INFLUENZA VACCINATION PROTOCOL – PRIMARY CARE

The aim of influenza immunisation is to reduce the morbidity and mortality from influenza by immunising those most likely to develop severe or complicated illness consequent to influenza infection.

Groups recommended for vaccination

National policy for 2006/2007 is that influenza immunisation should be offered to:

1. People of all ages in the following risk groups:

Chronic respiratory disease, including asthma / This includes
  • chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema
  • bronchiectasis
  • cystic fibrosis
  • interstitial lung fibrosis
  • pneumoconiosis
  • asthma requiring continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission

Chronic heart disease / This includes
  • chronic ischaemic heart disease,
  • congenital heart disease
  • hypertensive heart disease requiring regular medication and follow-up (but excluding uncomplicated controlled hypertension)
  • chronic heart failure

Chronic renal disease / Including
  • nephrotic syndrome
  • chronic renal failure
  • Renal transplantation.

Diabetes mellitus / Diabetes mellitus requiring
  • insulin
  • oral hypoglycaemic drugs.

Immunosuppression / Due to disease or treatment, including systemic steroids equivalent to 20mg prednisolone daily for more than 2 weeks. However, please note that some immunocompromised patients may have a suboptimal immunological response to vaccine.

2. All aged 65 years and over.

3. Those living in long-stay residential and nursing homes or other long-stay facilities.

Target
  • 70 % of patients recommended for vaccination
Frequency
  • Annually
Dose and administration of vaccine – Protocol should be updated annually to reflect current pharmaceutical recommendations

Adults and children aged 13 years and over:

a single injection of 0.5ml im or deep sc

Children aged 4-12 years:

0.5m1 im or deep sc, repeated 4-6 weeks later if receiving influenza vaccine for the first time

6 months to 3 years:

0.25m1 im or deep sc, repeated 4-6 weeks later if receiving influenza vaccine for the first time.

Only children with severe respiratory problems or immune deficiency should be immunised.

The deltoid muscle is the recommended site for adults and older children. For infants and young children the preferred site is the anterolateral aspect of the thigh.

Antibody levels may take up to 10-14 days to rise. Influenza activity is not usually significant before the middle of November, and therefore the ideal time for immunisation is October/early November.

Adverse reactions

Influenza vaccine is usually well tolerated apart from occasional soreness at the immunisation site. In rare instances it can, however, cause:

  1. Fever, malaise, myalgia and/or arthralgia beginning 6 to 12 hours after immunisation and lasting up to 48 hours.
  2. Immediate reactions such as urticaria, angio-oedema, bronchospasm and anaphylaxis, most likely due to hypersensitivity to residual egg protein.

Guillain-Barrésyndrome has been reported very rarely after immunisation with influenza vaccine, although a causal relationship has not been established.

Influenza vaccine contains inactivated virus and cannot cause influenza.

Contraindications
  • Known anaphylactic hypersensitivity to egg products
  • Pregnancy (unless specific indication: there is no evidence that influenza vaccine prepared from inactivated virus causes damage to the foetus).
  • Known severe sensitivity to an antibiotic
  • Known severe reaction to a previous dose of the vaccine
Equipment/Access to Facilities
  • Drugs fridge/vaccines
  • Cool box if indicated
  • Cotton wool
  • Small plasters
  • Hand-washing facilities
  • Sharps Bin
  • Seating and couch available
  • Emergency Patient Handling Procedure
  • Emergency Drugs
  • Anaphylaxis kit
Checklist – Refer to checklist regarding standards & procedures, June 2006
  • Check vaccine stored at correct temperature before use
  • Ascertain suitability for immunisation and record
  • Record informed consent
  • Record patient refusal if indicated
  • Ensure patient comfort
  • Check expiry date
  • Record batch number
  • Record date given
  • Record injection site
  • Record name of vaccine giver
  • Monitor patient reaction to vaccine – ask to remain on premises for 15 minutes
  • Advise patient regarding re-vaccination
  • Ensure syringe is safely disposed of
  • Return unused vaccines to the fridge at the end of the session
Additional Guidelines for Administration of Influenza Vaccination by HCAs to be used in conjunction with the above
  • General Practitioner must be on site at all times during clinic sessions
  • General Practitioner must give written authorisation on agreed clinic list of pre-booked appointments
  • A pre-filled syringe is to be used at all times.
  • No calculation of drugs can be undertaken.
  • Injection must be intra-muscular only and for administration in the right or left deltoid
  • Patients must be in a Department of Health at risk group and aged over 16

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DRAFT PROTOCOL