Important Londonwide CEO message, volume 2, number 2 - 16 October 2009
Here is the latest information written by me at 4.30 am this morning. It is concise, hard and accurate, and covers all you need to know to prepare your practice teams for the forthcoming mass at-risk vaccination programme. I will advise you of any changes or updates when they become available, but for now this is as good as it gets. It covers:
1. Swine Flu Vaccine Supply
2. Swine Flu At-Risk Population
3. The HAJJ (Swine and Seasonal Flu)
4. Swine Flu Vaccination Dosage Schedule
5. Swine Flu Vaccine Cold Chain and Storage
6. Administration of Pandemrix
7. Practice Funding and Contractual Arrangements
Please use the next 2 weeks to ensure that your staff are all brought up to speed, and ready to go.
With best wishes
Dr Michelle Drage FRCGP
Joint Chief Executive Officer
Londonwide LMCs
- Swine Flu Vaccine Supply
The first box of 50 vials containing 500 complete doses of vaccine will arrive directly to your practice over a 3-4 week period commencing 26 October 2009.
The only product you will receive at this time will be Pandemrix (GSK).
Pandemrix is advised for all patients, except those with a history of severe anaphylactic reaction (shock or acute difficulty in breathing) after egg containing products.
In due course, Celvapan (Baxter) will become available but this will be via a PCT arrangement to be advised. - Swine Flu At-Risk Population
The clinical risk groups, in order of priority are:
a. Individuals aged six months and up to 65 years in the current seasonal flu vaccine clinical at risk groups
b. Pregnant women
c. Household contacts of immunocompromised individuals
d. People aged 65 and over in the current seasonal flu vaccine clinical at risk groups - The HAJJ
I am seeking urgent clarification regarding requests for vaccination certificate for patients travelling to Mecca, not just for swine flu but also for seasonal flu.
For now, my advice is that you can do no harm and can get into no trouble by treating such patients as if they are at risk , since we already vaccinate them at risk for meningitis ACWY which if they caught, could theoretically put them at risk for H1N1. You may not charge for the vaccination of either type of flu. You may however charge for any certification required.
I will let you know as soon as I have any further advice to give. - Swine Flu Vaccination Dosage Schedule
a. For all patients, unless severe anaphylaxis to egg containing products.
PANDEMRIX should be given as follows:
Age 6 months – under 10s: TWO HALF DOSES of 0.25ml at least 3 weeks apart.
10 years and above : ONE DOSE of 0.5ml. (Please note that for over 60s, the schedule may revised in the light of any forthcoming data)
b. For pregnant women, the above schedule applies.
c. It is perfectly safe to co-administer Swine Flu Vaccines and Seasonal Flu vaccine together. Similarly Childhood Vaccines.
d. For immunocompromised patients 10 years and above TWO DOSES of 0.5ml at least 3 weeks apart.
e. For patients with anaphylaxis to egg-containing products, delay until PCT arrangements for Celvepan are made available.
f. People with previous lab-proven Influenza A(H1N1)v infection do not need vaccinating, although it is perfectly safe to do so. - Swine Flu Vaccine Cold Chain and Storage
As with all vaccines, storage is at 2 degrees – 8 degrees C. Please ensure your fridge is calibrated correctly and monitored regularly. - Administration of PANDEMRIX
a. As well as the vaccine, you will be supplied with dose-sparing orange fixed needle 1ml syringes. With every hundred of these a 3ml mixing syringe will also be supplied along with a box of green needles. Mix the antigen suspension with the adjuvant, and hey presto, you will be ready to inject!
b. For younger children , give in the usual way. For older children and adults give the vaccine IM into the upper arm.
c. For individuals with bleeding disorders, give deep subcutaneously.
d. A staff training video is downloadable from the Department of Health's website, - see 8 October. It’s actually useful. A few moments into the clip you will see how Pandemrix is packaged and prepared. This is particularly useful for those who are not familiar with multi-dose vials or fixed needle syringes, ie, Doctors like me!
e. Once it’s been reconstituted, Pandemrix can be stored in your fridge and used for up to 24 hours afterwards. - Practice Funding and Contractual Arrangements
These will be defined by a DES which is currently being finalised. Essentially, PCTS must offer the DES to every practice. The DES is national, and cannot be amended by PCTs. You will be identifying those at risk and calling them up. There are no targets.
By undertaking the DES, I’m certain you will be doing your very best as good professionals to ensure that your patients are offered the maximum available protection from the consequences of swine flu, which of course can be fatal.
The DES will fund to the profession as a whole the costs of administering the vaccination programme. The way the money will be delivered is calculated per injection given. This means that £5.25 is paid per injection of each at risk patient, irrespective of who gives it. Thus, if the district nurse gives it to a housebound patient, your practice will still receive £5.25. That £5.25 has been carefully calculated so that when all the £5.25s are added up for all practices in the UK, it roughly equates to the additional COSTS (staff time, call and recall and other additional costs), that all UK practices as a whole will incur in administering the programme on behalf of the government.