Communicable Diseases Services - Immunisation Services
COMMUNICABLE DISEASES SERVICES-
IMMUNISATION SERVICES
PUBLIC HEALTH SERVICES
TIER LEVEL THREE
SERVICE SPECIFICATION
Status:
This service specification may be amended for agreements as required to meet local needs. / Non-MANDATORY
Review History / Date
Approved by Nationwide Service Framework Coordinating Group (NCG)
Published on NSFL
Reviewed: Public Health Service Handbook (2003).Amendments: Updating Handbook content to new format, adding Purchase Unit, Service linkages and Quality requirements, insert standard Māori health clause. / March 2010
Change of status to non-mandatory as an interim step before the specification is retired or replaced. / November 2016
Note: Contact the Service Specification Programme Manager, Ministry of Health, to discuss the process and guidance available in developing new or updating and revising existing service specifications. Nationwide Service Framework Library website
COMMUNICABLE DISEASES SERVICES - IMMUNISATION SERVICES
PUBLIC HEALTH SERVICES
TIERLEVEL THREE
SERVICE SPECIFICATION
This tier three service specification for Communicable Diseases -Immunisation Services (the Service) must be used in conjunction with the overarching Public Health Services tier one service specification and the Communicable Diseases tier two service specification.
Refer to the Public Health Services tier one service specification under the following headings for generic details on:
- Service Objectives
- Service Users
- Access
- Service Components
- Service Linkages
- Exclusions
- Quality Requirements
- Regulatory
The above heading sections are applicable to all service delivery.
1.Service Definition
This Service specification describes public health immunisation services that includesthe: promotion of immunisation,leadership on immunisation issues and advocacy for its benefits, the facilitation and co-ordination of immunisation services, the surveillance of vaccine preventable diseases and ensuring the safe delivery of control programmes including immunisation and mass immunisation campaigns.
2.Service Objectives
To control or eliminate vaccine-preventable diseases through the delivery of safe and effective vaccination programmes across all communities.[1]
Immunisation is one of six New Zealandgovernment’s health targets.
- 95 percent of all eligible New Zealand children fully immunised at age two years 2012
- 75 percent or more of adults aged 65 years or older vaccinated annually against influenza (and that all children and adults at high risk of contracting influenza due to an on-going chronic medical conditions are identified and vaccinated annually against influenza – see Immunisation Handbook for eligible on-going medical conditions).
To assist/support DHBs to meet their population health targets in terms of childhood and adult immunisation targets through:
- leadership on immunisation issues and advocacy for its benefits
- increasing immunisation coverage and reducing the impact of vaccine-preventable disease
- increasing access of children/tamariki to immunisation services
- targeting groups with low rates of immunisation coverage to reduce health inequities
- providing surveillance of vaccine preventable diseases
- ensuring appropriate vaccine purchasing, storage and distribution
- ensuring there is promotion of immunisation, and co-ordination and linkages of services between Lead Maternity Carers (LMCs) Well Child/Tamariki Ora services, Before School Check Programmes, Primary Health Care services, Immunisation Co-ordinators, Outreach Immunisation Services, Public Health nurses and independent vaccinators
- encouraging the use of appropriate media strategies and activities
- ensuring there is education and training for all LMCs, Well Child/Tamariki Ora services, Before School Check Programmes, Primary Health Care services, Immunisation co-ordinators, Outreach Immunisation Services, Public Health Nurses and independent vaccinators encouraging prevention programmes, including health promotion activities and community development
- ensuring the delivery of control programmes including immunisation and mass immunisation campaigns
- ensuring safe delivery of effective vaccines, including assurance of the cold-chain, vaccinator training and approval and adherence to any applicable standards
- encouraging the provision of balanced, well researched/evidenced based information to clients by all health professionals.
2.2Māori Health
Refer to the tier two Communicable Disease Services service specification.
3.Service Users
- The New Zealand general public.
- Providers of education facilities.
- Providers of health care facilities.
4.Access
Public Health Services will be provided throughout New Zealand.
Access to the Service will be managed ethically and equitably such that priority is based on acuteness of need and capacity to benefit.
5.Service Components
The following set of service components have been grouped under four different types of providers in sub service specifications as follows. Services provided by:
A.Designated Services comprising Public Health Units and District Health Boards (DHBs)
- Immunisation Coordination/Facilitation Services
C.Immunisation Promoters
D.Vaccine Purchasers and Vaccine Storage and Distribution Services.
A.Services provided by designated services
Components of Service /Service Descriptions/Activities
A1.Quality / Ensure all immunisation services and advice provided are of good quality, meet all applicable standards and that any advice is evidence-based.Ensure an appropriate workforce is identified and recruited to meet the needs of the Service and to achieve population health targets. The workforce is to be appropriately trained and educated and each provider should have, in place, a plan for ongoing workforce development.
Ensure Māori participation and partnerships at all levels of planning, decision making and service delivery.
A2.Public Health Regulatory Services / Provide services in accordance with the Public Health Regulatory Services specification as detailed in the tier one Public Health Services service specification for and the Ministry of Health Environmental Health Protection Manual.
Ensure that independent vaccinators are authorised by a Medical Officer of Health, as per the most recent National Vaccinator Training Standards and the protocol for authorisation of vaccinators in New Zealand outlined in the Immunisation Handbook.
Report in agreed format and frequency to Ministry of Health (the Ministry) on independent vaccinators authorised in each reporting period.
A3.Increase adoption of immunisation policies and adherence to the Health (Immunisation) Regulations 1995 / Provide advice, support and training to early childhood centres and schools to raise their awareness of the Health (Immunisation) Regulations 1995 and to enable them to implement these regulations.
Adhere to any subsequent Regulations/Acts relating to immunisation and/or the National Immunisation Register (NIR).
A4.National Immunisation Register / Ensure all immunisations that are able to be recorded on the NIR are entered.
Use the NIR, according to level of access to the system, so as to increase coverage and ensure children/tamariki who have not completed their immunisations are followed up and/or referred to outreach services, as appropriate.
Use NIR data to assess progress on immunisation coverage targets, for planning of services to meet identified gaps and research purposes.
Use the NIR to identify un-immunised individuals in the investigation of any outbreaks of vaccine preventable diseases and to take appropriate action to protect public health. Such action should be in accordance with the Communicable Diseases Manual.
Support DHB Planning and Funding Teams to achieve the DHB population health targets for immunisation.
A5.Surveillance / Operate an effective local/regional surveillance system, which will systematically collect, analyse and report data from relevant sources and so inform prevention and control activities and initiate investigation and research.
Activities can include:
- participating in notifiable vaccine preventable disease surveillance, including entry into EpiSurv.
- participating in national surveillance activities.
- organising annual sentinel influenza surveillance.
- delivering other formal and informal surveillance systems, nationally and locally, including surveillance projects.
- collaborating with clinical practitioners and laboratories to obtain good quality, timely information on notifiable vaccine preventable diseases and adverse vaccine reactions, including reporting of the event to the Centre of Adverse Reactions Monitoring (CARM).
- providing feedback of surveillance information to practitioners and laboratories, and the public.
- assessing the effectiveness of control and prevention measures.
- undertaking surveillance-related investigations and research.
A6.High risk babies / Undertake promotion and education to Well Child/Tamariki Ora providers (Well Child & LMC) relating to the importance of effective service facilitation to deal with high risk babies. Specifically:
- babies of hepatitis B positive mothers to receive Hep B immunisation and Hep B immunoglobulin (HBIG) administration at birth.
- babies at risk of tuberculosis to receive BCG at birth (see Immunisation Handbook).
- these immunisations are to be recorded on the NIR.
A7.Media strategies / Develop an appropriate proactive and reactive media strategy, which links with and supports the Ministry’s immunisation communication strategy.
Ensure any approved or designated media spokespersons are media trained.
B.Services Provided by Immunisation Co-ordination/Facilitation Services
Health goals
- To improve the health and wellbeing of all children/tamariki in New Zealand by assisting immunisation providers to reach the immunisation coverage target of 95% of children fully immunised at two years of age.
- To improve the health and wellbeing of all New Zealanders by assisting immunisation providers to increase vaccine coverage rates for influenza vaccine, and other vaccines in the event of epidemics or pandemics or catch-up campaigns.
- To assist DHBs to meet their population health targets for immunisation coverage and child health. This may include working with the DHBs and PHOs to ensure PHOs are upskilled to meet their immunisation coverage targets.
- To ensure immunisation service providers are competent to safely administer vaccines and to assist them in maintenance of the cold chain.
- To ensure that vaccinators and the public are provided with up-to-date, evidence-based information to assist them in their decision making in regard to immunisation services and the immunisation of children, young people and adults.
Components of Service / Service Descriptions/Activities
B1.Quality / Ensure all immunisation services and advice provided are of good quality, meet all applicable standards and that any advice is evidence-based.
Ensure an appropriate workforce is identified and recruited to meet the needs of the service and to achieve population health targets. The workforce is to be appropriately trained and educated and each provider should have, in place, a plan for ongoing workforce development.
Ensure Māori participation and partnerships at all levels of planning, decision making and service delivery.
Components of Service / Service Descriptions/Activities
B2. NIR / Use the NIR, according to level of access to the system, so as to increase coverage and ensure children/tamariki who have not completed their immunisations are followed up and/or referred to outreach services, as appropriate.
Use NIR data to assess progress on immunisation coverage targets, for planning of services to meet identified gaps and research purposes.
Support DHBs to achieve their population health targets for immunisation by:
- working closely with the DHBs, their public health services/units, other immunisation providers, outreach immunisation services and Well Child/Tamariki Ora providers assisting providers to address gaps and methods of identifying children/tamariki missing out on services
- promoting effective referral and use of outreach services and the linking back of children/tamariki referred to outreach to a primary health care provider.
B3.Media strategies / Develop an appropriate proactive and reactive media strategy, which links with and supports the Ministry’s immunisation communication strategy.
Ensure any approved or designated media spokespersons are media trained.
B4.Vaccinator Training / Promote and distribute the most recent “National Standards for Vaccinator Training Courses”.
Provide vaccinator training courses according to the approved national standard and protocols in the most recent Immunisation Handbook. Facilitate approval of vaccinators as Independent Vaccinators by the Medical Officers of Health.
B5.Health provider support / Provide support and appropriate resources for health professionals and non-medical vaccinators delivering immunisation and information sharers, including Well Child/Tamariki Ora providers and LMCs and, which covers:
- the value of immunisation to individual and community/population health
- the need to ensure the follow-up of those missing out on immunisations or who have only partially completed their immunisations
- possible immunisation side effects, their relative risk and how these events should be reported to the Centre for Adverse Reactions Monitoring (CARM) if they occur.
B6.Promotion to parents /caregivers / Promote positive immunisation messages to parents/caregivers and their wider families and whānau and community through a range of activities, including:
- developing resources, where agreed with the Ministry and following the National Guidelines[2]
- carrying out health promotion
- providing information at coffee groups, parent meetings, etc.
- providing information at antenatal services and parenting organisations
- working with early childhood centres.
B7.Assist with provider recall systems / Provide advice and audit PHO Immuniser recall and coverage reporting systems using standard definitions and recall methods in the “National Audit and Terminology Standards”.
B8.Referral ofchildren / Assist with referral of unimmunised or partially immunised children to services specifically designed/contracted to provide such follow-up services (see also Section 4)
Encourage all children/tamariki to be linked with a Well Child/Tamariki Ora provider and a primary health care provider.
B9.Cold chain standards and audit / Promote and distribute the “National Cold Chain Standards” and assist management of cold chain audit in PHOs and General Practices.
Provide services to audit the national and/or regional vaccine storage and distribution providers to ensure cold chain integrity.
B10.High RiskBabies / Undertake promotion and education to Well Child/Tamariki Ora providers (Well Child and LMC) relating to the importance of effective service facilitation to deal with high risk babies. Specifically:
- babies of hepatitis B positive mothers to receive Hep B immunisation and Hep B immunoglobulin (HBIG) administration at birth.
- babies at risk of tuberculosis to receive BCG at birth (see Immunisation Handbook).
B11.Increasing uptake of (free) influenza Immunisation in “at risk” groups / Promote the annual influenza vaccination, particularly for those eligible for subsidised vaccination (those aged 65 and over and others at high risk – (refer to Immunisation Handbook) in conjunction with Primary Health Care providers , DHBs and groups representing those with high risk conditions.
Link with the National Influenza Immunisation Strategy Group (NIISG) to ensure consistency of message and for use of NIISG resources.
B12.Immunisation conferences and meetings / Provide national or regional immunisation conferences/meetings for providers of immunisation services.
C.Services provided by Immunisation Promoters
Components of Service /Service Descriptions/Activities
C1.Quality / Ensure all immunisation services and advice are of good quality, meet all applicable standards and that any advice is evidence based.Ensure an appropriate workforce is identified and recruited to meet the needs of the service and to achieve population health targets. The workforce is to be appropriately trained and educated and each provider should have in place a plan for on-going workforce development.
Ensure Māori participation and partnerships at all levels of planning, decision making and service delivery.
C2.NIR / Promote and use the NIR, according to level of access to the system, so as to increase coverage and ensure children/tamariki who have not completed their immunisations are followed up and/or referred to outreach services, as appropriate.
Support DHBs to achieve their population health targets for immunisation by working closely with all relevant Providers and services.
C3.Health Provider Support / Provide support and appropriate resources for all Well Child/Tamariki Ora providers (LMC, Well Child, authorised independent vaccinators) and any other workers who promote and/or deliver immunisation which includes:
- the value of immunisation to protect individual and community/population health
- the need to ensure the follow-up of those missing out on immunisations or who have only partially completed their immunisations
- possible immunisation side effects, their relative risk and how these events should be reported to the CARM if they occur.
C4.Promotion of Immunisation to Community and Parents/Care Givers / Promote accurate immunisation messages in community settings including:
- providing education sessions to groups/communities at meetings/hui/events
- organising information displays and distribution of resources
- identifying and supporting community leaders to promote immunisation
- using paid and unpaid media coverage, including participation in talkback and local print media.
- using media
- developing resources
- carrying out health promotion
- providing information at antenatal services and parenting organisations
- working with Early Childhood Centres and schools.
C5.Referral Of Children / Assist with referral of unimmunised or partially immunised children to services specifically designed/contracted to provide such follow-up services (See also Section 4).
Encourage all children/tamariki to be linked with a Well Child/Tamariki Ora Provider and a Primary Health Care Provider.
C6.Increasing Uptake Of (Free) Influenza Immunisation In At Risk Groups / Promote the annual influenza vaccination, particularly for those eligible for subsidised vaccination (those aged 65 and over and others at high risk - refer to Immunisation Handbook) in conjunction with Primary Health Care providers, DHBs and groups representing those with high-risk conditions.
Link with the National Influenza Immunisation Strategy Group (NIISG) to ensure consistency of messages and for use of NIISG resources.
D.Services provided by Vaccine Purchasers and Vaccine Storage and Distribution Services