two to 18 at risk for whom the LIAV is contraindicated.
  • Remember for every drug purchased over the counter, dispensed from general sales list, pharmacy list, on FP10 or administered there is a requirement for the patient to be given a patient information leaflet. For the influenza vaccination this year, this is more important as for many recipients there is a change in the vaccination.
  • Unless your practice purchased QAIV previously then your patients aged six months to two years and 18-65 who are at risk, will be getting the extra virus protection this year, and they will need to be informed of this. PHE (2018e) recommends that all vaccinators have a positive attitude and tell patients that the extra element in the vaccine will provide a wider level of protection.
  • Similarly, we need to be positive with the over 65 age group. I believe that the message to the 65 and over group should not be ‘this is new’, after all, the aTIV has been used in twenty countries or more already with good efficacy. I recall the uproar and refusal of vaccination when the swine flu vaccine came in 2009-10 – rejection of a ‘new,’ ‘untested’ vaccine was common place. However, as I pointed out at the time, with the constituents of the influenza vaccine changing annually, it is new every year. My suggestion is to tell your 65-year-old and over patients the vaccine is ‘different’ this year. Explain that as they age their body needs a little help to get the best response from the vaccine and this year it contains a key (the adjuvent) which will help in that process.   
  • It is reported though that the aTIV may result in a higher incidence of local reactions (PHE 2018a, 2018c), you can make this positive too. Local reactions are an indicator that the immune response is effective and that for the patient this means that they have had a greater response and will therefore, though not guaranteed, have more protection against the flu. 

Increasing the uptake in all influenza-eligible target categories is imperative to protect the wider population and primary care is at the forefront of the campaign. Remember, be informed and be positive.

References

 

Further reading

Public Health England (2018) National Flu Programme 2018 to 2019


About the author

Sharon Graham is senior lecturer in adult, primary care and general practice nursing, Centre of Excellence in Health Care Shrewsbury, Staffordshire University. In the interests of full disclosure, it should be noted that Ms Graham received honoraria for teaching from Seqirus over the past 12 months

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