- Latest Flu adviceLatest Flu advice
The situation re flu vaccination continues to cause difficulties.
Practices will already have received advice from NHSE on the details of flu vaccine supply and the issues between quadrivalent and adjuvant trivalent for the over 65’s. The advice is lengthy and complicated but the bottom line is that we cannot give QIV to the over 65’s until at least November. The official opinion is that while there is theoretically enough to go round then this is a situation to be managed in the community. This is extremely frustrating, but it seems that no one is going to come out and say that what we are experiencing equates to ‘exceptional circumstances’.
Email from Denise Jones:
You may be aware that further national guidance has recently been issued in respect of this year’s flu programme and following the issue of the guidance we have written to practices and CCGs. The new guidance addresses the management of the supply of Fluad (aTIV) (recommended vaccine for over 65 year olds) to the eligible population at a local level. The national guidance is consistent with that issued previously in that it reaffirms the need to offer aTIV to all eligible individuals, including signposting to alternative providers in the event of a practice or pharmacy having no stock, with QIV used as an exceptional circumstance. In the interests of protecting patients, the guidance also provides confirmation that should the system wish to respond across health services that vaccines may be moved between practices following delivery, subject to issues such as cold chain being maintained.
We are working in partnership with practices and CCG Flu Leads to understand patterns of vaccine supply at GP level within each CCG in the region and we have now received some positive information through our national team regarding further stock availability. Yesterday we contacted CCGs to make them aware that the manufacturer Seqirus has confirmed that they now have access to an additional 400,000 aTIV doses available on a national footprint. The priority for distribution of this additional supply will be firstly those providers who are already on a national waiting list, and secondly, by working with CCGs locally to target supplies to those providers who currently have no vaccine, or insufficient to ensure we make best use and availability of it for those practices and pharmacies to reach local populations with the recommended vaccine for people aged 65 years and over.
We are hopeful that this opportunity has potential to reduce the level of redistribution of stock that is currently available within practices and pharmacies. Should we need to reconsider this option we will discuss this further in due course.
We are also sending a further email out to practices today to offer guidance on what to do when the ‘wrong’ flu vaccine is given inadvertently. In due course, the national guidance will be refreshed to take account of this advice and will be available shortly in the Inactivated influenza vaccine: information for healthcare practitioners available on the PHE flu immunisation webpage. In summary the guidance states:-
If an individual has inadvertently received a flu vaccine different to the one recommended for their age group, they should be informed of the error and the potential implications of this error. Although both the QIV and aTIV should provide some protection against flu in all age groups, individuals aged 65 years and over (particularly those more than 75 years of age) may not respond as well to the QIV as they would to the aTIV, and individuals aged under 65 years will not benefit from the opportunity to make protection against an additional flu strain if they have been given aTIV.
Individuals who have inadvertently been given a flu vaccine that is not the one recommended for their age group:
If the individual wishes to receive the vaccine that they should have been given, this can be offered following a discussion of the benefits and risks. The clear benefit is the additional protection that may be offered by the correct vaccine but they should be alerted to the potential increased risk of a local or systemic reaction. Although there is no data available on the safety and effectiveness of administering a second flu vaccine shortly after the first in adults, this advice is based on general principles of vaccination, experience of flu revaccination following cold chain and administration incidents and information about the high dose flu vaccine used in the United States (which contains four times the amount of antigen that is in a single dose of QIV or aTIV).
If a decision is made to offer the vaccine the individual should have received, it is recommended that this is done as soon as possible after the first dose was given and ideally within a week. This will enable protection to be made as soon as possible. It can still be given if more than a week has elapsed however.
This advice also applies to those who have been given unadjuvanted TIV.
I hope you find this information helpful, if however you would like to discuss further, please contact the Public Health team at firstname.lastname@example.org and a member of the team will contact you as soon as possible.
- Supplies of Hepatitis B vaccine has improvedSupplies of Hepatitis B vaccine has improved
The DHSC has asked the GPC to inform LMCs that the supply situation for hepatitis B vaccines has improved and customers should be able to order as per historical demand.
Although MSD have constrained supplies of the vaccines, GSK have very good supplies available. However, GSK have been underselling significantly over the last few months and GPs are one customer type who are ordering much less than expected- taking into account their historical demand and need for a catch up for those who missed out on vaccination during the supply issues.
DHSC would therefore like to remind practices that they should now be able to access good supplies of the hepatitis B vaccines.
- Interim report – GP Partnership review
- Local Actions to ensure aTIV is offered to individuals aged 65 years and over.Local Actions to ensure aTIV is offered to individuals aged 65 years and over.
NHSE are now advising practices and pharmacies that they can exchange vaccines to ensure that it can be offered to patients in the priority group. The requirements around this are that:
- the surgery that is holding the excess stock can give an assurance that the vaccine has been held properly in the correct temperature controlled conditions;
- confirmed record keeping of temperature monitoring is available;
- the surgery that requests the aTIV is able to verify the assurances given;
- the vaccine can be transported appropriately under the right conditions.
To see the letter sent out by NHSE and for more information click here.
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