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Vaccine update: issue 313, September 2020

Published 2 October 2020

Applies to England

Impact of social distancing measures due to COVID pandemic in England on childhood vaccination counts

Childhood vaccination coverage in the UK is routinely monitored quarterly, but more timely monitoring has been required during the coronavirus (COVID-19) pandemic.

These reports review aggregated childhood vaccination counts (updated weekly from the electronic records of one supplier of IT services to general practices in England) as a means of assessing the impact of physical distancing measures on vaccination delivery.

The data presented are not for the whole of England, nor do they reflect regional or local variations that may exist.

This second report, that includes data up to week 37 of 2020, indicates that:

• vaccination counts for first dose MMR in children aged 12 to 18 months, and first dose of the hexavalent vaccine (DTaP/IPV/Hib/HepB) in children aged 6 months, fell at the introduction of the physical distancing measures in March 2020 compared to same period in 2019. This was followed by a rise from weeks 16 onwards which has stabilised and is comparable to vaccination counts prior to the COVID-19 pandemic

• the initial decrease in vaccination counts may be associated with COVID-19 messaging about staying home which could have overwhelmed the messaging that the routine immunisation programme was to continue and with GPs rescheduling appointments in the initial weeks to ensure social distancing measures were maintained within GP practices

• the data presented are from one GP IT supplier (TPP) and therefore do not represent data for all of England; therefore this data may not reflect regional and local variation

• as physical distancing measures relax it is important for GPs to continue offering routine immunisations and where required recovery plans should be put in place to account for the initial drop in vaccination counts observed

A communications toolkit has been developed to support general practice, Primary Care Networks and CCGs to explain to patients how they can safely access general practice.

Shingles vaccination programme

From September 2020 everyone from 70 years of age should routinely be offered the shingles vaccine and they remain eligible on an opportunistic basis up to their 80th birthday.

Individuals become eligible for routine vaccination against shingles when they become 70 years of age and all those aged up to and including 79 years, are now eligible to receive the vaccine until they become 80 years of age. This a reminder that the shingles vaccine can be offered to the cohorts outlined above.

Shingles vaccination as part of the routine immunisation programme is covered under the national PHE PGD and may be administered at the same time as the pneumococcal vaccine (Pneumovax 23) and inactivated influenza vaccines.

Some individuals who were eligible for the Shingles (catch-up) vaccination programme may have turned 80 years during the COVID-19 pandemic and missed the opportunity to be vaccinated, either due to lockdown or because they were shielding at home and unable to attend their general practice. This cohort of individuals is likely to be very small and can still be offered shingles vaccine unless contraindicated, up to the 31 December 2020. This temporary offer applies only to those who missed shingles vaccination because they were shielding and who turned 80 years of age during that period. It is only applicable to periods of time when lockdown or shielding was recommended. Payment for this should be at the same rate as other shingles vaccines and will be managed by local commissioners.

As this cohort will not be included in the Shingles PGD, a Patient Specific Direction (PSD) should be used by practices for this specific cohort of patients

Identifying patients eligible for the shingles vaccine in GP IT systems

MSD has created several video tutorials to support implementation of the national shingles immunisation programme; they are focussed on helping general practices set up their IT system to identify and invite eligible patients for their shingles vaccination. The videos are aimed at practices that use EMIS and System One.

The videos are available on MSD Connect, which is MSD’s website for UK Healthcare professionals. This website contains non-promotional and promotional content, and HCPs will need to register with the MSD Connect website to gain access to these videos.

Cumulative shingles vaccine coverage report to end of June 2020: England

This is the fourth quarterly shingles report of the fiscal year 2019 to 2020 evaluating cumulative shingles vaccine coverage among those who became 70 or 78 years old between 1 April 2019 and 31 March 2020, assessed at the end of June 2020.

Cumulative coverage at the end of June 2020 for cohorts first offered shingles vaccine prior to the fiscal year 2018 to 2019 was highest among 76 year olds (76.7%) and lowest among 71 (48.2%), who became eligible last year and 77 (48.0%) year olds – half of whom need to wait until their 78th birthday to become eligible for the vaccine as part of the catch-up cohort.

Cumulative vaccine coverage at the end of June 2020 among adults turning 70 and 78 years old during quarters 1, 2 3 and 4 (between 1 April 2019 and 31 March 2020) was 26.5% for the routine 70 year old cohort and 25.8% for the 78 year old catch-up cohort, compared to 31.9% and 32.8% respectively for the same age cohorts at the end of June 2019.

Vaccine coverage estimates for adults that became eligible for the shingles vaccine during quarter 4 (born between 1 January and 31 March) and evaluated at the end of June 2020 was 9.3% for the 70 year old routine cohort and 10.4% for the 78 year old catch-up cohort, compared to 13.1% and 13.8% for the 70 and 78 year olds respectively in quarter 4 last year.

Meanwhile, adults that became eligible for the shingles vaccine during quarter 1 (from 1 April 2019 to 30 June 2019) and evaluated at the end of June 2020 was 38.7% for the 70 year old routine cohort and 38.0% coverage for the 78 year old catch-up cohorts, coverage for adults becoming eligible for shingles vaccine during quarter 2 (from 1 July 2019 to 30 September 2019) and evaluated at the end of June 2020 was 35.1% for the 70 year old routine cohort and 34.1% coverage for the 78 year old catch-up cohorts, and coverage for adults becoming eligible for shingles vaccine during quarter 3 (from 1 October 2019 to 31 December 2019) and evaluated at the end of June 2020 was 22.4% for the 70 year old routine cohort and 22.8% coverage for the 78 year old catch-up cohorts.

The 2019 to 2020 annual shingles vaccine coverage for those turning 70 and 78 years old and coverage estimates during quarter 4 are lower compared to 2018 to 2019 and quarter 4 last year. Vaccine coverage cannot be compared with estimates prior to 2018 to 2019 estimates due to the new eligible criteria and changes in the coverage calculation methodology. Disruption to the delivery of the shingles vaccination programme caused by the COVID-19 pandemic and the guidance for elderly groups to shield may account for the lower coverage reported, particularly during quarter 4 when the lockdown measures were enforced.

From 1 July 2020 GPs have been advised to re-instate the shingles vaccination programme and offer vaccine on an opportunistic basis (unless contraindicated) to individuals who did not received the vaccine and turned 80 years old since 1 February 2020. This offer has been scheduled to end on 31 December 2020.

While it is important to ensure that individuals who become eligible for the shingles vaccine have the opportunity to get vaccinated in the year they become eligible, improving coverage among previously eligible cohort is equally important as these individuals remain at risk and are more likely to develop more severe outcomes. It is therefore reassuring to see that these cohorts are still being opportunistically vaccinated and that coverage among those who became eligible 5 years ago is high.

Shingles impact

Findings from a recent Public Health England (PHE) study provide important evidence of the sustained population impact of the shingles vaccination programme on GP consultations for herpes zoster and postherpetic neuralgia (PHN), 5 years following its implementation in England.

Despite some challenges in programme implementation and accurately identifying eligible individuals for vaccination, the evaluation suggests that the effectiveness of the vaccine programme has been maintained in the first years of the national programme, equivalent to an impact of approximately 40,500 fewer GP consultations for shingles and 8,700 fewer PHN consultations. In addition, the study shows the impact of the programme on hospital admissions. In total, an estimated 1,840 fewer herpes zoster hospitalisations including 540 PHN consultations were prevented in the first 5 years of the programme in England. The reduction in GP consultations and hospitalisations over the first 5 years of the vaccine programme is estimated to have resulted in a total cost saving of over 10.5 million pounds.

This emphasises the importance of ensuring all those individuals who have previously missed out but remain eligible are offered the vaccine to prevent the significant burden of disease experienced in the older adult population from shingles and its complications.

Shingles resources to deliver the programme

The ‘who’s eligible for shingles vaccination?’ poster (product code 2942856B) and the shingles eligibility age breakdown wheel poster (product code 2942856G) are available to download or to order paper copies and is suitable for all health and social care settings.

Shingles banners can be downloaded and shared on social media such as Facebook and Twitter or used on GP practice screens: female banner and male banner.

PNEUMOVAX® 23 (pneumococcal polysaccharide vaccine)

Pre-filled syringe presentation

The presentation of the pneumococcal polysaccharide vaccine (PPV) has been switched to a pre-filled syringe presentation called PNEUMOVAX® 23 and vials have now been discontinued. PNEUMOVAX® 23 pre-filled syringe is fully reimbursed for use under the national immunisation programme.

A combination of growing global demand for PPV, alongside manufacturing constraints, have led to regular interruptions in supply of PPV to the UK since 2017. The introduction of a pre-filled syringe presentation of PPV is intended to support the continuity of supply and to help address public health need.

Practices should ensure they are ordering PNEUMOVAX® 23 pre-filled syringes through AAH online. Customers will need an AAH account to place an order. For more information about the vaccine, please refer to the Summary of Product Characteristics.

Vaccine supply: routine vaccination programme

Vaccines for the 2020 to 2021 children’s flu programme supplied by PHE

Vaccine availability

The 2 vaccines in the table below are available to order by providers of the children’s flu programme in England at PHE’s ImmForm website.

Vaccine	Manufacturer	Available to order for
Fluenz® Tetra (LAIV)	AstraZeneca	All children aged from 2 years old to those in school year 7, and children in clinical risk groups aged 2 to <18 years
Quadrivalent Influenza Vaccine (split virion, inactivated) (QIVe)	Sanofi Pasteur	All children aged 6 months to <9 years in clinical risk groups for whom LAIV is unsuitable*

*please see Inactivated flu vaccine ordering section below

PHE does not supply any flu vaccines for patients aged 18 years and over.

Please refer to guidance from your respective health departments for arrangements in Scotland, Wales and Northern Ireland.

Vaccine ordering information for general practice

Ordering controls will be in place for Fluenz® Tetra to enable PHE to balance incoming supply with demand. As in previous years ordering controls for general practices are tailored to each practice and allocate an amount of vaccine based on the number of registered eligible patients.

• each GP practice has now been allocated sufficient vaccine to vaccinate at least 80% of their eligible patients (all 2 and 3 year olds, plus children in clinical risk groups from age 4 to <18 years)
• further changes to these allocations may be made in response to demand and vaccine availability. Please check ImmForm regularly for the latest information on LAIV order controls
• requests for extra vaccine will be considered on a case by case basis throughout

Requests for additional vaccine should be sent to the ImmForm helpdesk (helpdesk@immform.org.uk / 020 7183 8580) and should be sent in good time before your order cut-off. Out of schedule deliveries will be by exception only.

Multi-branch practices and Fluenz® Tetra allocations

Please note that GP practices or groups that operate over multiple sites but are part of the same organisation will have a joint allocation (as in previous years), even where each site has a unique ImmForm account. This means that it is possible for one site to potentially order all of the available vaccine for the group, unless there is local agreement on how the allocated volume is shared across multi-branch practices.

PHE recommend that this agreement is in place before ordering opens to reduce the risk of supply interruption. The information above allows practices to estimate the amount of vaccine they have been allocated and how it should be split between all sites.

Vaccine ordering information for school-age providers

A default ordering cap of 300 packs (3,000 doses) per week, per ImmForm account is in place for school providers.

Where this cap is insufficient and a provider needs a larger weekly volume of vaccine to deliver the programme (for example where a provider covers a large area using a single account), a higher weekly cap should be requested from the PHE Vaccine Operations team by emailing vaccinesupply@phe.gov.uk.

For one-off larger orders, requests should be made by emailing helpdesk@immform.org.uk in good time before the order cut-off.

Inactivated flu vaccine ordering

PHE also supplies an egg-based Quadrivalent Influenza Vaccine (split virion, inactivated).

• this vaccine has an order cap of 5 doses per week
• this vaccine should be ordered for all eligible children aged less than 9 years who are contraindicated for, or too young to receive Fluenz® Tetra (LAIV) and are in a clinical risk group

Vaccine arrangements for children in clinical risk groups aged 9 years and over for whom Fluenz® Tetra is unsuitable are as follows:

• those vaccinated in general practice should be offered locally procured QIVc where available. Where QIVc is unavailable, GPs can offer QIVe, either from locally procured stock or centrally supplied stock available at ImmForm
• school aged providers can continue to offer centrally supplied QIVe
• full details of the vaccine (and reimbursement) arrangements for this group can be found in the flu letter published Thursday 14 May 2020

Supply of inactivated flu vaccine for children who object to LAIV due to the porcine gelatine content

The Department of Health and Social Care (DHSC) has secured a supply of inactivated influenza vaccine for children who object to the porcine gelatine content of Fluenz® Tetra (LAIV), which is expected to be made available to NHS providers of the children’s flu programme from November.

Arrangements for this supply have not yet been finalised and further details will be communicated as soon as they are available.

All influenza vaccines for the 2020 to 2021 season

Further information on all influenza vaccines that have been marketed in the UK for the 2020 2021 season is are available.

Maternal Pertussis programme – change to dTaP/IPV vaccine

The vaccine currently supplied for the maternal pertussis programme is Repevax®. It is anticipated that supplies will revert back to Boostrix-IPV® in December 2020. This change is necessary as PHE is running down all stock of Repevax® before the introduction of Boostrix-IPV® across both the maternal pertussis and the pre-school booster programmes.

The maternal pertussis immunisation programme commenced in October 2012, initially using Repevax® vaccine (dTaP/IPV). From July 2014, Boostrix-IPV® (dTaP/IPV) has been supplied.

There is no other change to the maternal pertussis immunisation programme, further details about this programme can be found in chapter 24 of the Green Book.

Update to Bexsero Patient Information Leaflet

Every pack of Bexsero (Meningitis B vaccine; 10 doses) is supplied with a pad of 10 Patient Information Leaflets (PILs), as well as there being a single PIL inside each Bexsero pack. From September 2020, an updated version of the PIL pad will be distributed with Bexsero orders. Please dispose of the single PIL from inside the pack, as it will be out-of-date.

We will advise further when the PIL supplied in the pack is in line with the PIL pad.

MMR vaccine ordering

There are currently 2 different vaccines available to order for the MMR programme, MMRvaxPRO® and Priorix®. Orders for Priorix® are capped at 6 packs per order per week for accounts in England and Wales. Controls are also in place for Scottish customers. This is needed to rebalance central supplies.

The alternative MMR vaccine, MMRvaxPRO®, remains available to order without restriction. If you specifically require additional Priorix® stock, for example because you serve communities that do not accept vaccines that contain porcine gelatine then please contact the ImmForm Helpdesk for assistance at helpdesk@immform.org.uk or 020 7183 8580.

The EU Falsified Medicines Directive (FMD) and Delegated Regulation as applicable to PHE supplied vaccines for the national immunisation programme

Full information on FMD as it applies to centrally supplied vaccines for the National Immunisation Programme can be found in the April 2019 edition of Vaccine update.

ImmForm vaccines in FMD-compliant packs (ie subject to the requirements of the Delegated Regulation) are being distributed for all centrally supplied products. We would encourage all of our customers to visit the Implementing the Falsified Medicines Directive: Safety Features and spend some time becoming familiar with the content and links to various other guidance documents on the implementation of the legislation.

If you have identified yourself to PHE as being exempt from decommissioning under Article 23 of the Delegated Regulation and this has been agreed, then you will be supplied with decommissioned vaccine.

Please see our guidance for more information on the roles and responsibilities in relation to FMD and the Delegated Regulation, regarding vaccines and other medicines centrally supplied by PHE to the NHS and other customers.

Please note that the barcode on Rotarix batch AROLC284AA (exp. 31 May 2021) is non-serialised and therefore cannot be verified or decommissioned; however, it can still be used.

ImmForm web address has changed

As part of planned works to ensure continued availability of the ImmForm website, the web address has changed to https://portal.immform.phe.gov.uk. There is currently an auto-redirect from the old address to the new web address. However, please update your shortcut or favourite links to the new PHE URL before November 2020.

For assistance please contact the ImmForm Helpdesk by calling 020 7183 8580 or emailing helpdesk@immform.org.uk.

Registering for a new or updating your existing ImmForm vaccine ordering account

When you register for or update an existing ImmForm account, PHE as a wholesaler of vaccines need to verify the requesting customer.

Please ensure you have your professional regulatory body registration number or Wholesaler Dealer Licence and an organisation code which can be verified when requesting updates or requesting a new vaccine ordering account.

For more information please see the ImmForm how to register helpsheet.

Vaccine supply: non-routine vaccination programme

Hepatitis A vaccine:

Adult

• GSK: Havrix Adult PFS singles and packs of 10 are available
• Sanofi Pasteur: Avaxim PFS singles and packs of 10 are available
• MSD: VAQTA Adult is available

Paediatric

• GSK: Havrix Paediatric PFS singles and packs of 10 are available
• MSD: VAQTA Paediatric is available

Hepatitis B vaccine:

Adult

• GSK: Engerix B PFS singles and packs of 10 are available
• GSK: Limited supplies of Engerix B single vials remain available within the wholesaler network
• GSK: Engerix B vials packs of 10 are unavailable
• GSK: Fendrix is available
• MSD: HBVAXPRO 10 µg is unavailable until further notice
• MSD: HBVAXPRO 40 µg is unavailable until further notice

Paediatric

• GSK: Engerix B Paediatric singles are available
• MSD: HBVAXPRO 5µg is available

Combined Hepatitis A and B vaccine:

• GSK: Twinrix Adult singles and packs of 10 are available
• GSK: Twinrix Paediatric is available
• GSK: Ambirix is available

Combined Hepatitis A and Typhoid vaccine:

• Sanofi Pasteur: Viatim is available

Typhoid vaccine:

• Sanofi Pasteur: Typhim singles and packs of 10 are available
• Emergent: Vivotif is available

Rabies vaccine:

• GSK; Rabipur is currently available
• Sanofi Pasteur: Rabies BP is currently out of stock. An alternative vaccine is available, please contact Sanofi Pasteur directly for more information

Pneumococcal Polysaccharide Vaccine (PPV):

• MSD Pneumococcal Polysaccharide Vaccine vials have now been discontinued and all supply has been depleted
• MSD: Limited supplies of PNEUMOVAX 23 PFS are currently available

Pneumococcal polysaccharide conjugate Vaccine (PCV):

• Pfizer: Prevenar 13 is currently available

Varicella Zoster vaccine:

• GSK: VARILRIX is available
• MSD: VARIVAX is available
• MSD: ZOSTAVAX is available

Diphtheria, Tetanus and Poliomyelitis (inactivated) vaccine:

• Sanofi Pasteur: Revaxis is available

Diphtheria, Tetanus, Pertussis (acellular) and Poliomyelitis (inactivated) vaccine:

• GSK: Supply of Boostrix-IPV is currently available

MMR vaccine:

• MSD: MMRvaxPro is currently available
• GSK: Priorix are currently available

Meningitis ACWY vaccine:

• GSK: Menveo is available
• Pfizer: Nimenrix is currently available

Yellow Fever vaccine:

• Sanofi Pasteur: Stamaril is available

Human papillomavirus vaccine (HPV):

• MSD: Limited supplies of GARDASIL are available
• MSD: Gardasil 9 is currently available
• GSK: Cervarix is currently available

Cholera vaccine:

• Valneva: Dukoral is available

Japanese Encephalytis vaccine:

• Valneva: Ixiaro is available