Important information on shingles and flu programmes and vaccines in pregnancy for noting and action
Please note and act on the information given below:
- Flu vaccine products for 65 years + cohort
This is a reminder to providers regarding the appropriate flu vaccine products for 65 years + cohort.
A reminder to providers that flu vaccines for the 65 years + cohort are aQIV (Adjuvanted Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) Seqirus) or QIVr (recombinant Quadrivalent Influenza Vaccine; Supemtek by Sanofi), with QIVc (Cell-based Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) Seqirus) only recommended where aQIV and QIVr are not available.
QIVe products are Sanofi’s Quadrivalent Influenza Vaccine (split virion, inactivated) and Viatris (formerly Mylan)’s Influvac sub-unit Tetra vaccinations. The QIVe (egg-based Quadrivalent Influenza Vaccine) is not recommended by JCVI advice for the vaccination of the 65 years + cohort and is not covered in the pharmacy PGD or national protocol. Therefore, it should not be administered to patients aged 65 years or over.
If this occurs it should be reported, and the patient recalled for a discussion about further vaccination with the recommended vaccines. Please speak to your Public Health Commissioning team or Community Pharmacy Commissioning team for further advice. National programme guidance for health care workers also provides advice on Individuals who have inadvertently been given a flu vaccine that is not the one recommended for their age group. https://www.gov.uk/government/publications/flu-vaccination-programme-information-for-healthcare-practitioners
The vaccines for each cohort are set out in the annual flu letter 2023/24.
- Shingles Programme Changes – Update on immunocompromised cohort identification
The Immunisation Team in PHCO has been receiving a few queries around the challenges practices are having in identifying severely immunocompromised patients aged 50+ who should be eligible for the shingles vaccination programme based on the Green Book definition. Therefore please see information below which can be shared with practices who are querying how the GPES extract is capturing the severely immunocompromised cohort.
GPES business rules and Green Book definition of severely immunocompromised 50+ cohort
The GPES business rules are built for payment purposes and the criteria should not be used as a basis for identifying the eligible severely immunocompromised cohort aged 50+.
The development of the coding clusters to identify this cohort in the GPES business was developed to align as closely as possible to the Green Book definitions for severe immunosuppression for shingles however, it is not possible to build an automated payment extract that exactly mirrors the Green Book definitions. This is due to limitations in the way the relevant data can be extracted and clinically coded by practices. To ensure the payment extract sufficiently covers the definitions, it is in places over inclusive to reduce manual payment claim burden and allow clinical discretion, but in others it is limited for example, where a patients needs to be on a specific drug dosage.
Therefore we would suggest that if practices are using the business rules as a basis to create the cohort search criteria, they need to exclude patients who do not fall under the Green Book definition of ‘severely immunosuppressed’ from their routine call and recall, and consider any patients who may be missed but would be eligible due to specific drug dosages. Practices should apply searches that match the Green Book eligibility criteria which would also be in line with the PGD inclusion criteria as well.
We would like to take this opportunity to inform regional colleagues that the Shingles technical guidance is due for publication this week and will be available on the GP Contract webpage. This will be provide key advice for practices to ensure they identify eligible patients correctly. We are also discussing this issue with Ardens and will update regions accordingly.
Please note, however, that NHSE will be limited somewhat in what we can do to help practices given the disconnect between how clinical information is recorded by practice and extracted versus what the Green Book has stipulated.
- Vaccines in Pregnancy good practice examples from teams delivering COVID-19, flu and pertussis (whooping cough)
A revised Vaccines in Pregnancy inequalities toolkit has been published and shared on FutureNHS and is available on the link below:
This toolkit shares good practice examples from regional teams delivering vaccines in pregnancy – COVID-19, flu and pertussis (whooping cough) which we hope provides insights for those seeking to help tackle health inequalities which affect women in pregnancy.
The guidance aligns with our Core20PLUS5 approach to reducing healthcare inequalities and is aimed at helping staff to provide pregnancy vaccinations as part of a cross-system approach to ensure all mothers and babies receive safe, high-quality care.
For any queries, please contact ENGLAND.londonimms@nhs.net