Highland NHS Board 6 October 2015 Item 5.1 NEW VACCINATION PROGRAMMES

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1 Highland NHS Board 6 October 2015 Item 5.1 NEW VACCINATION PROGRAMMES Report by Abhayadevi Tissington, Nurse Consultant Health Protection and Ken Oates, Consultant in Public Health on behalf of Hugo Van Woerden, Director of Public Health & Health Policy The Board is asked to: Note the new vaccination programmes and the concomitant increase in workload Note the positive preventive impact of vaccines Note the potential health service savings resulting from delivery of effective vaccines Support the importance of NHS staff influenza vaccination 1 Background and Summary Changes to the UK vaccination programme are agreed and implemented by the Department of Health and devolved administrations on the basis of advice from the Joint Committee on Vaccination & Immunisation (JCVI). In 2013 there were major additions to the schedule: protection against rotavirus for infants; protection against shingles for those aged 70 to 79, and the introduction of flu vaccination for all 2 and 3 year olds, with flu vaccination also being piloted in approximately one quarter of primary school aged children. Rotavirus and shingles vaccination are now routine, and in 2014 flu vaccination was rolled out to all 2 to 5 year olds, and all primary school children - a huge increase in the number of vaccinations given each year. There are two further new programmes this year: MenACWY for 13 to 18 year olds from 1 August, and MenB vaccine for infants from 1 September. 2 New Vaccination Programmes Rotavirus Rotavirus is a very common and potentially serious infection of the gut. Highland uptake of rotivirus vaccine in quarter was 91.4% (Scotland 93.4%). Prior to introduction of the vaccine across Scotland there were estimated to be 55,000 episodes of rotavirus infection and 1200 hospitalisations each year. Positive rotavirus lab results and hospital admissions in NHS Highland residents have both decreased markedly since routine vaccinations began and already demonstrate the positive benefit of this programme. Figure 1: Number of hospital admissions due to rotavirus, NHS Highland residents aged under 15 years by month and year, July 2007 June 2015 (Source: NHS Highland Health Intelligence and Knowledge Team)

2 Reductions of over 200 bed days have been seen in both the years following the introduction of this vaccination programme in Highland. This equates to savings of around 181,858. It is expected that there will also have been reductions in GP visits and calls to NHS24. Shingles The vaccine to protect against herpes zoster (shingles) is now routinely offered by primary care to all 70 year olds, and the catch-up for all those aged up to 79 years at the time of introduction in 2013 is almost complete. Uptake in Highland in those who became 70 years old on 1 September 2014 is 55.8%, compared with 57.2% across Scotland. Again, HPS is conducting long term surveillance to demonstrate the effectiveness of the programme. Flu Flu vaccine is the best protection we have against an unpredictable virus which can cause severe illness and deaths each year among at-risk groups, including older people, pregnant women and those with a pre-existing health condition. Levels of vaccine uptake were maintained across all risk groups last year and the extension of the flu immunisation programme to children continued to roll-out successfully in 2014/15. In Highland an uptake of 70% was achieved in all primary school age children. (Scotland 71.8%) It is extremely difficult to evaluate the effectiveness of the extension of the flu vaccination programme to children as there are many variables, most importantly, how well the vaccine is matched to the circulating strains of flu which undergo frequent mutation. It is expected that the programme effectiveness will only become apparent as trends are reviewed over the long-term. Overall however, moderate levels of influenza illness activity were seen in the community in the UK in 2014 to 2015, with influenza A(H3N2) the predominant virus circulating for the majority of the season, and influenza B circulating later in the season. The impact of H3N2 was predominantly seen in the elderly, with more outbreaks in care homes and higher levels of excess winter mortality. Admissions to hospital were higher than seen in the previous few seasons, but lower than the recent notable season of 2010 to Encouragingly as a possible early indicator of the impact of vaccination of primary school age children, Scotland experienced a shorter period with GP flu activity above baseline levels compared to England and Wales where the school programme is yet to be fully rolled out. Large numbers of people receive flu vaccination each winter. There are 321,000 people living in the NHS Highland area (i.e. our total population figure). Of those, 98,915 had flu vaccination in the 14/15 season. i.e. 31% of our resident population were vaccinated against flu illness. 48% were eligible to be vaccinated. Of those eligible, 65% were vaccinated. These high levels of vaccination are undoubtedly a contributory factor in reducing the impact of flu illness - it is now 6 years since we have a bad flu winter 2

3 Figure 2: Flu Vaccination Coverage in NHS Highland Population 2014/15 Population group Total number eligible for vaccination in population group Flu vaccinations given - Highland Number (%) Flu vaccinations given Scotland (%) Elderly over 65 68,814 51,055 (74.2%) (76.3%) All at risk under 65 (excluding carers and 36,941 20,603 (55.8%) (54.0%) healthy pregnant women) Healthy pregnant women 2,420 1,046 (43.2%) (49.5%) Carers 2,429 1,080 (44.5%) (51.5%) Primary school children 23,016 16,121 (70.0%) (71.8%) 2 year olds 3,277 1,641 (50.1%) (51.0%) 3 year olds 3,258 1,666 (51.1%) (50.7%) 4 year olds 3,290 1,626 (49.4%) (40.6%) NHS H staff 9,747 4,077 (42%) (36.3%) Sub total 153,192 98,915 (64.6%) Total NHS Highland Population = 321,000 (NRS 2013 mid-year population estimate) NB There is the potential for some double counting across some categories such as NHS staff, at risk groups under 65 and pregnant women although this is only likely to involve small numbers Staff flu NHS Highland staff uptake of flu vaccine last winter was 42%, our highest ever, and considerably higher than the Scottish level. Uptake of flu vaccine in frontline healthcare workers in Scotland was 36.3% this compares with 34.7% in 2013 to In trusts in England it was 54.9%; in NI it was 22.6% and in Wales, uptake reached 44.3%. In Highland a total of 4,077 staff were vaccinated and further 550 or so vaccinations were given to other groups including both Local Authority employees and student nurses. Raigmore Unit achieved the highest uptake with an impressive 62% coverage. Doctors (59%) and AHPs (56%) recorded the highest uptake amongst staff groups. The delivery of vaccinations on the wards and within teams by trained peer vaccinators was successful, avoiding the need for staff to take time out to visit an occupational health clinic, and this model will be further developed this year. The staff programme is due to start during October. MenB 3

4 Although there are a relatively small number of cases of meningococcal infection due to MenB (42 across Scotland in 2014, three of which were in Highland), it has high morbidity and mortality, and parents are expected to overwhelmingly support this new programme. Vaccination will involve 3 doses given to infants routinely at age 2, 4 and 12 months. MenACWY Surveillance demonstrates that since 2009 there has been an increasing number of cases of MenW infection in England, which has also been witnessed in Scotland since the beginning of this year. The JCVI has recommended the implementation of an urgent programme to vaccinate all 14 to 18 year olds. This has started now for school leavers aged years and from January all -S6 pupils will also be offered the vaccine. 3 Contribution to Board Objectives Objective 2. Improving Population health and Reducing Inequalities There is equity of access to all childhood immunisation programmes. Childhood immunisation is one of the most important and cost effective health interventions carried out by health services across the globe. 4 Governance Implications Finance Summary of the annual primary care cost of programmes introduced since 2013 Vaccine intro Potential cohort uptake cohort Cost of Item of 7.67 Rotavirus (2013) % 2,850 21,859 Shingles (2013) % 3,172 24,329 Flu 2-5yr olds 10,000 75% 7,500 57,525 (2013) TOTAL 103,713 Vaccines intro Potential cohort uptake cohort 5-11 yr old mopup % 666 6,520 MenB (3 doses) % 2,850 83,704 MenACWY % 1,909 18,689 TOTAL 108,913 Cost of Item of per dose 5 Risk Assessment Prior to 2013 school nurses delivered HPV vaccine in S2, and boosters for diphtheria, tetanus and polio in. This equated to approximately 8,350 vaccines per academic year. This contrasts with the current academic year in which they will administer 43,370 vaccines, as illustrated in the appended tables. Although additional funding has been provided to cover item of service payments to GPs, this new work has been incorporated into school nurses workload without any additional resource. There is a risk that other essential school nursing work will not be undertaken timeously, especially as there is difficulty in filling some vacancies. In addition, the Scottish Government has recently undertaken a review of school nursing which is to be implemented in The role of the school nurse will change significantly, and there is an expectation that they should no longer have responsibility for administering 4

5 vaccines, but rather, that this will be done by less specialist staff. In some areas this is likely to necessitate the creation of immunisation teams which will inevitably incur additional expense and are a model of delivery which is not best suited to Highland with our dispersed population and vast geography. 6 Planning for Fairness All of the vaccination programmes above are delivered in GP practices and schools, and there is therefore equality of access. 7 Engagement and Communication All vaccination programmers are currently UK-wide and their implementation in Scotland is overseen by Health Protection Scotland (and NHS Scotland) on behalf of the Scottish Government. Thus there is national engagement and national communications are produced. Abhayadevi Tissington Nurse Consultant Health Protection Ken Oates Consultant in Public Health September

6 Vaccines given in schools Highland Council Vaccine Cohort 2012/ / /16 When (2015/16) Flu Primary 1 to 7 17,000 17,000 Oct Dec 75% HPV 1 st dose S1 1,150 1,150 1,150 Jan 100% HPV 2 nd dose HPV 2 nd dose (2016 only) S2 1,150 1,150 1,150 Jan 100% 1,150 1,150 1,150 Men ACWY S4, 5, and Feb 100% Diphtheria/ tetanus/polio MenC (or MenACWY) MMR + mop up S4 to 6 + mop-up S4 to 6 + mop-up S4 to 6 2,500 2,500 2,500 March 100% 2,500 2,500 March 100% March 100% TOTAL 6,150 25,650 32,150

7 Vaccines given in schools Argyll & Bute Council Vaccine Cohort 2012/ / /16 When (2015/16) Flu Primary 1 to 7 5,750 5,750 Oct Dec 75% HPV 1 st dose S Jan 100% HPV 2 nd dose HPV 2 nd dose (2016 only) S Jan 100% Men ACWY S4, 5, and 6 2,370 Feb 100% Diphtheria/ tetanus/polio MenC (or MenACWY) MMR + mop up S4 to 6 + mop-up S4 to 6 + mop-up S4 to March 100% March 100% March 100% TOTAL 2,200 8,850 11,220 7

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