FLU Update 2020

FLU Update 2020

PRE-COURSE WORKBOOK

Kirsty Armstrong

Kirsty Armstrong is an advanced nurse practitioner in out-of-hours care and a senior

lecturer in primary care and workforce development at Kingston Universtiy and St

George's University of London. Kirsty works in primary care and has published

extensively.

Her most recent publications

Armstrong, Kirsty and Olphonse, Michele (2018) Debate : should patients be charged

for missing appointments? Nursing in Practice : Voices,

Armstrong, Kirsty (2018) The safe storage and management of vaccines. Practice

Nursing, 29(4), pp. 167-170. ISSN (print) 0964-9271

Armstrong, Kirsty (2018) Undertaking ear assessment and irrigation. Journal of

General Practice Nursing, 4(1), pp. 56-60.

Armstrong, Kirsty (2017) Safely administering and storing vaccines in the community

setting. British Journal of Community Nursing, 22(9), pp. 226-229. ISSN (print) 1462-

4753

www.belmatt.co.uk

www.belmatt.co.uk

TIMETABLE GPNs/HCAs/Pharmacists ‘FLU UPDATE 2020’

PRACTICE SCENARIOS

INTRO FROM COURSE DIRECTOR

CLINICAL GUIDANCE DURING COVID19

NHS IMMUNISATIONS FAQs

LONDON IMMUNISATION COMMISSIONING TEAM

FLU AND IMMUNISATIONS CROSSWORD

FLU VACCINES 2020 SEASON

FLU VACCINATOR COMPETENCY ASSESSMENT

TOOL

1. Mrs Patel, aged 64 comes to you for her ‘flu jab. She is on no medication and has no history

of any illness or hospitalisations. How would you proceed?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

2. John Smith, 72 with COPD, comes to you for his ‘flu jab. He has recently had a chest

infection and is still on ofloxacin. Can he have his ‘flu jab today?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

3. Jenny Chan has ulcerative colitis and is currently using predsol enema – one daily (40mg).

She would like her ‘flu jab and she falls into a risk group suffering also from asthma for which

she takes her’brown’ inhaler 2 puffs twice a day. Do you have any concerns about this

patient?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

4. Kathy Bronte is 24/40 pregnant. She wants to know if she can have a ‘flu jab and why this is

recommended. Is there anything else she needs?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

5. Carmel Reid, 55 has diabetes controlled with gliclazide twice a day. She wants to go ahead

with influenza immunisation but heard that if you are allergic to eggs you cannot have the jab.

She is concerned because last time she had an omelette at her friends house she felt

nauseous afterwards and developed a rash and a temperature. What might you discuss

with this lady?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

6. Jonny aged 3 is brought by his mother for nasal flu vaccine. He is wheezy – without a

fever. What can you give today?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

PRACTICE SCENARIOS

www.belmatt.co.uk

INFLUENZA IMMUNISATION FOR PRIMARY CARE

7. Josie is aged 10 and has a severe egg allergy for which she has been hospitalised in ITU.

What ‘flu vaccine can she have ?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

8. Fred aged 5 is due an intra nasal ‘flu vaccine but is screaming, running around the room

and refuses to sit still. His parents demand you hold him down and give the vaccine. Discuss.

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

9. Joe is an 8 month old baby with cardiomyopathy? He has no allergies -should he have a ‘flu

vaccine? If so which one?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

10. Mrs Khan does not wish her 6 year old son Imran to have LAIV at school as this contains

porcine gelatine. How would you manage this? Is there an alternative for Imran?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

11. Jennifer aged 26 is 20/40 weeks pregnant. She works in a general practice as an HCA

and does not want to give intra nasal ‘flu vaccine as she hears it is ‘live’ and that these are not

be given to pregnant women. Discuss.

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

12. Your GPs keep sending you practice notes asking if you can give ‘flu immunisation to

people undergoing chemotherapy.

Can you?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

PRACTICE SCENARIOS

www.belmatt.co.uk

INFLUENZA IMMUNISATION FOR PRIMARY CARE

Influenza: Tips from the World Health Organisation

As summer speeds past with the current heat wave which we are enjoying for albeit a short

period of time, we will soon be approaching winter and the flu season. Our Flu Update on 12

August 2020 will focus on updating your knowledge and skills on the influenza virus and the

2020 vaccination programme.

Immunization is important as Influenza is a contagious, acute respiratory illness caused by

influenza viruses. There are 4 types of seasonal influenza viruses, types A, B, C and D.

Influenza A and B viruses circulate and cause seasonal epidemics of disease.

• Influenza A viruses are further classified into subtypes according to the combinations of

the hemagglutinin (HA) and the neuraminidase (NA), the proteins on the surface of the

virus. Currently circulating in humans are subtype A(H1N1) and A(H3N2) influenza viruses.

The A(H1N1) is also written as A(H1N1)pdm09 as it caused the pandemic in 2009 and

subsequently replaced the seasonal influenza A(H1N1) virus which had circulated prior to

2009. Only influenza type A viruses are known to have caused pandemics.

• Influenza B viruses are not classified into subtypes, but can be broken down into lineages.

Currently circulating influenza type B viruses belong to either B/Yamagata or B/Victoria

lineage.

• Influenza C virus is detected less frequently and usually causes mild infections, thus does

not present public health importance.

• Influenza D viruses primarily affect cattle and are not known to infect or cause illness in

people.

Influenza viruses can infect humans and other animals. Viruses that infect humans circulate in

seasonal epidemics, although some tropical regions experience endemic influenza circulation.

Influenza viruses are continuously changing, necessitating annual updates of influenza

vaccine formulations. Occasionally, animal influenza viruses may also infect humans. These

infections can manifest in a broad range of clinical symptoms from mild disease to death. If

new or adapted influenza viruses cause disease in humans, and if they can be efficiently

transmitted from person to person, then an influenza pandemic may occur. Pandemics are

characterized by the rapid dissemination of a new, virulent influenza A viruses to which there is

little or no existing immunity within the population. There have been four influenza pandemics

since 1900, with the most recent pandemic occurring in 2009 caused by a new influenza A

(H1N1) virus. Animal influenza viruses, including influenza A (H5N1) and influenza A (H7N9)

have occasionally caused illness in humans. There is limited incidences of efficient human-to-

human transmission of these viruses. However, the high case fatality rates of human infection

by these viruses highlights the importance of these pathogens to public health.


www.belmatt.co.uk

INTRODUCTION SESSION

Signs and symptoms

Seasonal influenza is characterized by a sudden onset of fever, cough (usually dry),

headache, muscle and joint pain, severe malaise (feeling unwell), sore throat and a runny

nose. The cough can be severe and can last 2 or more weeks. Most people recover from fever

and other symptoms within a week without requiring medical attention. But influenza can

cause severe illness or death especially in people at high risk .

Illnesses range from mild to severe and even death. Hospitalization and death occur mainly

among high risk groups. Worldwide, these annual epidemics are estimated to result in about 3

to 5 million cases of severe illness, and about 290 000 to 650 000 respiratory deaths.

Interestingly, at present the incidence of influenza is lower than previous years, but it is still

early days. The current COVID pandemic which ahs results in more stringent infection control,

use of PPE, quarantine of infected individuals and shielding may potentially reduce the spread

of the influenza virus. However, there is insufficient data on this at present.

In industrialized countries most deaths associated with influenza occur among people age 65

or older. Epidemics can result in high levels of worker/school absenteeism and productivity

losses. Clinics and hospitals can be overwhelmed during peak illness periods.

The effects of seasonal influenza epidemics in developing countries are not fully known, but

research estimates that 99% of deaths in children under 5 years of age with influenza related

lower respiratory tract infections are found in developing countries .

Epidemiology

All age groups can be affected but there are groups that are more at risk than others.

• People at greater risk of severe disease or complications when infected are: pregnant

women, children under 59 months, the elderly, individuals with chronic medical conditions

(such as chronic cardiac, pulmonary, renal, metabolic, neurodevelopmental, liver or

hematologic diseases) and individuals with immunosuppressive conditions (such as

HIV/AIDS, receiving chemotherapy or steroids, or malignancy).

• Health care workers are at high risk acquiring influenza virus infection due to increased

exposure to the patients and risk further spread particularly to vulnerable individuals.

In terms of transmission, seasonal influenza spreads easily, with rapid transmission in

crowded areas including schools and nursing homes. When an infected person coughs or

sneezes, droplets containing viruses (infectious droplets) are dispersed into the air and can

spread up to one meter, and infect persons in close proximity who breathe these droplets in.

The virus can also be spread by hands contaminated with influenza viruses. To prevent

transmission, people should cover their mouth and nose with a tissue when coughing, and

wash their hands regularly.

In temperate climates, seasonal epidemics occur mainly during winter, while in tropical

regions, influenza may occur throughout the year, causing outbreaks more irregularly.

The time from infection to illness, known as the incubation period, is about 2 days, but ranges

from one to four days.


www.belmatt.co.uk


Diagnosis

The majority of cases of human influenza are clinically diagnosed. However, during periods of

low influenza activity and outside of epidemics situations, the infection of other respiratory

viruses e.g. rhinovirus, respiratory syncytial virus, parainfluenza and adenovirus can also

present as Influenza-like Illness (ILI) which makes the clinical differentiation of influenza from

other pathogens difficult.

Collection of appropriate respiratory samples and the application of a laboratory diagnostic

test is required to establish a definitive diagnosis. Proper collection, storage and transport of

respiratory specimens is the essential first step for laboratory detection of influenza virus

infections. Laboratory confirmation of influenza virus from throat, nasal and nasopharyngeal

secretions or tracheal aspirate or washings is commonly performed using direct antigen

detection, virus isolation, or detection of influenza-specific RNA by reverse transcriptase-

polymerase chain reaction (RT-PCR).

Rapid influenza diagnostic tests (RIDTs) are used in clinical settings, but they have lower

sensitivity compared to RT-PCR methods and their reliability depends largely on the conditions

under which they are used.

Treatment

Patients with uncomplicated seasonal influenza:

Patients that are not from a high risk group should be managed with symptomatic treatment

and are advised, if symptomatic, to stay home in order to minimize the risk of infecting others

in the community. Treatment focuses on relieving symptoms of influenza such as fever.

Patients should monitor themselves to detect if their condition deteriorates and seek medical

attention Patients that are known to be in a group at high risk for developing severe or

complicated illness, (see above) should be treated with antivirals in addition to symptomatic

treatment as soon as possible.

Patients with severe or progressive clinical illness associated with suspected or confirmed

influenza virus infection (i.e. clinical syndromes of pneumonia, sepsis or exacerbation of

chronic underling diseases) should be treated with antiviral drug as soon as possible.

• Neuraminidase inhibitors (i.e. oseltamivir) should be prescribed as soon as possible (ideally,

within 48 hours following symptom onset) to maximize therapeutic benefits. Administration

of the drug should also be considered in patients presenting later in the course of illness.

• Treatment is recommended for a minimum of 5 days, but can be extended until there is

satisfactory clinical improvement.

• Corticosteroids should not be used routinely, unless indicated for other reasons (eg: asthma

and other specific conditions); as it has been associated with prolonged viral clearance,

immunosuppression leading to bacterial or fungal superinfection.

• All currently circulating influenza viruses are resistant to adamantane antiviral drugs (such

as amantadine and rimantadine), and these are therefore not recommended for

monotherapy.


www.belmatt.co.uk


Prevention

The most effective way to prevent the disease is vaccination. Safe and effective vaccines are

available and have been used for more than 60 years. Immunity from vaccination wanes over

time so annual vaccination is recommended to protect against influenza. Injected inactivated

influenza vaccines are most commonly used throughout the world.

Among healthy adults, influenza vaccine provides protection, even when circulating viruses do

not exactly match the vaccine viruses. However, among the elderly, influenza vaccination may

be less effective in preventing illness but reduces severity of disease and incidence of

complications and deaths. Vaccination is especially important for people at high risk of

influenza complications, and for people who live with or care for the people at high risk.

WHO recommends annual vaccination for:

• pregnant women at any stage of pregnancy

• children aged between 6 months to 5 years

• elderly individuals (aged more than 65 years)

• individuals with chronic medical conditions

• health-care workers.

Influenza vaccine is most effective when circulating viruses are well-matched with viruses

contained in vaccines. Due to the constant evolving nature of influenza viruses, the WHO

Global Influenza Surveillance and Response System (GISRS) – a system of National

Influenza Centres and WHO Collaborating Centres around the world – continuously monitors

the influenza viruses circulating in humans and updates the composition of influenza vaccines

twice a year.

For many years, WHO has updated its recommendation on the composition of the vaccine

(trivalent) that targets the 3 most representative virus types in circulation (two subtypes of

influenza A viruses and one influenza B virus). Starting with the 2013–2014 northern

hemisphere influenza season, a 4th component is recommended to support quadrivalent

vaccine development. Quadrivalent vaccines include a 2nd influenza B virus in addition to the

viruses in trivalent vaccines, and are expected to provide wider protection against influenza B

virus infections. A number of inactivated influenza vaccines and recombinant influenza

vaccines are available in injectable form. Live attenuated influenza vaccine is available as a

nasal spray.

Pre-exposure or post-exposure prophylaxis with antivirals is possible but depends on

several factors e.g. individual factors, type of exposure, and risk associated with the exposure.


www.belmatt.co.uk


Apart from vaccination and antiviral treatment, the public health management includes

personal protective measures like:

• Regular hand washing with proper drying of the hands

• Good respiratory hygiene – covering mouth and nose when coughing or sneezing, using

tissues and disposing of them correctly

• Early self-isolation of those feeling unwell, feverish and having other symptoms of influenza

• Avoiding close contact with sick people

• Avoiding touching one’s eyes, nose or mouth

• Influenza can cause mild to severe illness, and it may predispose to exacerbations of

underlying disease or development of secondary bacterial infections. Some people are at

risk for serious influenza complications, such as pregnant women, older people, young

children, and people with certain chronic health conditions. Immunization is the best

intervention to prevent influenza virus infection.

• There are numerous licensed seasonal influenza vaccines available. Several of these

vaccines have been prequalified by the WHO for purchase by UN agencies. This process of

vaccine prequalification provides independent opinion and advice on the quality, safety, and

efficacy of vaccines. There are also several vaccine candidates under development against

animal influenza viruses.

• WHO has identified several conditions which are associated with elevated risk of

complications from influenza virus infection. These groups include pregnant women,

children aged 6–59 months, the elderly, individuals with specific chronic medical conditions,

and health-care workers. For countries considering the initiation or expansion of

programmes for seasonal influenza vaccination, WHO recommends that pregnant women

should have the highest priority.

• For WHO, the development of vaccines against animal influenza viruses, as well as

seasonal influenza vaccines that induce broadly protective and long-lasting immune

responses, are high priorities. WHO supports these efforts through provision of technical

guidance and advice.

To red more of our blogs click on : https://www.belmatt.co.uk/post/preparing-for-the-flu-season


www.belmatt.co.uk


https://www.belmatt.co.uk/post/preparing-for-the-flu-season

www.belmatt.co.uk

Clinical guidance for healthcare professionals on

maintaining immunisation programmes during

COVID-19

The national immunisation programme is highly successful in reducing the incidence of

serious and sometimes life-threatening diseases such as pneumococcal and meningococcal

infections, whooping cough, diphtheria and measles. It remains important to maintain the

best possible vaccine uptake to prevent a resurgence of these infections. This will also

prevent increasing further the numbers of patients requiring health services, as well as

outbreaks of vaccine-preventable diseases, and allow us to provide important protection to

children and other vulnerable groups. Where possible, the routine immunisation programmes

should be maintained and offered in a timely manner.

Most vaccine preventable diseases are spread from person to person and so it is likely that

social distancing to prevent COVID-19 will also reduce but not abolish the risk of some

vaccine preventable diseases. Other factors, such as reduced travel overseas, may also

reduce the overall risk. However, many vaccine preventable disease are more infectious

than COVID-19 – for example measles is around six times more infectious – and so

vaccination is the only reliable way to avoid infection. In addition, for some vaccine

preventable diseases, people can carry the organism for months or even years. Infections

such as meningococcal, haemophilus influenzae type b (Hib), and pneumococcal infection

are therefore most commonly acquired from other people in your own household. Timely

vaccination is therefore still an important way of keeping people safe.

GENERAL PRINCIPLES

www.belmatt.co.uk



COVID-19

The routine immunisation programme should be maintained.

As well as protecting the individual, this will avoid outbreaks of vaccine-preventable diseases

that could further increase the numbers of patients requiring health services.

Non-scheduled vaccinations should still be given, e.g. for control of outbreak(s) of vaccine

preventable conditions as well as opportunistically, e.g. missing doses of MMR.

Anyone who has had their appointment cancelled as part of the COVID-19 response should

be invited for vaccination as soon as possible.

Immunisation should proceed providing those attending for vaccination (including parents

and carers) are well, are not displaying symptoms of COVID-19 or other infections, and are

not self-isolating because they are contacts of suspected or confirmed COVID-19 cases.

Anyone with an acute febrile illness should not be immunised until the condition has

resolved.

Post-immunisation fever is not a reason to self-isolate.

Child health surveillance (NIPE infant check): To reduce the number of visits to the

general practice, consideration could be given to carrying out the 6 to 8-week NIPE check at

the same time as the 8-week scheduled vaccinations. Please note if the 6 to 8-week baby

check has not been completed, immunisation should still start at 8 weeks of age.

Advice for healthcare workers where parents/patients have concerns about

immunisation in general practice

Parents, carers and patients may be worried they or their baby may be exposed to

coronavirus when attending the practice.

GENERAL PRACTICES

www.belmatt.co.uk



COVID-19

Individuals and carers should be informed that, despite the COVID-19 pandemic, starting

and completing routine childhood immunisations on time remain important. This will help

protect the infant or child from a range of serious and sometimes life-threatening infections.

The much-reduced incidence of infections such as invasive pneumococcal and

meningococcal disease has only come about because of high levels of vaccination. To

prevent resurgence, infants need protecting through vaccination. Pertussis still circulates at

elevated levels and pregnant women must continue to be offered the pertussis vaccine, and

their babies vaccinated against this and other infections from 8 weeks of age.

Practices should reassure individuals that the most up-to-date guidance on maintaining

social distance in the waiting room (e.g. separating individuals by 2m) and decontamination

of premises and equipment is being strictly followed in line with Public Health England (PHE)

guidance on Infection Prevention and Control (IPC). In practice, this may be achieved by

adjusting appointment times to avoid waiting with others. In some areas, practices may also

be working with neighbouring practices to deliver COVID-19 and non-COVID-19 activity on

separate sites (please below for additional information).

Compliance with national advice from PHE and others on preventing spread of coronavirus

through appropriate infection control measures will help ensure parents, carers and pregnant

women feel confident that it is safe to attend for vaccination.

Further information on COVID-19 precautions for primary care is available at:

https://www.england.nhs.uk/publication/coronavirus-standard-operating-procedures-

forprimary-care-settings/

GENERAL PRACTICES

www.belmatt.co.uk



COVID-19

Parents and carers may be concerned that their baby’s/child’s immune system cannot

cope with both COVID-19 and immunisations and that in responding to vaccines, their

ability to fight COVID-19 will be reduced/affected.

Parents and carers should be reassured that as vaccines contain either weakened viruses or

only a small amount of the inactivated organism/toxoid, the response uses only a tiny

proportion of the capacity of an individual’s immune system. Vaccination will not overload

their immune system, does not make them more susceptible to other infections and, if they

do contract an infection in the immediate post-immunisation period, or were already

incubating one when they were vaccinated, their immune system will still respond to it.

Vaccinating babies reduces the chances of co-infection with COVID-19 and a serious

vaccine-preventable disease.

Both live and inactivated vaccines should continue to be given when due.

GENERAL PRACTICES

Parents and carers may be concerned that if their baby/child develops a fever

following immunisation, they will not know if it is due to the vaccines or COVID-19.

Parents and carers should be advised that the vaccines may cause a mild fever which

usually resolves within 48 hours (or 6 to 11 days following MMR). This is a common,

expected reaction and isolation is not required, unless COVID-19 is suspected.

Fever is more common when the MenB vaccine (Bexsero) is given with other vaccines at 8

and 16 weeks of age. Where parents are able to obtain liquid infant paracetamol, they

should follow existing Public Health England (PHE) guidance on its prophylactic use

following MenB vaccination: https://www.gov.uk/government/publications/menb-vaccine-

andparacetamol

INFANT PARACETAMOL AND

PRIMARY IMMUNISATIONS

https://www.gov.uk/government/publications/menb-vaccine-andparacetamol

www.belmatt.co.uk



COVID-19

As has always been recommended, any infant with fever after vaccination should be

monitored and, if parents or carers are concerned about the infant’s health at any time, they

should seek advice from their GP or NHS 111.

This advice applies to recently vaccinated people of all ages.

Given the risk of the serious infections that the vaccines protect against, PHE recommends

that the routine primary immunisation schedule should not be delayed.

Parents may be unable to obtain liquid infant paracetamol.

While parents should continue to try to obtain and administer infant paracetamol where

possible, infant vaccines can and should still be given even if they do not have prophylactic

paracetamol to hand.

Where parents have been unable to obtain infant paracetamol, the following advice is for

clinical staff in primary care and parents.

Fever can be expected after any vaccination but is more common when the MenB vaccine

(Bexsero) is given with the other routine vaccines at 8 and 16 weeks of age.

In infants who do develop a fever after vaccination, this tends to peak around 6 hours after

vaccination and nearly always resolves completely within 2 days.

Ibuprofen can alternatively be used to treat a fever and other post-vaccination reactions.

Prophylactic ibuprofen at the time of vaccination is not effective. Ibuprofen is not licensed for

infants under the age of 3 months or with a body weight under 5kg. However, the BNF for

Children advises that ibuprofen can be used for post-immunisation pyrexia in infants aged 2

to 3 months, on doctor’s advice only, using 50mg for one dose, followed by 50mg after

6 hours if required. See the BNF for Children for more details

https://bnfc.nice.org.uk/drug/ibuprofen.html#indicationsAndDoses

Information about treating a fever in children is available from the NHS UK webpage ‘Fever

in children’ at: www.nhs.uk/conditions/fever-in-children/.



https://bnfc.nice.org.uk/drug/ibuprofen.html#indicationsAndDoses

http://www.nhs.uk/conditions/fever-in-children/

www.belmatt.co.uk



COVID-19

If an infant still has a fever 48 hours after vaccination, or if parents are concerned about their

infant’s health at any time, should be advised to seek help from their GP or ring NHS 111.

The diseases that the vaccines protect against are very serious and therefore vaccination

should not be delayed because of concerns about post-vaccination fever.

As a temporary measure, PHE have secured a small supply of liquid infant paracetamol in

sachets which can be ordered from Immform. To support their use a protocol for health

professionals to follow has been published here:

https://www.gov.uk/government/publications/menb-vaccine-and-paracetamol



Those who miss the opportunity to be vaccinated still require their missing vaccinations.

Without these they remain unprotected against vaccine-preventable disease. This makes the

retention of accurate records of unvaccinated individuals important, and their appointments

should be rescheduled as soon as is reasonably practical.

What about all those individuals who do not attend for vaccination?


www.belmatt.co.uk



COVID-19

Well individuals should attend for vaccination (with parents or carers) at premises that are

following the recommended IPC guidance. Those displaying symptoms of COVID-19, other

infections or who are self-isolating because they are contacts of suspected or confirmed

COVID-19 cases should not attend.

There is no evidence that crying or screaming are aerosol generating. A list of potentially

aerosol generating procedures is available here:

https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-

preventionand-control/covid-19-personal-protective-equipment-ppe

The immunising clinician should risk assess their need to wear PPE. All other infection

prevention precautions, such as handwashing and sharps disposal, should continue.

Guidance from NHS England on infection prevention and the use of PPE during the

COVID19 pandemic is available here: https://www.england.nhs.uk/coronavirus/primary-care/

What is the advice about personal protective equipment (PPE) and

immunisations?

NHS Specialist Pharmacy Services (SPS) has published guidance on this question:

https://www.sps.nhs.uk/articles/patient-group-direction-use-in-primary-care-networks/

Can practice nurses use patient group directions (PGDs) in primary care

networks (PCNs) at various general practice sites where they will be

vaccinating children?

https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-preventionand-control/covid-19-personal-protective-equipment-ppe

https://www.england.nhs.uk/coronavirus/primary-care/

https://www.sps.nhs.uk/articles/patient-group-direction-use-in-primary-care-networks/

www.belmatt.co.uk



COVID-19

Continue to order vaccines through the usual routes and ensure that no more than 2 weeks’

supply is maintained as stock in your vaccine fridge. This will help to avoid vaccine

shortages and reduce wastage. Vaccines near their expiry date should be used first.

What should I do about vaccine ordering during the COVID-19 pandemic?

Where vaccines remain in a site or branch that has become non-operational during the

COVID-19 pandemic, the usual cold chain guidance still applies. Further detail can be found

in Chapter 3 of the Green Book:

https://www.gov.uk/government/publications/storagedistribution-and-disposal-of-vaccines-the-

green-book-chapter-3

How do I maintain vaccine cold chain across practices where one site

may be closed?

Where the same practice has more than one site or branch, vaccines can be transferred to

the operational site, providing the cold chain is maintained.

Can I transfer vaccines between different branches of the same practice?

https://www.gov.uk/government/publications/storagedistribution-and-disposal-of-vaccines-the-green-book-chapter-3

www.belmatt.co.uk



COVID-19

NHS England has recently published guidance on transferring vaccine stock between

providers. In summary, the Medicines and Healthcare Products Regulatory Agency (MHRA)

has confirmed that it would not prevent the transfer of locally held vaccine stock from the

NHS routine immunisation services during COVID-19, provided that:

• the CCG, PCN or general practice believes the transfer of vaccine(s) is necessary to

support the continued delivery of routine immunisations in primary care during the

COVID-19 response and will ensure the effective use of available resource

• the CCG, PCN or general practice holding the vaccine stock has assurance that the

vaccine has been stored in the correct temperature-controlled conditions

• confirmed daily record-keeping of temperature monitoring is available

• the CCG, PCN or general practice requiring locally held vaccine supply can verify

the assurances given, and

• the vaccine(s) can be transported appropriately under the right cold chain conditions.

Regional NHS England and NHS Improvement commissioners should be informed of any

incidents, including cold chain breaches during transfer of vaccines. CCGs, PCNs and

primary care providers should refer to PHE’s protocol for the ordering, storing and

management of vaccines.

Further details can be found in the NHS England and NHS Improvement COVID-19 primary

care bulletin: http://createsend.com/t/d-E5434ABA283BEA792540EF23F30FEDED

Can I transfer vaccines between completely different practices (different legal

entities)?

It is important that parents and carers have a contemporaneous record of all immunisations

administered. If local advice is to not bring the Red Book (personal child health record), the

immuniser should provide sufficient information about the vaccines given to care giver to

update the record themselves. For example, a print-out, text message, email with vaccine

details.

What information should I provide parent/ carer about vaccinations

administered?

http://createsend.com/t/d-E5434ABA283BEA792540EF23F30FEDED

www.belmatt.co.uk



COVID-19

It is important to share clinical data with CHIS. CHIS’s purpose, and that of the systems that

support it, is to ensure that each child in England has an accurate, active record supporting

delivery of public health interventions, including screening, immunisation and the other

Healthy Child Programme services. CHIS providers will continue to deliver these vital

services as business as usual during the COVID-19 incident. It is therefore important that all

clinical colleagues contribute to ensuring that each child’s CHIS record is up to date by

transferring data from clinical systems in a timely manner to the local CHIS provider. This will

ensure those involved in the care of young children have access to the contemporaneous

health record to support any rescheduling and catch-up programmes for those who miss

appointments for public health programmes.

CHIS is the definitive source of immunisation uptake and coverage data in England and, as

such, is essential in limiting the spread of communicable diseases. This data is particularly

important for monitoring and ensuring uptake levels during the COVID-19 pandemic. In the

event of a cluster or an outbreak of a vaccine-preventable disease, CHIS is the primary

source of information to help target resources.

What should I do to inform my local Child Health Information Services

(CHIS) about vaccines administered?

The first annual flu letter has been published (see the link below). Further information will be

published in due course.

https://www.gov.uk/government/publications/national-flu-immunisation-programme-plan

Below we give answers to some frequently asked questions (FAQs) to help discussions with

individuals, parents or carers.

What do I need to do to prepare for the next flu season?

www.belmatt.co.uk

NHS Immunisations FAQs (for the public)

While preventing the spread of COVID-19 and caring for those infected is a public health

priority, it remains very important to maintain good coverage of immunisations, particularly in

the childhood programme. In addition to protecting the individual, this will avoid outbreaks of

vaccine-preventable diseases that could harm individuals and increase further the numbers

of patients requiring health services.

Why are you continuing to offer routine immunisations?

Yes, your GP surgery or health clinic will take all possible precautions to protect you and

your baby from COVID-19. People should still attend for routine vaccinations unless they are

unwell (check with your GP whether you should still attend) or self-isolating because they

have been in contact with someone with COVID-19. In these circumstances, please

rearrange your appointment. Vaccines are the most effective way to prevent other infectious

diseases. Babies, toddlers and pre-school children in particular need vaccinations to protect

them from measles, mumps, rubella (MMR), rotavirus, diphtheria, whooping cough,

meningitis, polio, tetanus, hepatitis B, and more.

Should people/babies still go and be immunised at their GP surgery?

Different vaccines are given at different ages to protect you and your child. They form part of

the national immunisation programme and are offered free of charge by the NHS. The

national immunisation programme is highly successful in reducing the incidence of serious

and sometimes life-threatening diseases such as pneumococcal and meningococcal

infections, whooping cough, diphtheria and measles. It remains important to maintain the

best possible vaccine uptake to prevent a resurgence of these infections.

Some children will also need to be protected with neonatal BCG and hepatitis B vaccination.

Both BCG and all doses of targeted hepatitis B vaccines should be offered in a timely

manner.

What are ‘routine’ childhood immunisations?

www.belmatt.co.uk


School-aged immunisations will be rescheduled. UK government has provided clear public

health advice on specific measures to take to prevent further coronavirus cases, including

social distancing and school closures.

If you are not doing school age immunisations when will young people

get their vaccinations?

GP practices will continue to ensure vaccinations are offered to all eligible individuals.

Despite COVID-19, the routine childhood immunisation programme will continue to play an

important role in preventing ill-health through causes other than coronavirus infection.

Do GP surgeries really still have the time to do immunisations?

It is very important that routine childhood immunisations are started and completed on time

despite the COVID-19 pandemic. This will help protect the infant or child from a range of

serious and sometimes life-threatening infections. The much-reduced incidence of infections

such as invasive pneumococcal and meningococcal disease has only come about because

of high levels of vaccination. To prevent resurgence, infants need protecting through

vaccination. Pertussis still circulates at elevated levels and pregnant women must continue

to be offered the pertussis vaccine, and their babies vaccinated against this and other

infections from 8 weeks of age. Diseases such as pertussis, Hib, MenB, pneumococcal are

more common or more serious in infants and so it is important not to delay vaccines.

Measles can be a very serious disease and is still circulating so timely immunisation is

important.

How important is it that my child is immunised at the time they are called?

Is there a risk in delaying for a few months? If there isn’t, why not stop

immunisations for now and reduce the risk of contracting COVID-19 by

visiting the general practice?

www.belmatt.co.uk


The vaccines given may cause a fever which usually resolves within 48 hours (or 6 to 11

days following MMR). This is a common, expected reaction and isolation is not required,

unless COVID-19 is suspected.

Fever is more common when the MenB vaccine (Bexsero) is given with other vaccines at 8

and 16 weeks of age. Where parents are able to obtain liquid infant paracetamol, they

should follow existing PHE guidance on its prophylactic use following MenB vaccination:


As has always been recommended, any infant with fever after vaccination should be

monitored and, if parents or carers are concerned about the infant’s health at any time, they

should seek advice from their GP or NHS 111.

This advice applies to recently vaccinated people of all ages.

How will parents and carers know when their babies have a temperature after

their regular immunisations whether it is an expected reaction or COVID-19?

www.belmatt.co.uk

Advice from the London Immunisation Commissioning Team for

delivering childhood immunisations in general practice during

COVID-19 in London

The national immunisation programmes reduce incidence of vaccine-preventable

diseases in our population. In addition to protecting the individual, the programmes

prevent outbreaks of vaccine-preventable diseases that could increase further the

numbers of patients requiring health services.

• It is important to maintain routine immunisation services and ensure on-time vaccination

according to the current recommended schedules. This will prevent a resurgence of vaccine

preventable diseases.

• Where practices experience high demand on services, it is important to prioritise time

sensitive vaccines for babies, children and pregnant women:

o All routine childhood immunisations offered to babies and infants including vaccines

due at one year of age including the first MMR dose

o All doses of targeted hepatitis B vaccines for at-risk infants should also be offered in

a timely manner

o Pertussis vaccination in pregnancy

o Pneumococcal vaccination for those in risk groups from 2 to 64 years of age and

those aged 65 years and over (subject to supplies of PPV23 and clinicalprioritisation)

The purpose of this document is to provide some public health principles to help guide you in

the delivery of vaccination services in your practice. Please read this in conjunction with

PHE and NHSE Clinical guidance for healthcare professionals on maintaining

immunisation programmes during COVID-19 (ref: 0001559).

INTRODUCTION

You will need to adapt your appointment approach and practice to comply with the

recommended measures to reduce transmission of COVID-19. This will ensure that

vaccination services can continue without exposing healthcare workers, patients, children and

their care-givers to undue risk.

• Consider timed spaced out appointments and introduce one-way patient flow through the

premises. Providing floor markings and signage should remind both workers and patients to

follow to social distancing wherever possible

• Separate vaccination visits from other patient visits – avoid sharing of a waiting room.

• Consider telecommunications for scheduling appointments.

• Reserve one room for vaccination that is well-ventilated and cleaned between patients. If

possible, this room could be accessed separately to the main entrance to the reception

area.

• Consider delivering vaccinations in a single appointment with other face-to-face contact

(e.g. baby’s 6-8 week check). This will reduce visits needed for the family and the cleaning

requirements for the practice.

• Consider a flexible offer of appointment times through a shared immunization delivery

through your EPCS services. This will help support your ‘catch-up’ and use under-utilised

appointments in the EPCS services.

• If you are considering alternative models of delivery such as outdoor areas for vaccination

or ‘drive through’ models, a risk assessment should be undertaken before any model is

implemented.

• Comply with NHSE guidance and standard operating procedures for general practice during

COVID-19

• Comply with current PHE infection control guidance and check PPE availability.

• Implement strategies to facilitate follow-up of patients with overdue vaccinations. Some

individuals will miss out on doses as there will have been reticence to come to the general

practice for vaccinations during COVID-19. It is important that they are identified, reassured

and vaccinated.

• Consider collaborating with neighbouring practices and voluntary organisations to inform the

community about the risks of not having immunisations and the safety measures practices

are undertaking.

• If you do not have capacity to meet the demand, please notify

[email protected] to help support you.

www.belmatt.co.uk



COVID-19 in London

KEY PRINCIPLES

• Consider texting, emailing or a phone call to the parents about the importance of being

vaccinated in accordance to the National Schedule, the risks of delaying vaccinations and

that it is safe to attend an immunisation appointment.

• Use text messages to remind parents that their infant vaccination appointment is due and

they that they can come to the practice for a medical appointment.

• Parents should be invited in advance for a vaccination appointment. Invitations should

include information on how the risk of COVID is being mitigated at the practice to

encourage attendance and not to attend if they are self-isolating due to COVID symptoms.

• Try to schedule the appointments rather than rely on them to book the appointment.

• A telephone consultation with parents should be done prior to the appointment to compete

the pre-immunisation discussion, discuss consent, and give postimmunisation advice prior

to the patient attending the practice.

• Acknowledge the parent/carer’s concerns around exposure to COVID-19 when attending for

immunisations.

• Do a risk assessment – ask if they have COVID-19 symptoms and not to attend if unwell or

if any member of the household is in self-isolation.

• Communicate the extra precautions and procedures you have implemented to keep them

safe whilst attending for vaccination (including your social distancing policy, PPE, surgery

access and cleaning programmes).

• If the patient must attend a different venue, talk through what the experience will be like.

• Document the telephone conversation.

www.belmatt.co.uk



COVID-19 in London

KEY PRINCIPLES

• Only one adult accompanies the infant/child.

• By having allocated appointments, it should reduce waiting times but people waiting should

observe 2m social distancing guidance.

• Where possible, only have one infant/child and parent in the room at a time.

• Check the parent and child details and check that they don’t have COVID19 symptoms.

• Observe PPE guidance from PHE.

• Patient contact can be defined as being within 2 metres. Consider positioning of the patient,

vaccinate side on to reduce face-to-face exposure.

www.belmatt.co.uk



COVID-19 in London

APPOINTMENT

• Input details onto the data management system for the child’s practice and if provided into

the Redbook (consider eRedbook). Parents can document vaccines in the Redbook

themselves if they do not have at it at the appointment.

• Ensure the environment is cleaned between patients– see NHS Infection Control guidance.

POST - APPOINTMENT

www.belmatt.co.uk

Flu and Immunisations

Crossword

Across

2. This is needed each and every time you do something with a patient

6. How often should you check the 'fridge temperature?

7. Nursing regulator

9. Ask this question of any person that brings a child or patient who cannot

consent for themselves

12. The earliest age that we can administer 'flu vaccine in risk groups (1,2)

Down

1. Needs to be completed at the time of the consultation

3. Muscle site in adults commonly used for giving 'flu vaccines (7)

4. Consider if what you to do today may cause..... (4)

5. You cannot work without this type of cover

8. The document you use to enable you to give vaccines without a prescription

(3)

10. The strains of 'flu used in this years 'flu vaccine (1,2)

11. You must be up to date in this to be able to vaccinate safely (3)

www.belmatt.co.uk

Flu Vaccines 2020 season

www.belmatt.co.uk

FLU VACCINATOR COMPETENCY ASSESSMENT TOOL

The competency assessment tool has been divided into three areas:

1. knowledge

2. core clinical skills

3. the clinical process/procedure for vaccine administration

Immunisers should be assessed against the competencies relevant to the role

assigned to them. It is recognised that not all competencies will be relevant to all

staff, for example if they have been assigned a role in vaccine administration

only and are not responsible for assessing suitability for vaccination and taking

consent. Additional competencies can be added if necessary.

How to use the competency assessment tool:

The assessment tool can be used as a self-assessment tool, an assessment tool for use with

a supervisor or both. Where a particular competency is not applicable to the individual’s role,

indicate ‘not applicable’ (NA).

The immuniser should complete the self-assessment column and then, if they are new to

immunisation, share it with their supervisor/assessor. The supervisor assessing the immuniser

must be a registered healthcare practitioner who is competent and experienced in delivering

immunisations.

The supervisor carrying out the assessment should:

• review the immuniser’s self-assessment, discussing any areas that are identified as ‘need

to improve’ and the relevant action plan

• observe their performance as they provide immunisations/advice to several patients and

indicate whether each competency is ‘met’ or ‘needs to improve’ in the supervisor review

column

• if improvement is needed, help the immuniser to develop an action plan that will enable

them to achieve the required level of competence and plan a further assessment

• when the supervisor and immuniser agree that the immuniser is competent in all the

relevant areas, sign off the section at the bottom of the assessment

• acknowledge if they and/or the immuniser decide that they are not suitable for the role and

communicate this to the employer

Competency Assessment Tool

Contact Us

PHONE CALL

0207 692 8709

FOLLOW US

Belmatt Healthcare

Training

EMAIL US

[email protected]

BELMATT HEALTHCARE TRAINING

Belmatt Healthcare Training Limited, provider of postgraduate training.

Registered Office: Suite 570 405 Kings Road, Chelsea, London, England, SW 10 0BB

FLU Update 2020

Documents

Transcript of FLU Update 2020