Pandemic Influenza a H1n1v(2009) Vaccination Programme

24February 2009

Dear Colleagues

Pandemic influenza A H1N1v(2009) vaccination programme

1. This letter provides you with an update on vaccination uptake, the latest expert advice from the Joint Committee for Vaccination and Immunisation (JCVI), and advises that guidance for the 2010-11 seasonal flu programme will follow shortly.

1. I am pleased to see that the number of people vaccinated continues to rise. As at 19 February, data obtained from the Audit+ system extracted from 85% of GP practices reported that Wales has vaccinated31,190 (21%) of all children under 5 years of age, 113,786 (42%) of patients aged 5 to 65 years in the at risk groups, and 103,880 (42%) of patients aged over 65 in the at risk groups. This shows that 11% of Welsh population has been vaccinated.

1. I continue 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. I again urge you to encourage individuals in the at risk groups who have not yet had the vaccine to be vaccinated. 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.

1. Anecdotal evidence suggests that some people are not aware of their need and entitlement for vaccination, or are being told that clinics are unavailable. It is essential that you work with your GP practices to ensure these issues are not a factor locally.

1. We continue to take expert advice from the Joint Committee for Vaccination and Immunisation (JCVI) on the ongoing priorities for vaccination. At its 3 February meeting, the JCVI recommended that during the spring and summer, the following groups should continue to be encourage to be vaccinated:

From the Chief Medical Officer

Welsh Assembly Llywordraeth Cynulliad

Government Cymru

CathaysPark Parc Cathays

Cardiff Caerdydd

CF10 3NQ CF10 3NQ

CMO(2010)02

PANDEMIC INFLUENZA A H1N1v(2009) SWINE FLU UPDATE

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Electronic distribution to:

Health Boards:

Chief Executive Officers

Medical Directors

Hospital Chief Pharmacists

Public Health Wales:

Chief Executive Officer

Director of Health Protection Services,

Lead Microbiologist

Director of CDSC

Consultants in Communicable Disease Control

NHSDW

All-Wales Senior Nurse Advisor Groups

LA Social Services Directors

Business Service Centres to distribute to GP practices

For information:

Welsh Assembly Government:

Head of DHSS

Nursing Officers

Health Professions Group

Regional Nursing Officers

Vaccination Policy Lead

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Requests for further copies of this letter should be addressed to:

Shane Williams

Health Protection Division

Department for Public Health and Health Professions

Welsh Assembly Government

CathaysPark

Cardiff CF10 3NQ

Crown copyright 2009

This circular may be freely reproduced by all those to whom it has been addressed

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People in the clinical risk groups, pregnant women, household contacts of immunocompromised individuals,and frontline health and social care workers:

1. The JCVI has advised that unvaccinated people over the age of six months in clinical risk groups (as defined for the seasonal influenza vaccination programme), pregnant women 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.

1. Health Boards 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. I would encourage you to take every opportunity to encourage those eligible to be vaccinated.

Vaccination for travellers:

1. 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.

1. The Welsh Assembly Government is considering how this advice might best be promulgated and further information will be provided.

Children aged over six months and below five years:

1. JCVI has also advised that the vaccination of healthy children aged over six months and below five years should be completed. Health Boards will therefore wish to make whatever plans they consider necessary to complete this programme by the end of March 2010. This should allow adequate opportunity for arrangements to be made to offer vaccination to this group, irrespective of when individual GP practices have started to implement the programme.

1. While children over 6 months and below 5 years of age are not included in the summer vaccination programme, you should continue to vaccinate as many of this cohort as possible before the end of March.

Other individuals:

1. JCVI did not consider that there is any scientific justification to offer the H1N1v vaccine to any other individuals who wish to have it nor is there any scientific justification for the vaccination of carers or poultry workers.

1. A full statement and meeting minutes can be found at:

1. I hope that GPs will embrace this work as part of their routine business and also antenatal services where pregnant women present for booking or follow up care. In practice opportunistic vaccination should now take place when eligible patients present themselves over the spring and summer until next winter’s seasonal ‘flu season. For some practices this may mean continuing with current arrangements, but for the majority we expect the vaccine to be offered when the patient is present for other reasons. Although vaccine wastage is likely to rise, this should not be a barrier to vaccination of eligible patients or front line health and social care staff by occupational health departments.

1. 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 recognition of the increased workload during the peak of the vaccination programme will cease on 31 March 2010.Funding will be provided to Health Boards for the costs associated with reimbursing GPs for continuing with the extension to the Phase 1 vaccination programme. An allocation will be made to Health Boards in-year based upon uptake between 1 April and 30 September.

Seasonal influenza vaccination programme - winter 2010/11:

1. Emerging data from around the world suggests that pandemic H1N1 (2009) is likely to be the predominant influenza strain circulating next winter, and it is possible that it could re-emerge earlier than the usual influenza season. H3N2 and B influenza viruses may also play an important role in the next influenza season.

1. International experts recently met in Geneva to advise the World Health Organization on the composition of next winter’s seasonal influenza vaccine. I will write to you separately about the plans for next winter’s vaccination programme.

1. This will also include advice 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 I am keen to see this carried through into next year and beyond.

1. Thank you for your continued efforts in protecting the public from influenza. I appreciate that continuation of the vaccination campaign on top of routine work isa further challenge, andI extend my thanks to each of you personally involved in the vaccination programme. Please continue to ensure all those eligible for the vaccine are made aware of their entitlement and are offered the opportunity to receivethe vaccine.

Dr Tony Jewell

Chief Medical Officer

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