Shahj Ahmed€¦ · 01/03/2020 · [email protected] 07860 178052 31 PHE Screening &...

Shahj AhmedScreening & immunisation coordinator

Plymouth practice nurse forum

Immunisations update14 Jan 2020

2 PHE Screening & Immunisations Team

Routine NHS Immunisations Queries

The Green Book


https://www.gov.uk/gover

nment/collections/immuni

sation-against-infectious-

disease-the-green-book

The Green Book - chapters


Uncertain or Incomplete Imms Queries


Cold Chain Incidents - Immediate Actions


• Quarantine vaccines immediately and label clearly

• Contact the SW Screening & Immunisations Team preferably by email:

[email protected]

• with the following information:

• Temperature that the vaccines have reached and duration

• Number of patients inadvertently vaccinated, with which vaccines

and when

• Vaccines involved: name, batch number(s), expiry date(s) and

amount

• The screening & immunisation team can support

you to source stability data

mailto:[email protected]

Cold Chain Incidents - Immediate Actions

• Local clinical decision whether to offer vaccines ‘off-

label’ – but this course of action is

supported/encouraged where there is positive

stability data (significantly reduces waste)

• Report any discarded vaccines involved on

ImmForm

• Complete and return Significant Event Audit (SEA)

form to Screening & Immunisations Team

• Develop action plan from lessons learnt to avoid

repeat of incident


Cold Chain Incidents / Vaccine Wastage


Cold chain audit (2019)

The storage of vaccines is an important component in the safe delivery of immunisation

programmes and providers have a duty to have in place policies and procedures to ensure

vaccines are kept in optimum condition. A vaccine that has not been stored appropriately may

become ineffective and an unlicensed product.

Vaccine effectiveness cannot be assured unless the vaccine has been stored correctly.

Vaccines should be stored in the original packaging, retaining batch numbers and expiry

dates. Vaccines should be stored according to the manufacturer’s summary of product

characteristics (SPC) – usually at +2˚C to +8˚C and protected from light.

In the South West area between 1st April 2018 and 31st March 2019, 1477 incidents were

reported on ImmForm and £600788.91 of vaccine was lost which equated to 144012

doses. This does not include the vaccine that was lost in instances where the vaccine is

supplied at cost to the practice and reclaimed through insurance or vaccine which may have

been lost but not reported to ImmForm. Vaccines for the immunisation schedule routinely cost

£200 million a year and if every GP practice lost one dose of Pediacel a month it would cost

the NHS £2 million. Assuring safe handling of vaccines is vital to maintaining the confidence

in the vaccine and the national programmes.


Cold chain audit - recommendations


Results

The responses were collated and areas of non-compliance were highlighted these are

detailed in the table below. There were 9 responses from the 29 (at Dec 2018) practices in

the area. Recognised risk issues are summarised below

• Having more than four weeks supply in stock was an issue for 3 practices. This can

increase the loss when an incident happens and impacts on national supply

• 1 practice does not check the vaccine on delivery

• 2 practices do not have arrangements in place in the event of a refrigerator failure or

power cut

• 4 practices do not have records of regular servicing, defrosting and cleaning as per

manufacturer’s recommendations?

PHE Vaccine Incident Guidance 2019https://www.gov.uk/government/publications/vaccine-incident-guidance-responding-to-vaccine-errors


Off label use https://www.gov.uk/government/publications/off-label-vaccine-leaflets


Significant Events Audit (SEA) form / Serious incidents


• What happened?

• Time and date?

• Were any patients vaccinated /

involved?

• What action has been taken?

• Learning from the incident?

• Share learning and good practice

from the incident !

Poster and magnets available to

download, print or order from:

https://www.gov.uk/government/

publications/keep-your-

vaccines-healthy-poster


Vaccine ordering and storage

https://www.gov.uk/government/publications/keep-your-vaccines-healthy-poster

Vaccine Updates / Weekly GP Bulletins


PHE Resources on Gov.UK website


PHE Resources on Gov.UK website


Screening Resources on Gov.UK website


Latest screening resources on gov.uk

New guidance published last week 03/01/2020Immunisations – guidance from Public Health EnglandPublic Health England has issued guidance with examples to help health and care professionals make interventions to promote the benefits and increase uptake of immunisations


Child Health Information Services

Please remember to advise CHIS of all vaccines

given (childhood and adolescent) for the following

reasons:• Minimise the risk of repeat vaccinations, e.g., school outside of area

or child has moved into the area

• Ensure data is robust to prepare for catch-up campaigns for children

with incomplete history

• Ensure accurate data is shared with other CHIS departments when

moved out of the area

We are all working together to achieve a minimum

of 95% uptake across all immunisation programmes


Training for practice reception/admin staff

The SIT has produced some online training for reception/admin practice staff re

immunisation (and screening) and this may help staff who are responsible

for booking patients into imms clinics/appointments be more familiar with

the various routine vacs programmes:

https://www.england.nhs.uk/south/info-professional/public-health/training/


https://www.england.nhs.uk/south/info-professional/public-health/training/

Update 1: new incident guidance

Updated guidance: Vaccine incident guidance: responding to vaccine errors An updated version of the HPA Vaccine Incident Guidance was published in September 2019. We would encourage all practices to read this guidance and to make themselves familiar with the content. https://www.gov.uk/government/publications/vaccine-incident-guidance-responding-to-vaccine-errors


Update 2: change to the PCV schedule


PCV Schedule Change PCV13 has previously been administered following a 2 + 1 schedule at 8 and 16 weeks, with a booster dose given at one year old. Based on the advice of the JCVI this is changing to a 1 + 1 schedule. All infants born on or after 1 January 2020 will be offered the changed schedule- a single dose of PCV13 given alongside the routine DTaP/IPV/Hib/HepB and rotavirus immunisations at 12 weeks of age, followed by a PCV13 booster at one year old (on or after the first birthday). There is a new PGD available, as well as updated leaflets, Green Book etc.

Update 3: HepB case studies

Missed Children’s Hepatitis B Vaccines The Screening and Imms Team operate a failsafe designed to ensure that children born to Hepatitis B positive mothers are appropriately vaccinated in a timely fashion to reduce the risk of them contracting chronic Hepatitis B. Whilst CHIS schedule these children, there are still occasions when children miss vital early vaccinations . Recommended Practice failsafe procedures to ensure child receives timely Hep B vaccinations:

1. Weekly searches for pregnant women who are diagnosed with Hepatitis B linking to their delivery date.

2. All newborn baby hospital discharge documents to be thoroughly reviewed (regardless of registration) and, where Hepatitis B vaccination indicated, link with mother and call for vaccination at 4 weeks

3. When infant registered, check if 4 week dose has been given/is scheduled 4. 6-8 week infant check – has infant received 4 week vaccination?

For more information re the vaccination pathway for children born to Hepatitis B positive mothers see: https://www.england.nhs.uk/south/info-professional/public-health/immunisations/hepatitis-b/


Update 4: maternal pertussis

Maternal Pertussis programme – Upcoming changes to dTaP/IPV vaccine

The maternal pertussis immunisation programme commenced in October 2012, initially using Repevax® vaccine (dTaP/IPV). From July 2014, Boostrix®-IPV (dTaP/IPV) has been supplied.

In January 2020, Repevax® will become available to order through ImmForm for use in the maternal pertussis immunisation programme instead of Boostrix®-IPV. This is a temporary change and it is anticipated that supplies will revert back to Boostrix®-IPV in autumn 2020.

This change is necessary as PHE is running down all stock of Repevax® before the introduction of Boostrix®-IPV across both the maternal pertussis and the pre-school booster programmes.

There is no other change to the maternal pertussis immunisation programme, further details about this programme can be found in chapter 24 of the Green Book.


Update 5: Flu 2019/20 Please continue vaccinating eligible patients until the end of March. For the children’s flu vaccine, Fluenz remains available for order from Immform. Flu vaccine recommendations for 2020/21 season

20 December NHS

England JCVI advce and NHS reimbursement flu vaccine 2020-21.pdf

Info released 23rd December 2019. NHSE reimbursement guidance uses JCVI recommendations for their considerations. As was the case in 2019/20, the JCVI recommendations and NHSE reimbursement differ slightly: NHSE will reimburse:

• Over 65s: aTIV – please order enough aTIV to vaccinate your whole over 65s population (QIVc will be a ‘back up’ option to order should you not be able to access further aTIV).

• Under 65s: QIVe and QIVc (no change)

• Under 18s: LAIV (except where contraindicated) If practices have made orders for 2020/21 for QIVc for their over 65 populations, the manufacturer (Seqirus) has said that the practice can cancel that part of their order (this is in the terms and conditions). The practice will then need to ensure they have ordered aTIV for their whole over 65 population. The Screening & Imms Team will produce a table indicating which vaccine should be used in each scenario.


Update 5: Flu (continued)

Childhood (nasal spray) flu vaccine supplies for GPs GP practices can now order the equivalent of last year’s uptake for their practice or 45% of their eligible population (whichever is higher). If you require larger orders of LAIV, please contact Immform directly as they are sometimes able to release additional stock (after understanding the scenario): 0844 376 0040 or [email protected] Questions to [email protected] The Transfer of Excess QIV and LAIV Flu Vaccine Stock Between Providers Additional stock of LAIV may make this less likely to be necessary. Please note QIV can still be ordered from some manufacturers. The MHRA has confirmed that it would not prevent the transfer of flu vaccines QIV for under 65s and LAIV for children between providers under the given circumstance of ‘in short supply’ or ‘no supply’ available. More information has been sent in the GP bulletin.


Update 5: Flu (continued)

Data submission on Immform Reminder to ensure your uptake data is submitted on Immform. Most practices have an automatic extraction, but please log on to check the data is accurate. The deadlines are as below and next deadline is 17th January 2020 for vaccinations 1st Sept – 31st Dec.


Update 6: PGDs

Recently updated PGDs:

• Please check for recently updated PGDs:

https://www.england.nhs.uk/south/info-professional/pgd/south-

west/downloads/


SouthWest Screening & Immunisations Team,

Public Health England

30 PHE Screening & Immunisations Team,

For routine NHS immunisation enquiries, to report vaccine incidents, information about Screening

Programmes and advice contact the

PHE SouthWest Screening& Immunisations Team

[email protected]


Thank you

[email protected]

[email protected]

07860 178052




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Shahj Ahmed€¦ · 01/03/2020 · [email protected] 07860 178052 31 PHE Screening &...

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