Transcript Flu training template slides 2016-17 ammended version September

Flu 2016/17
Template Training Set
Vaccine Preventable Disease Programme
Public Health Wales
Vaccine Preventable Disease Programme: Promoting immunisation in Wales
Notes to trainers
• This template slide set has been produced to assist with the delivery of local
update sessions, to explain current flu epidemiology, and evidence, to share
key information, and promote positive messages about flu vaccination
• The content is not exhaustive, local trainers should check prior to use and
amend as appropriate. This template is designed to allow slides to be
added/removed to suit local delivery
• It is important to critically appraise sources of information prior to using
them in the training session
• Material contained in this document may be reproduced without prior
permission provided it is done so accurately and is not used in a misleading
context
• Acknowledgement to Public Health Wales NHS Trust Vaccine Preventable
Disease Programme to be stated
Vaccine Preventable Disease Programme – template slide set
Learning objectives
At the end of this training session, learners will be able to:
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Describe influenza infection and the associated complications
Describe the different types of influenza virus
Explain the importance of annual influenza vaccination for eligible groups
Outline the influenza programme for 2016/17
Explain why different brands of vaccine are recommended for certain
individuals
Outline the contraindications and precautions for live attenuated
intranasal vaccine and injectable influenza vaccine
Outline the administration technique for live attenuated intranasal vaccine
and injectable influenza vaccine, and possible adverse reactions
Outline strategies for improving uptake of influenza vaccination
Describe further sources of information on influenza and influenza
vaccination
Vaccine Preventable Disease Programme – template slide set
What is flu?
• Flu is a highly infectious viral illness and can cause
serious disease
• Easily transmitted by large droplets, small-particle
aerosols and by hand to mouth/eye contamination
from an infected surface or respiratory secretions of
infected person
• People with mild or no symptoms can still infect
others
• Incubation period is 1-3 days (average 2-3 days),
though may be longer especially in hosts with
immune deficiency
Vaccine Preventable Disease Programme – template slide set
Influenza (flu) viruses
There are 3 types of influenza (flu) viruses:
A - Causes epidemics and pandemics; animal
reservoir – wildfowl, also carried by other
mammals
B - May cause epidemics, predominantly found in
humans
C - Minor respiratory illness only
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Genetic changes in the flu virus – what this means
• Changes in the surface antigens (H & N) result in the flu virus
constantly changing
• Antigenic drift: refers to minor changes (natural mutations) in the
genes of flu viruses that occur gradually over time
• Antigenic shift: when two different strains combine. This abrupt major
change results in a new subtype. Immunity from previous flu
infections/vaccinations may not protect against the new subtype,
potentially leading to a widespread epidemic or pandemic
• Because of the changing nature of flu viruses, WHO monitors
their epidemiology throughout the world. Each year WHO
makes recommendations about the strains of influenza A and
B which are predicted to be circulating in the forthcoming
winter. These strains are then included in the influenza
vaccine developed each year
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Influenza vaccine composition for
2016/17
• Trivalent vaccines will contain the following three viruses:
– an A/California/7/2009 (H1N1)pdm09-like virus;
– an A/Hong Kong/4801/2014 (H3N2)-like virus;
– a B/Brisbane/60/2008-like virus.
• It is recommended that quadrivalent vaccines containing
two influenza B viruses contain the above three viruses
and a B/Phuket/3073/2013-like virus.
• None of the influenza vaccines for the 2016/17 season contain
thiomersal as an added preservative
• More detailed information on the characteristics of the available
vaccines, including age indications can be found in the June issue
248 of vaccine update
Vaccine Preventable Disease Programme – template slide set
Common symptoms include
Vaccine Preventable Disease Programme – template slide set
Complications of flu
• Common:
– Bronchitis
– Otitis media (children)
– Sinusitis
– Secondary bacterial pneumonia
• Less common:
– Meningitis, encephalitis
– Primary influenza pneumonia
• Most serious illness is seen in neonates,
pregnant women, older people and those in
clinical risk groups
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How flu spreads
• Flu spreads rapidly, especially in closed
communities. e.g. Care homes/hospitals – the virus
can live on hard surfaces for 24 hours
• Transmission is by droplets, aerosol, or through
direct contact with respiratory secretions of
someone infected with flu
• A person with flu infection may be contagious
before they feel ill
• Some individuals may be asymptomatic even with
the infection
• The illness can be infectious from one day before to
several days after symptoms start
Vaccine Preventable Disease Programme – template slide set
Burden of influenza season 2015/16
• >9,887 patients diagnosed by GPs to have flu-like
illness
• 807 patients in hospital confirmed to have influenza
• 125 patients in intensive care units (ICU) in Wales
were confirmed with influenza
• This season, confirmed cases of influenza were seen
in all age-groups, children (<15y) and adults aged
45y to 64y accounted for half of all cases
• 20 outbreaks reported to PHW (in hospitals,
residential homes nurseries and an army barracks)
• Much lower level of seasonal excess mortality than
last year
Flu epidemiology
Influenza-like illness consultation rate per 100,000 practice population in Welsh
sentinel practices
Source Vaccine Preventable Disease Programme Public Health Wales
Vaccine Preventable Disease Programme – template slide set
Seasonal influenza vaccine effectiveness (VE)
• Efficacy calculated at between 50-60% for adults aged 1865yrs, Lower efficacy in elderly although immunisation shown
to reduce incidence of severe disease including
bronchopneumonia, hospital admissions and mortality
• End of season overall adjusted VE of the 2015-2016 influenza
vaccine in preventing medical consultation in primary care
with a laboratory confirmed Influenza like illness (ILI) across
the UK was 52.4%
Pebody et al. Effectiveness of seasonal influenza vaccine in preventing
laboratory –conformed influenza in primary care in the United Kingdom:
2015/16 mid-season results. Euro Surveill. 2016;21 (13):pii=30179
Vaccine Preventable Disease Programme – template slide set
The National Influenza
Immunisation Programme 2016/17
• Eligibility
– In 2016-17 the following groups are eligible for flu vaccination:
– those aged 65 years and over
– those aged six months to under 65 years in clinical risk groups
– pregnant women
– those in long-stay residential care homes
– carers and third sector carers
– members of voluntary organisations providing emergency first aid
– community first responders
– all two and three year olds (age on 31 August 2016)
– All children in reception class and year 1,2 and 3 in primary school
– In addition, all health and social care workers with direct patients/client
contact should be offered flu vaccine by their employer
A more detailed list can be viewed in the Welsh Health Circular (2016) 039
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Individuals over the age of 65 years
Individuals aged 65 years
of age and over who catch
flu are about twenty times
more likely to die than
individuals under 65 years
of age who get flu.
(Pebody et al, 2010)
©Leah Milinship
Vaccine Preventable Disease Programme – template slide set
People with certain underlying chronic
health conditions from 6 months of age
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Chronic respiratory disease
Chronic heart disease
Chronic kidney disease
Chronic liver disease
Chronic neurological disease
Diabetes
Immunosuppression
Asplenia or splenic dysfunction
Pregnancy
Morbidly obese (class lll obesity)
–
(BMI) of 40 or more
Source: Green Book chapter 19 - Influenza
Individuals who have chronic
liver disease are around 48
times more likely to die if they
catch flu than someone with
no underlying health condition
Individuals with neurological
disease are around 40 times
more likely to die if they catch
flu
Individuals who are
immunosuppressed are around
47 times more likely to die if
they catch flu
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Pregnant women
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All pregnant women are recommended to receive the
inactivated flu vaccine irrespective of their stage of
pregnancy and with each subsequent pregnancy
Pregnant women at increased risk from complications if they
contract flu
Having flu during pregnancy may be associated with premature
birth and smaller birth size and weight
Flu vaccination during pregnancy provides passive immunity
against flu to infants in the first few months of life
Studies on safety of flu vaccine in pregnancy show that
inactivated flu vaccine can be safely and effectively administered
during any trimester of pregnancy
No study to date has demonstrated an increased risk of either
maternal complications or adverse foetal outcomes associated
with inactivated flu vaccine
Vaccine Preventable Disease Programme – template slide set
Benefits of flu vaccine
for mother and infant
• Risk of serious illness and death
from flu is higher in pregnant
women.(1)
• Influenza vaccine given to pregnant
women is 91.5% effective in
preventing hospitalisation of their
infants from influenza in the first
six months of life.(2)
1.Pebody Ret al (2010) Pandemic influenza A (H1N1) 2009 and mortality in the
United Kingdom: risk factors for death, April 2009 to March 2010.
Eurosurveillance 15(20): 19571.
2.Benowitz I, et al. Influenza vaccine given to pregnant women reduces
hospitalization due to influenza in their infants. Clin Infect Dis 2010; 51
(12):1355-61
Vaccine Preventable Disease Programme – template slide set
Uptake of influenza vaccinations in pregnant women participating in the
2013 -2016 surveys, by Health Board *
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Why vaccinate children against flu?
• Extension of the seasonal flu vaccination programme to all
children aims to appreciably lower the public health impact of
flu by:
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Providing direct protection thus preventing a large number of
cases of flu in children
Providing indirect protection by lowering flu transmission from
children:
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to other children
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to adults
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to those in the clinical risk groups of any age
• Reducing flu transmission in the community will avert many
cases of severe flu and flu-related deaths in older adults and
people with clinical risk factors
• Annual administration of flu vaccine to children is expected to
substantially reduce flu-related illness, GP consultations,
hospital admissions and deaths
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Uptake of flu vaccine in children
2015/16
• Uptake of influenza immunisation in children
aged two to three years was 44.4%
• Uptake of influenza immunisation in primary
school cohort (reception class, year 1 and 2)
was 63.4%
• No specific target will be set for children’s flu
vaccination until the programme is more
established
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Who else needs the flu vaccine?
People who could give the illness to someone
who is vulnerable or who would leave a
vulnerable person at risk if they were ill
• Health and social care workers with patient/client contact
• Residents of long-stay care facilities such as residential homes
and nursing homes
• Anyone who is the main carer for a vulnerable person (this
doesn’t include parents of healthy children)
• Third sector/voluntary carers
• Members of certain voluntary organisations who may be
involved in the provision of care at mass gatherings. This
includes members of the British Red Cross and St John
Ambulance
• Community first responders
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Healthcare workers
• Patients can infect healthcare workers.
Healthcare workers are at risk of
occupationally acquired flu.
• Healthcare workers can infect
patients. Several studies show patients in
risk groups such as the elderly are at
increased risk of catching and dying from
flu if cared for by unvaccinated staff
• Vaccination of healthcare workers against
flu is a World Health Organisation
recommendation. It has been policy in the
United Kingdom since 2000
Vaccine Preventable Disease Programme – template slide set
Key messages to health and social care workers
• Duty of care as professionals to patients or residents to do everything in your
power to protect them against infection, including being immunised against flu
• Getting vaccinated against flu can help protect you, your patients and family
• Everyone is susceptible to flu, even if you are in good health and eat well
• You can be infected with the virus and have no symptoms but can still pass flu
virus to others including patients or residents
• Impact of flu on frail and vulnerable patients can be fatal and outbreaks can
cause severe disruption in communities, care homes and hospitals
• Flu vaccine has a good safety record and will help protect you. It cannot give
you flu. Having the vaccination can encourage your colleagues to do likewise
• Throughout the last ten years there has generally been a good to moderate
match between the strains of flu virus in the vaccine and those that
subsequently circulated
• Staff act as positive role models for patients aged 65 and over, those with
long-term health conditions and pregnant women to take up the offer too
Vaccine Preventable Disease Programme – template slide set
Healthcare workers
Click here to view: “Flu signs’’
Vaccine Preventable Disease Programme – template slide set
Healthcare workers
Are you a healthcare worker? Will you get your flu vaccine this
year? Unsure, Watch Louise’s story
Get your flu vaccine to protect yourself, your family and your patients
Vaccine Preventable Disease Programme – template slide set
Uptake of influenza immunisation in Occupational
Health departments in Health Boards and Trusts
2012/13 - 2015/16
30.2%
31.0%
27.6%
Abertawe Aneurin
Betsi
Cardiff and Cwm Taf Hywel Dda
Powys
Public
Velindre
Welsh
Bro
Bevan UHB Cadwaladr Vale UHB
UHB
UHB
Teaching
Health
NHS Trust Ambulance
Morgannwg
UHB
HB
Wales NHS
Service NHS
UHB
Trust
Trust
35.5%
40.6%
42.9%
46.0%
69.1%
62.9%
52.2%
55.1%
2015-16 season
33.9%
41.2%
36.8%
42.4%
48.6%
55.7%
41.2%
34.8%
48.7%
2014-15 season
29.8%
35.9%
41.1%
44.9%
48.3%
2013-14 season
36.5%
41.0%
44.9%
44.8%
35.9%
41.0%
49.6%
43.6%
37.6%
39.4%
40.0%
40.8%
35.9%
41.1%
41.0%
52.1%
2012-13 season
Wales
Source: Public Health Wales
Vaccine Preventable Disease Programme – template slide set
When to vaccinate
• As early as possible between September and early
November before flu starts circulating in the community
• The immune response following flu vaccination takes
about two weeks to develop fully so early vaccination is
important
• Efforts to vaccinate should continue until the end of
March and should include people who fall into an at risk group
during the flu season (for example women who become
pregnant during the influenza season)
• Protection afforded by the vaccine is thought to last at least
one influenza season
• However, as antibody levels are likely to reduce in subsequent
seasons and there may be changes to circulating strains from
one season to the next, annual revaccination is important
Vaccine Preventable Disease Programme – template slide set
Uptake targets for seasonal flu
vaccination in Wales
• 75% uptake for:
– Those age 65 years and over;
– Those aged six months to under 65 years in
clinical risk groups;
– Pregnant women.
• 50% uptake for:
– Healthcare workers with direct patient care.
No specific target will be set for children’s flu
vaccination until the programme is more established
Vaccine Preventable Disease Programme – template slide set
Influenza vaccine uptake rates in
Wales 2015/16
• 66.6% of patients aged 65 years and older have been
vaccinated against influenza (Health Board range 63.9% to
68.9%)
• 46.9% of patients aged six months to 64 years in atrisk groups have been vaccinated against influenza
(Health Board range 43.2% to 49.4%)
• Annual uptake of influenza immunisation in Health Board
and NHS staff in Wales, reported by Health Board
Occupational Health Departments continues on a positive
trend and was 46.0% during 2015/16, an increase of 3.1
from 42.9% last season
Vaccine Preventable Disease Programme – template slide set
Trends in seasonal influenza immunisation uptake in
patients aged 65 years and over and in those aged six
months to 64 years in clinical risk groups, Wales, 2008/09 –
2015/16.
Patients aged 65y and over
68.3%
48.5%
50.0%
49.7%
51.1%
2011-12
2012-13
2013-14
63.5%
67.7%
2010-11
Patients aged under 65y at risk
65.7%
67.7%
68.0%
66.6%
59.5%
49.1%
49.3%
46.9%
2015-16
2014-15
2009-10
2008-09
40.8%
Summary of influenza uptake rates in patients aged 65
years and over and six months to 64 years at risk, by
individual risk group, Wales, 2015/16.
2015-16 summary data
65y and older
Younger than 65y at risk
Diabetes
Immunosuppression
Chronic kidney disease
Chronic respiratory disease
Chronic heart disease
Neurological conditions
Chronic liver disease
Morbidly obese
Pregnant women
Carers
Vaccine Preventable Disease Programme – template slide set
66.6%
46.9%
62.3%
55.9%
51.2%
46.4%
46.7%
44.6%
40.6%
34.8%
75.6%
49.1%
Which flu vaccine should be
used?
Vaccine Preventable Disease Programme – template slide set
Types of flu vaccines
Two main types of vaccine available:
• Inactivated – by injection
• Live - by nasal application
• None of the flu vaccines can cause clinical influenza in those
that can be vaccinated
• Trivalent: flu vaccines contain two subtypes of Influenza A
and one type B virus
• Quadrivalent vaccines contain two subtypes of Influenza A
and two B virus types*
• As quadrivalent vaccines may be better matched and therefore
may provide better protection against the circulating B
strain(s) than trivalent flu vaccines, the live intranasal vaccine
offered to children aged 2yrs and over is a quadrivalent
vaccine
*Quadrivalent inactivated flu vaccine only authorised for children aged 3 years and older
Vaccine Preventable Disease Programme – template slide set
Live Attenuated Influenza Vaccine (LAIV)
• Fluenz® Tetra is the recommended flu vaccine for children
between the ages of 2 and 17 unless it is contraindicated
• Live attenuated influenza vaccine (LAIV) provides good
protection against flu for children*JCVI statement on the nasal
spray vaccine
• It may offer some protection against strains not contained in
the vaccine as well as to those that are
• It is cold adapted, so it replicates in the cooler nasal mucosa
but not at body temperature in the lungs. It cannot cause a
systemic flu illness
• Fluenz® Tetra contains 4 (two A and two B) influenza virus
strains as directed by WHO
Image source: AstraZeneca UK Ltd
Vaccine Preventable Disease Programme – template slide set
Inactivated flu vaccines
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A number of different manufacturers
produce flu vaccines. Those available for
2016/17 season are listed in the June issue
248 2016 Vaccine Update
Most of the inactivated vaccines are
administered by intramuscular injection,
although one vaccine (Intanza®) is
administered by the intradermal route
Most flu vaccines are prepared from viruses
grown in embryonated hens eggs – details
of ovalbumin content available in Vaccine
Update June 2016 and product SPC
Some flu vaccines are restricted for use in
particular age groups. The SPC for
individual products should always be
referred to when ordering vaccines for
particular patients
Vaccine Preventable Disease Programme – template slide set
Vaccine Update Issue 248
June 2016
Suitable Flu vaccines for patients in clinical risk groups
Age
Which vaccine?
How many doses?
Children aged six These children should be offered inactivated
months to less
trivalent influenza vaccine
than two years of
age in clinical risk
groups
Those who have not
received flu vaccine before
should receive a second dose
of vaccine at least four
weeks later.
Children aged
two to less than
18 years of age in
clinical risk
groups
Those aged two to less than
nine years who have not
received flu vaccine before
should receive a second dose
of vaccine at least four
weeks later
These children should be offered the live
intranasal vaccine Fluenz® Tetra unless it is
contraindicated. For those children for whom
Fluenz® Tetra is contraindicated, a suitable
inactivated flu vaccine should be offered.
The quadrivalent inactivated influenza vaccine
(Fluarix™ Tetra) is authorised for children from
the age of three years and is preferred
because of the additional protection offered.
The quadrivalent vaccine has both lineages of
influenza B and may therefore provide better
protection against the circulating B strain(s)
than trivalent inactivated influenza vaccines.
Children aged two years should be given an
inactivated trivalent vaccine.
Over 18 years
Any of the inactivated vaccines
Vaccine Preventable Disease Programme – template slide set
A single dose
Which vaccine and how many doses?
Vaccine type
Authorised age
indication
Dose
Live attenuated intranasal
vaccine - Fluenz® Tetra
Children aged two to under
18 years (if no
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.
N.B Follow Green Book not SPC
Inactivated intramuscular
vaccine (number of
different brands)
Inactivated intradermal
vaccine - Intanza® 15µg
Children aged six months and
older and adults (including
adults aged 60 years and
older)
(N.B some of the vaccines are
not authorised for young
children)
Adults aged 60 years and
older
Single injection of 0.5ml
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.
Single injection of 0.1ml
Vaccine Preventable Disease Programme – template slide set
Storage of flu vaccine
• Flu vaccines must be stored in accordance with manufacturer’s
instructions:
– Store between +2°C and +8°C
– Store in original packaging
– Protect from light
– Fluenz® Tetra may be taken out of the fridge, without being replaced,
for a maximum of 12 hours at a temperature not above 250C. If the
vaccine has not been used after this 12 hour period, it should be
disposed of
• Check expiry dates regularly:
• The expiry date on the nasal spray applicator should always be checked
before use.
– Fluenz® Tetra has an expiry date 18 weeks after manufacture – this is
much shorter than inactivated flu vaccines.
– All Fluenz® Tetra will have expired in early 2017 – aim to vaccinate
children before the Christmas holidays *
Vaccine Preventable Disease Programme – template slide set
Vaccine administration
•
Intramuscular flu vaccines should be given into the upper arm (or
anterolateral thigh in infants). Administration of intramuscular flu
vaccine to children is not a role for HCSWs
•
Individuals with a bleeding disorder should be given vaccine by deep
subcutaneous injection to reduce the risk of bleeding
•
Intradermal: Intanza® is supplied in a micro-needle injection system that
should be held at right-angles to the skin. The device allows intradermal
vaccination to be performed without the need for additional training
•
Both inactivated and live flu vaccines can be given at the same time as, or
at any interval before or after, other live and inactivated vaccines
•
Different vaccines should be given at separate sites, preferably in a different
limb. If given in the same limb, they should be given at least 2.5cm apart
Vaccine Preventable Disease Programme – template slide set
Administration of Fluenz® Tetra
• Fluenz® Tetra is a live nasal vaccine and must not be
injected
• Fluenz® Tetra can be administered at the same time as, or at
any interval from other vaccines including live vaccines
• Patient should breathe normally - no need to actively inhale or
sniff
• The vaccine is rapidly absorbed so no need to repeat either
half of dose if patient sneezes, blows their nose or their nose
drips following administration
Image courtesy of AstraZeneca
Vaccine Preventable Disease Programme – template slide set
Patient Group Directions (PGDs)
• Two separate PGDs are available:
– One for the childhood Live Attenuated
Intranasal Vaccine (LAIV) - Fluenz® Tetra
– One for the Inactivated Vaccines - Flu
injection
– Template PGDs available at:
http://nww.immunisation.wales.nhs.uk/pgds-psds
Vaccine Preventable Disease Programme – template slide set
Contraindications
• There are very few individuals who cannot receive
any flu vaccine
• Where there is doubt, expert advice should be
sought promptly so that the period the individual
is left unvaccinated is minimised
• For children aged 2-17 years, where live flu
vaccine cannot be given, it is likely that
inactivated vaccine could be given instead
Vaccine Preventable Disease Programme – template slide set
Contraindications to flu vaccines
None of the influenza vaccines should be given to those who have
had:
• Confirmed anaphylactic reaction to a previous dose of the vaccine
• Confirmed anaphylactic reaction to any component of the vaccine
The live attenuated flu vaccine should not be given to children who
are:
• Clinically severely immunodeficient due to conditions or
immunosuppressive therapy:
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Acute and chronic leukaemias
Lymphoma
HIV infection not on highly active antiretroviral therapy
Cellular immune deficiencies
High dose corticosteroids
• Receiving salicylate therapy
• Known to be pregnant
Vaccine Preventable Disease Programme – template slide set
Precautions to flu vaccines
• Acutely unwell:
defer until recovered
• Heavy nasal congestion:
defer live intranasal vaccine until resolved or consider
inactivated flu vaccine
Use with antiviral agents against flu:
• The live intranasal vaccine (Fluenz® Tetra) should not be
administered at the same time or within 48 hours of cessation
of treatment with flu antiviral agents
• Administration of flu antiviral agents within two weeks of
administration of Fluenz® Tetra may adversely affect the
effectiveness of the vaccine
Vaccine Preventable Disease Programme – template slide set
Severe asthma or active wheezing
• Live flu vaccine is not recommended for children who are
currently taking or have been prescribed oral steroids in the last
14 days
• Children currently taking a high dose inhaled steroid Budesonide >800 mcg/day or equivalent (e.g. Fluticasone > 500
mcgs/day) should only be given live flu vaccine on the advice of
their specialist
As these children are a defined flu risk group, those who cannot receive
LAIV should receive an inactivated flu vaccine
• Vaccination with Fluenz® Tetra should be deferred in children
with a history of active wheezing in the past 72 hours or those
who have increased use of bronchodilators in the previous 72
hours. If not improved after a further 72 hours then inactivated
flu vaccine should be offered to avoid delaying protection in this
high risk group
Vaccine Preventable Disease Programme – template slide set
Egg allergy - adults
• Most flu vaccines are prepared from flu viruses grown in
embryonated hens eggs-the final vaccine products contains
varying amounts of egg (as ovalbumin)
• Adults with egg allergy can be immunised in any setting using
 an inactivated flu vaccine with an ovalbumin content less than 0.12
µg/ml (equivalent to <0.06 µg for 0.5 ml dose)
• Adults with either severe anaphylaxis to egg which has
previously required intensive care, or with both egg allergy
and severe uncontrolled asthma should be referred to
specialists for immunisation in hospital
Vaccine Preventable Disease Programme – template slide set
Egg allergy - children
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•
•
•
Children with an egg allergy can be safely vaccinated with
Fluenz® Tetra in any setting (including primary care and schools)
Those with both egg allergy and clinical risk factors* that contraindicate
Fluenz® Tetra (e.g. immunosuppression) should be offered an inactivated
flu vaccine with a very low ovalbumin content (less than 0.12 μg/ml)
Children with a history of severe anaphylaxis to egg which has
previously required intensive care, should be referred to specialists
for immunisation in hospital
For children with egg allergy and asthma, follow recommendations for
severe asthma (previous slide)
*Children in a clinical risk group and aged under nine years who have not
been previously vaccinated against influenza will require a second dose
whether given LAIV or inactivated vaccine
Green Book influenza Chapter 19
Vaccine Preventable Disease Programme – template slide set
Risk of transmission
• There is the potential for transmission of live attenuated
influenza vaccine virus from the vaccinated person to other
people. This does not pose a risk to most people (including
healthcare workers). However transmission of live
attenuated influenza vaccine virus to very severely
immunocompromised contacts (e.g. bone marrow
transplant patients requiring isolation) following
immunisation with Fluenz® Tetra may pose a risk to them
– Risk is for one to two weeks following vaccination
– Where close contact is likely or unavoidable (e.g.
household members) consider using an inactivated flu
vaccine
– For less severely immunocompromised close contacts,
the benefits of immunisation outweigh any risks
Vaccine Preventable Disease Programme – template slide set
Commonly reported adverse reactions
Following inactivated flu vaccine:
• Pain, swelling or redness at the injection site, low grade fever, malaise,
shivering, fatigue, headache, myalgia and arthralgia
•
A small painless nodule (induration) may also form at the injection site
•
These symptoms usually disappear within one to two days without
treatment
Following live attenuated flu vaccine:
• Nasal congestion/rhinorrhoea, reduced appetite, weakness and headache
•
Rarely, after live or inactivated vaccine, immediate reactions such as
urticaria, angio-oedema, bronchospasm and anaphylaxis can occur
Vaccine Preventable Disease Programme – template slide set
Reporting suspected adverse reactions
• All serious suspected reactions following flu vaccination
should be reported to the Medicines and Healthcare
products Regulatory Agency using the Yellow Card
scheme at http://yellowcard.mhra.gov.uk/
• Fluenz® Tetra and Fluarix™ Tetra carry a black triangle
symbol (▼) (as do all vaccines during the earlier stages
of their introduction)
• This is to encourage reporting of all suspected adverse
reactions
Vaccine Preventable Disease Programme – template slide set
Data collection
• Public Health Wales will monitor and report on uptake of
influenza immunisations for general practice and health
boards
• Data will be collected automatically throughout the season via
the Audit+ software
• It is important that vaccinations are recorded in a timely
manner in the GP practice clinical information system using
appropriate read codes in order for it to be included in the
data collection
• Guidance on appropriate read codes for data recording
proposes will be provided by PHW on the Vaccine Preventable
Disease Programme intranet site at:
http://howis.wales.nhs.uk/immunisation
Vaccine Preventable Disease Programme – template slide set
Strategies for improving uptake
Several strategies have been identified which have
been shown to increase flu vaccination rates in
primary care settings. These include:
• Having an identified person in the practice who plans
the vaccine campaign
• Using a computer search to identify the people who
are eligible for vaccination (ideally using a programme
specifically designed for this purpose)
• Personally contacting patients to invite them for the
flu vaccine
Vaccine Preventable Disease Programme – template slide set
Strategies for improving uptake
• Ordering sufficient vaccine to meet at least 75% uptake
• Continuing to offer vaccinations until targets have been
reached or the end of the flu season, rather than stopping
earlier either on an arbitrary date or once an initial supply
of vaccines has been used up
• Producing a written report on the practice’s campaign at
the end of the campaign, including an assessment of the
practice’s performance in the campaign
• Having midwives involved in the vaccination campaign
(Dexter et al, 2012)
Vaccine Preventable Disease Programme – template slide set
Resources -
Welsh Government Posters and leaflets
NHS Wales immunisation leaflets and posters
[email protected]
Phone number: 0845 606 4050
Vaccine Preventable Disease Programme – template slide set
Resources -websites
•
•
•
•
•
•
•
NHS Direct Wales –primary source of public facing flu information in
Wales:
http://www.nhsdirect.wales.nhs.uk/Encyclopaedia/f/article/flujab,seasonal/
#Leaflets
Flu “Frequently Asked Questions”
http://nww.immunisation.wales.nhs.uk/check-the-faqs
Template PGD
http://nww.immunisation.wales.nhs.uk/pgds-psds
Public Health Wales: Influenza page
http://www.wales.nhs.uk/sitesplus/888/page/43745
Influenza vaccination programme intranet page 2016-17
http://nww.immunisation.wales.nhs.uk/flu-2016-17-season
Public Health Wales: Childhood influenza vaccination programme 2016-17
www.publichealthwales.org/childrensfluvaccine
Childhood influenza vaccination programme intranet page 2016-17
http://nww.immunisation.wales.nhs.uk/childhood-influenza-vaccinationprogramm-3
Vaccine Preventable Disease Programme – template slide set
Resources -websites
WHO influenza information
• http://www.euro.who.int/en/what-we-do/health-topics/diseases-andconditions/influenza
Beat Flu
• www.beatflu.org – public facing information, fully endorsed by Public
Health Wales
My Health Text
• My Health Text - supporting free text messaging services for general
practice
Vaccine Preventable Disease Programme – template slide set
Resources -videos
• “Flu and you” - a short video about the benefits of
flu immunisation for those aged 65 and over
• “Flu signs” - We asked healthcare workers in Wales
why they had their flu vaccine. This short video
shares some of their answers
• Louise’s story - is a short video from a nurse who
didn’t get the flu jab
• “Why would you not?” - A short video encouraging
health care workers to get the flu vaccination
• Message to say “thank you” for doing the right
thing_- A short video highlighting that More NHS
Wales staff decided to protect themselves and their
patients against flu last year than ever before
Vaccine Preventable Disease Programme – template slide set
Resources – e-learning
• Three flu related e-learning resources are
available:
– FluOne (health) - Information for all NHS
Staff
– FluOne (social) - Information for social care
staff (including care home workers)
– FluTwo - Information for immunisers
Vaccine Preventable Disease Programme – template slide set
Vaccine Preventable Disease Programme – template slide set
References
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36-44.
2. Fleming DM, Watson JM, Nicholas S et al. (1995) Study of the effectiveness of influenza vaccination in the elderly in the epidemic of 1989/90 using a general practice database.
Epidemiol Infect 115: 581–9
3. Wright PF, Thompson J, Vaughn WK et al. (1977) Trials of influenza A/New Jersey/76 virus vaccine in normal children: an overview of age-related antigenicity and reactogenicity. J
Infect Dis 136 (suppl): S731–41.
4. Mangtani P, Cumberland P, Hodgson CR et al. (2004) A cohort study of the effectiveness of influenza vaccine in older people, performed using the United Kingdom general practice
research database. J Infect Dis 190(1): 1–10.
5. Pebody, R et al. (2015) Low effectiveness of seasonal influenza vaccine in preventing laboratory-confirmed influenza in primary care in the United Kingdom: 2014/15 mid-season
results. Eurosurveillance. 20. Issue 5. www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21025
6. Immunisation against infectious disease (‘the Green Book’) Chapter 19 ‘Influenza’. Updated 21 May 2015. Available at: https://www.gov.uk/government/organisations/public-healthengland/series/immunisation-against-infectious-disease-the-green-book
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study. PLoS Med. 8: (5) e1000441.
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Vaccine Preventable Disease Programme – template slide set
References (continued)
19. Zaman K, Roy E, Arifeen SE et al. (2008) Effectiveness of maternal influenza immunisation in mothers and infants. N Engl J Med. 359: 1555-64.
20. Poehling KA, Szilagyi PG, Staat MA et al.(2011) Impact of maternal immunization on influenza hospitalizations in infants. Am J Obstet Gynecol. 204:(6 Suppl 1) S141-8.
21. Dabrera G, Zhao H, Andrews N et al. (2014) Effectiveness of seasonal influenza vaccination during pregnancy in preventing influenza infection in infants, England, 2013/14.
Eurosurveillance. Nov 13;19. www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20959
22. Tamma PD, Ault KA, del Rio C et al. (2009) Safety of influenza vaccination during pregnancy. Am. J. Obstet. Gynecol. 201(6): 547-52.
23. Department of Health, Public Health England, NHS England. Flu Plan Winter 2015/16. Published March 2015. Available at: https://www.gov.uk/government/publications/flu-plan-2015to-2016
24. Joint Committee on Vaccination and Immunisation. JCVI statement on the annual influenza vaccination programme – extension of the programme to children. 25 July 2012. Available
at: https://www.gov.uk/government/publications/jcvi-statement-on-the-routine-annual-influenza-vaccination-programme
25. Potter J, Stott DJ, Roberts MA et al. (1997) The influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients. Journal of Infectious
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26. Carman WF, Elder AG, Wallace LA et al. (2000) Effects of influenza vaccination of healthcare workers on mortality of elderly people in long term care: a randomised control trial. The
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27. Hayward AC, Harling R, Wetten S et al. (2006) Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among
residents: cluster randomised controlled trial. British Medical Journal doi:10.1136/bmj.39010.581354.55
28. Lemaitre M, Meret T, Rothan-Tondeur M et al. (2009) Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster randomised trial. Journal of American
Geriatric Society 57:1580-6.
29. Belshe RB, Edwards KM, Vesikari T et al. (2007) Live attenuated versus inactivated influenza vaccine in infants and young children. New England Journal of Medicine 356(7): 685-96.
http://www.ncbi.nlm.nih.gov/sites/entrez/17301299
30. Ashkenazi S, Vertruyen A, Aristegui J et al. (2006) Superior relative efficacy of live attenuated influenza vaccine compared with inactivated influenza vaccine in young children with
recurrent respiratory tract infections. The Pediatric Infectious Disease Journal 25(10): 870-9. http://www.ncbi.nlm.nih.gov/sites/entrez/17006279
31. Fleming DM, Crovari P, Wahn U et al. (2006) Comparison of the efficacy and safety of live attenuated cold-adapted influenza vaccine, trivalent, with trivalent inactivated influenza virus
vaccine in children and adolescents with asthma. The Pediatric Infectious Disease Journal 25(10): 860-9. http://www.ncbi.nlm.nih.gov/sites/entrez/17006278
32. Allison MA Daley MF, Crane LA et al. (2006) Influenza vaccine effectiveness in healthy 6 to 21 month-old children during the 2003--2004 season. The Journal of Pediatrics 149: 75562.
33. Neuzil KM, Jackson LA, Nelson J et al. (2006) Immunogenicity and reactogenicity of 1 versus 2 doses of trivalent inactivated influenza vaccine in vaccine-naive 5-8-year-old children.
Journal of Infectious diseases 194(8): 1032-9. http://www.ncbi.nlm.nih.gov/sites/entrez/16991077
34. Bracco Neto H, Farhat CK, Tregnaghi MW, et al. (2009) Efficacy and safety of 1 and 2 doses of live attenuated influenza vaccine in vaccine-naive children. Pediatr Infect Dis J. 28: 36571.
35. Block S L, Toback SL, Yi T et al. (2009) Efficacy of a single dose of live attenuated influenza vaccine in previously unvaccinated children: a post hoc analysis of three studies of
children aged 2 to 6 years. Clin Ther. 31: 2140-7.
36. Des Roches A, Paradis L, Gagnon R, et al. (2012). Egg-allergic patients can be safely vaccinated against influenza. J Allergy Clin Immunol. 130(5):1213-6.
37. Centers for Disease Control and Prevention. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices —
United States, 2013–2014. MMWR September 20, 2013 / 62(RR07);1-43 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6207a1.htm#LiveAttenuatedInfluenzaVaccines
38. Department of Health, Public Health England, NHS England. The national flu immunisation programme 2015 to 2016: supporting letter. 27 March 2015. Available at:
https://www.gov.uk/government/publications/flu-plan-2015-to-2016
Vaccine Preventable Disease Programme – template slide set
Acknowledgements
• This resource was prepared by the Vaccine
Preventable Disease Programme, Public Health
Wales as a national training template to
support the influenza vaccination programme
2016/17
• Some information has been adapted for use by
kind permission from colleagues in Public
Health England
Vaccine Preventable Disease Programme – template slide set