BASIC IMMUNISATION FOR NEW IMMUNISERS Alison Johnson Immunisation Facilitator.
Contents. Why vaccinate? Basic Immunology UK immunisation programme/selective Policies and guidelines. Cold chain Consent process Coffee break Vaccine types Live/inactivated Adverse events Current issues.
Why do we vaccinate?
Piglet has pig flu
Why vaccinate? To protect the individual To eliminate disease (e.g. small pox) To increase herd immunity To prevent disease outbreak (e.g. measles)
The two public health interventions that have had the greatest impact on the world s health are clean water and vaccines WORLD HEALTH ORGANIZATION
Measles disease
Tetanus Disease No protection from herd
Types of Immunity Passive Active
Immunology - Passive Transfer of antibody produced by one human or other animal to another. Trans placental Immunity most important source in infancy Temporary protection Sourced from almost all blood or blood products.
Immunology Active Immunity Protection produced by persons own immune system Usually long lasting Can be induced by disease (but risk of disease complications) By vaccination
UK routine schedule Tetanus Diphtheria Pertussis Hib meningitis Pneumococcal (specific strains) Polio Meningitis C Measles Mumps Rubella Girls HPV age 12/13
Selective immunisation (for at risk groups ) Hep B Influenza BCG Additional pneumococcal Additional pertussis (pregnant women)
UK immunisation programme. UK schedule Immunisation schedule sheet Unscheduled forms Incomplete immunisation document Selective immunisation at risk groups.
Preparing to vaccinate Setting up of clinics. Sharps,disposal of consumables Presentation of vaccine Policies and documents accessible Documentation.
Policies and guidelines Training Immunisation, CPR and anaphylaxis Policies- PGD,cold chain, needlestick, consent policy, incident reporting (trust website) National guidance department of health green book, chief medical officer (CMO letters) (CMO) Specific product information/patient information leaflets
Patient Group Directions Legal document and requirement Acts as a direction to a nurse to supply and/or administer prescription only medication (POM s) to patients using their own assessment of patient need, without necessarily referring back to a doctor for an individual prescription. In certain circumstances patient specific direction.
Cold chain Local policy and procedure Receipt handling and storage of vaccines Vaccine must be stored between 2-8 degrees. Current audit Vaccine fridges Transporting of vaccination Implications of cold chain failure Incident reporting - datix
Consent 1 For consent to be valid, it must - be given voluntarily by an appropriately informed person who has the capacity to consent to the intervention in question (this will be the patient or someone with parental responsibility for a patient under the age of 18). Reference Dept of Health/ Reference guide to consent for examination or treatment July 2009
Consent 2 Consent must ALWAYS be obtained before immunisation. Consent gained before occasion is only agreement to join the programme (e.g. HV consent at 10 days prior to baby immunisation at 8 weeks) Consent CANNOT be given by another person for an adult
Consent process What immunisation is to be given What diseases will be prevented Establish any contraindications (refer back to Contraindication slide ) Any new information Benefits and risks of immunisation v risk of disease Patient information to take away Follow up when next vaccine due AGREEMENT TO PROCEED
Consent process. What immunisation is to be given What diseases will be prevented Establish any contraindications (refer back to Contraindication slide ) Any new information Benefits and risks of immunisation v risk of disease Patient information to take away Follow up when next vaccine due AGREEMENT TO PROCEED
Comfort break
Immunisation procedure
Vaccines Two main vaccine groups used in the UK: Inactivated (killed) Live
Immunology inactivated vaccines Cannot replicate (inactivated influenza vaccine cannot cause influenza disease) Minimal interference form circulating antibodies. (via placenta) Generally not as effective as live vaccines (requires more doses) Antibody diminishes with time (e.g. tetanus)
Contraindications to inactivated vaccine. Acute febrile illness A confirmed anaphylactic reaction to a previous dose of vaccine A confirmed anaphylactic reaction to any component of the vaccine e.g. neomycin, streptomycin or polymixin B (which may present in small amounts in some vaccines Pregnancy requires risk assessment
Immunology Live vaccines Attenuated (weakened) form of the wild virus or bacteria. Must replicate to be effective Immune response to natural infection. What live vaccines do we use in the UK?
Contraindication to a live vaccine As for inactive vaccines febrile illness and anaphylaxis. IN ADDITION Pregnancy Immunosuppression caused by treatment e.g. chemotherapy/radiotherapy Immunosuppression caused by disease e.g. HIV Need 4 week gap between 2 live vaccines. 3 month gap between live and immunoglobulin. Following BCG no vaccine in that limb for 3 months
Vaccine specific contraindications Important to know the vaccine you are giving and how it works. (SPC/Green book chapters) Egg allergy caution with influenza vaccine Egg allergy absolute contraindication for yellow fever and one type of hepatitis A vaccine Not all flu vaccines are suitable for children
Adverse events Observe for immediate reaction. Accurate documentation essential Advise patient/parent what to expect Information to take away Follow up, if concerns Adverse event reporting Yellow card reporting
Adverse event reporting 2 Adverse event reporting What IS a Black Triangle Drug? How long is it applicable for? Who can use it?
Seasonal influenza At risk groups from 6 months. Chronic respiratory Disease Chronic heart disease Chronic kidney disease Chronic liver disease Chronic neurological Disease All over 65 year olds. Diabetes Immunosuppression Pregnant women
Vaccine composition 2012/13 Influenza A/Californian/7/2009 (H1N1) pdm09-like virus. A/Victoria/361/2011 (H3N2)- like virus B/Wisconsin/1/2010 like virus NB. This is an inactivated vaccine
Risks to pregnant women Mortality rate several times higher than that of non pregnant women same age 1 Pregnant women with flu 10 x more likely to need care in ITU compared to general pop 2 Greater risk of hospitalisation Greater risk of needing ECMO Pregnant women hospitalised with flu infection 3x more likely to deliver prematurely, It s 5x more likely their babies will be stillborn 1 Yates et al Influenza A/H1N1 v in pregnancy : an investigation of the characteristics and management of affected women and the relationship to pregnancy outcomes for mother and infant. HTA 2010; 14 (34) ;109-182 http://www.hta.ac.uk/project/2224.aspmre 2 WHO Pregnancy and pandemic influenza a (H1N1)2009: http://www.who.int/csr/resources/publications/swineflu/h1n1_guidnace_pregnancy/en/
Currents Issues Seasonal Flu 2012/2013 Injection sites local issue Pregnant women flu risk. CMO letters/green book chapters updated Over 65 s/at risk groups Measles outbreaks in Merseyside 2012 Pertussis increase in disease. Documentation/incident reporting Never too late to vaccinate. Uncertain immunisation history Vaccines on the horizon
Current Issues 2 Hard to Reach groups Queue and failsafe work Keeping up to date with new vaccines
Immunisation NMC Code of Professional Conduct, 2008 You are professionally accountable for your practice. This means that you are answerable for your actions and omissions, regardless of advice or directions from another professional. Ref www.nmc-uk.org
Resources www.dh.gov.uk ( professionals and public) www.nhschoices.uk public access www.yellowcard.gov.uk (adverse reactions etc) www.hpa.org.uk (information for disease etc) Child Health Dept 01743 450800 www.travax.nhs.uk (Professionals ONLY) www.nathnac.org.uk for travel advice www.fitfortravel.nhs.uk - general public www.publicguardian.gov.uk/mca/code-ofpractice.htm
Immunisation LOCAL PCT IMMUNISATION INFORMATION SERVICE EMAIL: immunisation.telfordpct@nhs.net (Strictly for health professionals only)