Friday, July 3, 2009

Letter to Immunisation Coordinators etc from Dept of Health

To: PCT Immunisation Coordinators
SHA Immunisation Leads
Cc: HPU Immunisation Leads
Gateway reference no: 12122

Room 510
Wellington House
133-155 Waterloo Road
Tel: 020 7972 2000
Fax: 020 7972 3989

Dear Colleague

I know that you are working hard to help prepare the NHS and social care sector for the impact that the swine flu pandemic may have. I want to update you on the preparations that the Department of Health is making on developing the H1N1 swine flu vaccination strategy, including prioritisation and ‘at risk’ groups for vaccination. This will help your local planning for the delivery of a vaccination programme.

Vaccine Procurement
The Department of Health has made arrangements for the supply of sufficient H1N1 swine flu vaccine for the population of the UK. We have contracts with Baxter Healthcare Ltd and GlaxoSmithKline.

The first supplies of vaccine are expected to be available from August, increasing over the next three months and will continue over about 12 months.

I will provide more detailed delivery data when they are available.
A vaccine distribution strategy, similar to that used for HPV vaccine, is being developed. We will also supply needles and syringes.

The Vaccines
Two doses of both Baxter and GSK vaccines are currently recommended with a minimum interval of three weeks between doses. These vaccines will go through the previously established European licensing procedures for pandemic vaccines.

There is no evidence that the vaccines are interchangeable – so individuals need to receive two doses of the Baxter vaccine, or two doses of the GSK vaccine (but not one dose of each). This will require accurate recording of which vaccine was administered for the first dose.

As for other vaccines, the vaccines need to be stored between 2°C and 8°C. It is likely that the vaccines will be supplied in the following presentations:

The Baxter product:
• will be presented in a pack of 20 multidose vials of 5ml suspension per pack.
• Each 5ml vial should provide 10 doses.
• Each pack should provide 200 doses.
The pack size is 206mm x 166mm x 55mm.

The GSK product:
• will be presented in a box of 50 multidose vials of 2.5ml suspension and two boxes containing 25 2.5ml vials of adjuvant
• each 5.0 ml of reconstituted vaccine should provide 10 doses.
• Each pack should provide 500 doses.
The pack size is 260mm x 113mm x 97mm.

Priority Groups
Sufficient vaccine is being secured for the UK population. Because of the phased delivery of the vaccine, prioritisation for vaccination of individuals and groups will be needed. The decision on prioritisation will be taken on the basis of epidemiological evidence, vaccine supply and capacity of the NHS to implement the programme. This decision will be subject to further work over the summer period. Until further decisions on prioritisation are made, plans should be made to deliver vaccine to the following groups:

o Individuals aged between six months and 65 years in the current seasonal flu clinical risk groups.
o Pregnant women in their second and third trimester
o Health and social care workers directly involved in patient care.
o Other health and social care workers
o Children aged from 3 years to 16 years of age.
o People aged 65 years and over
o Poultry workers
o All others not in the above groups

Until decisions on the order of vaccination of priority groups are made, NHS organisations will need to ensure robust plans are in place to ensure vaccine could be offered to all these groups.

Information materials and publicity
We are preparing a range of information materials to support an H1N1 swine flu vaccination programme. These will include a leaflet, surgery poster and vaccine record card available to be ordered through Prolog. In addition, there will be web based resources including a new Green book chapter, fact sheet, Q&A, consent template, Patient Group Directive (PGD) template and patient vaccine invitation letters. Training materials to support NHS staff are also being developed.

Materials should be available from late July onwards.

An advertising campaign is being planned to raise awareness and understanding of the H1N1 swine flu immunisation programme. More details will be given once the plans are finalised.

Data Recording and Data Collection
Accurate data recording and data collection will be vital in assessing the roll out and impact of a swine flu vaccination campaign. We are in the process of contacting GP IT suppliers and Child Health Information Systems to identify the need for their systems to be prepared for this programme. We anticipate that vaccine uptake data collections will be based on existing collections wherever possible, modified as appropriate, and subject to the normal approval processes.

As two doses of vaccine are required and the two brands of vaccine are not interchangeable, data will need to be collected per dose, by brand. We will ensure the appropriate recording codes (READ/SNOMED) become available to facilitate this and further details will be issued in due course.

We will do our best to ensure that PCTs are kept up to date as new information becomes available. We will be able to discuss some of the issues raised at the flu conference scheduled for 8th July (contact for details).

Yours sincerely, Professor D M SALISBURY CB
FRCP FRCPCH FFPH Director of Immunisation
Direct line: 020 7972 4377
Email address:

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