Gateway reference : 13683

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1 Gateway reference : Richmond House 79 Whitehall London SW1A 2NS ian.dalton@dh.gsi.gov.uk TO: All Chief Executives in NHS Trusts in England, All Chief Executives in Primary Care Trusts in England, All Chief Executives in NHS Foundation Trusts in England, All Chief Executives in Strategic Health Authorities in England CC: All Chairs in NHS Trusts in England, All Chairs in Primary Care Trusts in England, All Chairs in NHS Foundation Trusts in England, All Chairs in Strategic Health Authorities in England All Flu Lead s in Strategic Health Authorities in England All Chief Executives in Local Authorities in England Monitor Care Quality Commission Health Protection Agency 18 February 2010 Dear Colleague, Pandemic H1N1 (2009) influenza vaccination programme We are pleased to report that the pandemic H1N1 (2009) influenza vaccination programme has gathered pace since Christmas, as more people in the clinical at-risk groups have been vaccinated. Some 4.54 million doses have been administered so far to people in the priority groups, including 518,000 doses given to healthy children over six months and under five years of age. These figures reflect the tremendous and continued efforts made by general practitioners and their staff, district nurses and all NHS staff involved in the programme since it began in October It is noteworthy however, that uptake levels in the other countries of the United Kingdom and some European countries are higher than we have achieved in England so far. With your support we expect to see uptake in this country increase even further. Pandemic H1N1 (2009) influenza results in predominantly mild illness for most people, but clinical at-risk groups, pregnant women and young children are at increased risk. The Chief Medical Officer has continued to stress the importance of vaccination to prevent complications, hospital admissions and death in potential future outbreaks of the disease. Vaccination offers the best protection for those at risk of complications from influenza. Those who have already been immunised with the adjuvanted monovalent pandemic H1N1 (2009) influenza vaccine are likely to remain protected next winter and possibly longer. The

2 vaccine may also provide some protection should a drift in the genetic make-up of the virus occur and the disease becomes more severe. We continue to receive anecdotal accounts of people not being aware of their need and entitlement for vaccination or believing that vaccination clinics are unavailable. We expect PCTs to ensure that eligible groups are aware and able to access the vaccine in their practices. That way we can ensure that this important protection is widely in place. We have continued to seek advice from the Joint Committee for Vaccination and Immunisation (JCVI) on the vaccination programme and we are now able to set out the expected parameters for its continued delivery by the NHS. The Chief Medical Officer has also written today to general practitioners, and a copy of this letter is available at the following link. ndex.htm People in the clinical risk groups, pregnant women, household contacts of immunocompromised individuals and frontline health and social care workers The JCVI has advised that unvaccinated people over the age of six months and in clinical risk groups (which include those people aged 65 and over and in a clinical risk group but not healthy people aged 65 and over), pregnant women, household contacts of immunocompromised individuals, and front line health and social care workers should continue to be encouraged to receive the pandemic H1N1 (2009) influenza vaccine during the coming spring and summer. This is because these people are at particular risk if they become infected with the virus or, in the case of front line health and social care workers, may expose at risk patients to infection. Vaccination of these groups will provide protection against the possible early re-emergence of pandemic H1N1 (2009) influenza this year. NHS organisations should continue with the plans in place for offering vaccine to those in at risk groups over the spring and summer and until next winter s seasonal flu vaccine becomes available. We expect PCTs to discuss with GPs the options available to maximise uptake. The DES covering the vaccination of these groups was not time-limited, and payment for vaccinations will continue to be made as before. However, the easements including as recognition of the increased workload during the peak of the vaccination programme will cease on 31 March The Department will not be making additional funding available to PCTs on top of that already received for the vaccination programme in the 2009/10 financial year. Healthy children aged over six months and below five years of age JCVI has advised that the vaccination of healthy children aged over six months and below five years should be completed. PCTs are expected to put plans in place to complete the work for this programme by the end of March This should allow adequate opportunity for arrangements to be made to offer vaccination to this group, irrespective of when individual Primary Care Trusts started to implement the programme.

3 Vaccination for people travelling this summer to the Southern Hemisphere JCVI has suggested that the monovalent pandemic H1N1 (2009) influenza vaccine could be offered as a travel vaccine for the benefit of those people travelling to Southern Hemisphere countries during the Southern Hemisphere seasonal influenza season. The Department is currently exploring how this advice might best be implemented and we will contact you again shortly with more information. Seasonal influenza vaccination programme: winter 2010/11 Emerging data from around the world suggest that pandemic H1N1 (2009) is likely to be the predominant influenza strain circulating next winter, and it is possible that it could reemerge earlier than the usual influenza season. H3N2 and B influenza viruses may also play an important role in the next influenza season. International experts are meeting in Geneva currently to advise the World Health Organisation on the composition of next winter s seasonal influenza vaccine. The Department will write to you in due course about this, and the plans for next winter s seasonal influenza vaccination programme. Guidance will also be issued on the vaccination of frontline health and social care workers with seasonal influenza vaccine. We have seen a significant improvement in the vaccination rates in these groups since the pandemic H1N1 (2009) influenza vaccination programme was launched and we expect to see this carried through into next year and beyond. You will want to continue to review your organisations uptake performance with your Board, as set out in the letter of 27 January. Uptake data The collection of data as previously set out will continue for vaccinations up to 31 March 2010 for all groups. The final data collection for vaccinations of healthy children under five will be in early April From 1 April 2010, data will be collected on uptake in clinical risk groups and pregnant women automatically through ImmForm on a monthly basis from the GP systems, where this is possible. All GP practices will be expected to submit a final return on uptake in clinical risk groups and pregnant women for vaccinations up to the end of September Data on the vaccination of healthcare workers will continue as previously set out until 1 April Vaccinations given after this date up to the end of September 2010 will be requested in a single final return via Immform. Data on vaccinations of both patients and healthcare workers will need to be submitted in early October. A communication on the formal procedure will be sent closer to the time. Many thanks for your continued support for this vaccination programme, as we look to continue to protect as many people in the risk groups as possible over the coming months.

4 Yours sincerely, Ian Dalton National NHS Flu Resilience Professor D M SALISBURY CB Immunisation

5 Annex A SHA Flu Lead s SHA Name Title Contact Details South Dr James Operational Flu James.mapstone@southcentral.nhs.uk Central Mapstone East Midlands John Newton Professor David Walker Executive flu Lead Regional Public Health John.newton@southcentral.nhs.uk fluresponse@southcentral.nhs.uk David.walker@eastmidlands.nhs.uk lindsey.beasley@eastmidlands.nhs.uk South East Coast Guy Boersma Commissioning & System Development emergency.planning@southeastcoast.nhs.uk Please also copy s to: guy.boersma@southeastcoast.nhs.uk Nicola.Ranger@southeastcoast.nhs.uk North Marie Burnham Regional for Flu and NHS Resilience North East Martin Wilson NHS Flu Resilience Yorks and Humber South Simon Morritt Andrew Millward Chief Executive, NHS Bradford and Airedale Communications and Corporate Affairs London Daniel Elkeles NHS Flu Resilience East of England East of England Midlands Paul Cosford Linda Sheridan Steve Allen Regional Public Health Flu Resilience Performance and Information Marie.burnham@northwest.nhs.uk Martin.wilson@northeast.nhs.uk Simon.morritt@bradford.nhs.uk sha.incidentroom@yorksandhumber.nhs.uk Andrew.millward@southwest.nhs.uk daniel.elkeles@london.nhs.uk Flu Resilience Office Paul.cosford@eoe.nhs.uk Linda.sheridan@eoe.nhs.uk Steve.allen@westmidlands.nhs.uk Rashmi.shukla@dh.gsi.gov.uk