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Vaccine update: issue 335, February 2023

Published 28 February 2023

Achieving targets for eliminating transmission of hepatitis B

The UK has been certified as meeting the new World Health Organization (WHO) Europe regional targets for control of hepatitis B virus (HBV) through immunisation, focusing on elimination of mother to child transmission.

Hepatitis B is a viral infection that affects the liver, and if untreated can lead to serious liver damage including cirrhosis, cancer as well as premature death. It is passed on through blood and sex. Pregnant women who have hepatitis B can pass the infection onto their baby around the time of birth – this is one of the most common routes of infection globally.

To reduce the chances of a baby developing the infection, since the late 1990s, all pregnant women in England have been offered an antenatal blood test for hepatitis B (as well as HIV and syphilis). For women with evidence of hepatitis B infection (HBsAg positive), their newborn babies are offered a course of hepatitis B vaccination starting at birth. In addition, in 2017 the UK introduced universal infant hepatitis B immunisation within the 6-in-1 vaccine at 8 weeks, 12 weeks and 16 weeks of age. Through this 3-pronged approach, the UK not only met, but exceeded the WHO targets.

This success is thanks to NHS maternity and primary care teams delivering the hepatitis B universal antenatal screening, selective neonatal and universal infant immunisation programmes – along with the UK Health Security Agency (UKHSA) free dried blood spot (DBS) testing service for infants on the selective programme at 12 months of age. In 2021, guidance on the hepatitis B antenatal screening and selective neonatal immunisation enhanced pathway was published to improve the quality of these programmes.

The first ever UKHSA report on Hepatitis B in England, 2023: progress towards elimination contains the data from programme monitoring which show that England has met the WHO targets for eliminating vertical transmission (see table below). Achieving this is a key milestone in the UK’s commitment to the WHO’s strategy for the overall elimination of viral hepatitis as a public health threat by 2030.

WHO targets to demonstrate elimination of mother to child transmission and England’s status

WHO Indicator	WHO 2023 target	England status 2020-2021
Impact target
Mother to child transmission rate	<2%	Target met: 0.1% among infants tested through UKHSA DBS service
Programmatic (coverage) targets
Coverage of antenatal HBsAg testing among pregnant women	≥90%	Target met: ≥99%
HBIG coverage of HBV-exposed babies at highest risk	≥90%	HBIG coverage target met: ≥97.6%
Coverage of infants at risk targeted with timely birth dose (BD)	≥90%	Target met: ≥99.2%
HepB3 coverage (3 doses in universal hexa programme)	≥90%	Target met: ≥92%

The UKHSA report on hepatitis B highlights that, although the UK has met elimination targets overall, to demonstrate sustained elimination and reduce inequalities, efforts are needed to reduce variation in vaccine uptake in different communities, maintain high coverage of the 6-in-1 vaccine programme, and expand coverage of 12 months testing with UKHSA’s national DBS testing service.

UKHSA estimates that around 206,000 people are living with chronic hepatitis B infection in England. Most cases are in migrants who have acquired infection overseas in endemic countries prior to arrival in the UK. Although the risk of hepatitis B in the UK is low, UKHSA continues to encourage all those eligible to take up vaccination to lower the risk of themselves or their children becoming seriously ill in future.

Chapter 18 of the green book on GOV.UK and National Institute for Health and Care Excellence (NICE) guidance recommend the testing and immunisation of communities at higher risk of HBV infection in the UK, such as:

• migrants from endemic countries
• close household contacts of cases
• people who inject drugs
• gay, bisexual and other men who have sex with men (GBMSM)
• people detained in prisons or immigration detention centres

Improved monitoring and implementation of targeted adult immunisation in prisons, sexual health services and drug services are also needed along with scale up testing, diagnosis and referral and retention in care, particularly in black and minority ethnic groups, to see longer term reductions in hepatitis B related cirrhosis, cancer, transplants and deaths as well as associated disparities in health.

Alongside hepatitis B, progress towards eliminating hepatitis C as a public health problem by 2030 in England continues, although there is no vaccine. Hepatitis C virus (HCV) is spread in similar ways to hepatitis B infection, but most people in the UK have acquired infection through injecting drug use. Latest modelling suggests that 92,900 people were living with hepatitis C in the UK at the end of 2021 – a decline of 47.2% since 2015. These data are published in recent UKHSA reports on Hepatitis C in the UK and England. Thanks to increased testing and curative treatments, the UK is on track to achieve the 2030 WHO elimination goal for HCV.

Many people are unaware of their infection because the viruses can be symptomless or non-specific until liver complications occur. To encourage testing and engagement in care in people at risk of hepatitis B and C and to support health professionals, UKHSA in partnership with community partners and clinicians, is refreshing its resources on hepatitis B and C – watch this space!

Resources

Hepatitis B immunisation information for public health professionals, is published as part of the Hepatitis B: the green book, chapter 18.

Hepatitis B antenatal screening and selective neonatal immunisation enhanced pathway guidance is available from UKHSA on GOV.UK.

Learn more about the national DBS testing service for infants.

Hepatitis B symptoms, diagnoses and treatment information is available from the NHS website.

Hepatitis C symptoms, diagnoses and treatment information is available from the NHS website.

The Royal College of General Practitioners (RCGP) detection and management of hepatitis B and C e-learning module is free for RCGP members through the RCGP e-learning platform.

Results of our 2022 parental attitudes to vaccination survey

UKHSA designed an online survey to find out what parents think about vaccination, the results of which have now been published.

UKHSA commissioned the commercial parenting organisation, Bounty, to send an invitation email and survey link to parents registered with their organisation who had children aged between 2 months and under 5 years. Parents were emailed on 2 September 2022 and a reminder email was sent on 16 September 2022.

A slide set of the survey findings is available to download.

Notable findings from the study

Most parents felt their baby or child would have all the vaccines offered before any discussion with a health professional:

• 89% of parents with children aged under 3 years and 4 months did speak to a health professional about vaccines
• 36% of parents felt more confident about vaccinating their baby after receiving information from a health professional
• 42% of parents who were undecided felt more confident about getting their baby vaccinated after speaking to a health professional

We are pleased to see that there is a sustained overall trust in the vaccination program in England and would like to highlight the work of our frontline colleagues whose advice, time and professionalism contribute to our continued high uptake.

A set of graphics relating to the survey’s results are available to download from Health Publications for use online and face-to-face.

New human papillomavirus (HPV) teaching resource

EDUCATE, co-produced by young people and researchers from the University of Bristol and London School of Hygiene and Tropical Medicine with input from colleagues at UKHSA, will help professionals inform Key Stage 3 students about the HPV vaccine. The resources are aimed at Year 8 students before they are offered the HPV vaccine. However, other young people may also benefit from having the opportunity to find out more about the process.

The resources for the EDUCATE lesson include films and exercises to assist learning and support the delivery of the HPV vaccination programme by providing young people with information and answering any questions they may have. It prepares them to be vaccinated at school and helps them make the decision to be vaccinated or not.

As well as covering key learning opportunities from the ‘Health and Wellbeing’ section of the Programme of Study, the lesson pack also covers the statutory Health Education requirements to ensure students know ‘about personal hygiene, germs including bacteria, viruses, how they are spread, treatment and prevention of infection, and the facts and science relating to immunisation and vaccination’.

The EDUCATE resources can be accessed for free from the PSHE Association.

Save a Life – for university accommodation and further education settings

As the university recruitment begins for another year of prospective students we have created a suite of posters ideal for university halls, student accommodations and gathering spaces. Knowing the signs and symptoms of meningitis and septicaemia is essential for young people and those who work with them. All young people remain eligible for MenACWY vaccine up to their 25th birthday and, even if vaccinated, need to be aware of signs and symptoms as Meningococcal B disease is not covered by the vaccine.

These A5 sticker posters use no glue, require no fixtures to hold them up and do not damage walls or painted surfaces. The outer surface can be washed and reused for up to 5 years.

These Save a Life resources are available to order for free through Health Publications.

We have now developed new translated versions of the stickers available to order for free to make sure international students have the same information at university and in colleges. You can order translated versions in:

• Arabic
• Bengali
• Chinese (simplified)
• Chinese (Traditional)
• Gujarati
• Hindi
• Japanese
• Korean
• Urdu

Vaccine supply - routine vaccination programme

Vaccines for the 2022 to 2023 children’s flu programme supplied by UKHSA

Fluenz® Tetra ordering now closed

Ordering of Fluenz® Tetra, for the 2022 to 2023 children’s flu programme, closed on Friday 24 February 2023, with final deliveries taking place on Tuesday 28 February 2023.

Expiry dates for all batches of Fluenz® Tetra

Batch numbers and associated expiry dates of all batches of Fluenz® Tetra, that either have or will be issued for the 2022 to 2023 children’s flu programme, are set out in the table below. Please ensure that the expiry date is always checked before use and that expired stock is disposed of in line with local policies. Any disposed stock should be recorded through the ImmForm stock incident page.

Batch number	Expiry date	Status
PH3539	28 November 2022 [footnote 1]	Expired
PH2004	12 December 2022 [footnote 2]	Expired
PF3032	23 December 2022	Expired
PH2003	26 December 2022	Expired
PJ2632	30 December 2022	Expired
PK2464	20 January 2023	Expired
PK2446	27 January 2023	Expired
PH3537	31 January 2023	Expired
PL2619	8 February 2023	Expired
PK3269	9 February 2023	Expired
PL2706	13 February 2023	Expired
PL3844	1 March 2023
PM2408	13 March 2023
PM2427	14 March 2023

Inactivated flu vaccine and availability and ordering

Inactivated flu vaccines for the 2022 to 2023 children’s flu programme remain available to order by NHS programme providers in England via UKHSA’s ImmForm website.

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

For customers in Scotland and Wales, please refer to guidance from your respective health departments.

The table below shows the inactivated vaccines that remain available to order, and the groups these vaccines should be ordered for:

Vaccine	Manufacturer	Available to order for
Cell Based Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (QIVc)	Seqirus	Eligible children [footnote 3] for whom LAIV is unsuitable
Quadrivalent Influenza Vaccine (split virion, inactivated) (QIVe)	Sanofi Pasteur	Children in clinical risk groups aged from 6 months to under 2 years

Both of these vaccines will remain available to order until the end of the season.

Providing a second dose of flu vaccine after all Fluenz® Tetra has expired

If you still need to give a second dose of flu vaccine 4 weeks after the first dose (for example, for children in clinical risk groups aged from 2 to under 9 years who have not received influenza vaccine before), then it is safe and effective to give inactivated vaccine as a second dose where Fluenz® Tetra is no longer available.

All influenza vaccines for the 2022 to 2023 season

Information on all influenza vaccines that were marketed in the UK for the 2022 to 2023 season is available on GOV.UK.

DTaP/IPV/Hib/HepB vaccine ordering

Supplies of DTaP/IPV/Hib/HepB vaccine Infanrix hexa® and Vaxelis® are available for the routine infant primary immunisations programme.

Orders for Infanrix hexa® remain unrestricted. Customers in England and Wales may order up to 20 packs of Vaxelis® per ImmForm account per week – this will vary for customers in the polio booster programme in London and those taking part in the Oxford Vaccine Group trial. Customers in Scotland should refer to their local ordering restrictions. Providers should not order more than 2 weeks’ worth of stock to minimise wastage due to fridge failures.

For assistance, please contact the ImmForm Helpdesk at helpdesk@immform.org.uk

Supply of vaccines with reduced shelf life

Vaccines supplied via ImmForm for the routine immunisation programme will usually have at least 3 months of shelf-life remaining at the time of delivery. Vaccines with reduced shelf life will occasionally be supplied. ImmForm customers will be informed of vaccines which have short shelf life via ImmForm news articles, updates on the particular ImmForm product page, or a click-thru pop-up message at the time of ordering.

ImmForm customers should order no more than 2 weeks’ worth of stock to minimise wastage due to fridge failures or failure to use stock before expiry. See chapter 3 of the green book (immunisation against infectious disease) for further details on the storage and supply of vaccines.

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. Since September 2020, an updated version of the PIL pad has been distributed with Bexsero orders. Please dispose of the single PIL from inside the pack and issue the updated PIL.

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

When you register for or update an existing ImmForm account, UKHSA 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.

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

The EU FMD 2011/62/EU and Delegated Regulation impose legal obligations on the EU medicines supply chain to prevent entry of falsified medicinal products into the supply chain. The Delegated Regulation was implemented in all EU Member States on 9 February 2019. Following the UK’s departure from the EU, the Delegated Regulation ceased to apply in Great Britain from 31 December 2020, but continues to apply in Northern Ireland.

Information for customers in Northern Ireland

FMD-barcoded packs of routine immunisation programme vaccines that are centrally supplied by UKHSA continue to be supplied with active FMD serialisation, and should be decommissioned by end users in Northern Ireland. Customers in Northern Ireland who access centrally supplied vaccines are encouraged to review local guidance on implementation of the EU FMD.

Measles, mumps and rubella (MMR) vaccine ordering

To rebalance central supplies of both MMR vaccines, please consider ordering M-M-RvaxPRO® as your first choice, which is available without restriction.

Customers in England and Wales who require Priorix®, for example because you serve communities that do not accept vaccines containing porcine gelatine, may order up to 6 packs of Priorix® per ImmForm account per week. For assistance please contact the ImmForm Helpdesk at helpdesk@immform.org.uk. Customers in Scotland should refer to their local ordering restrictions.

Vaccine supply for non-routine vaccination programme

Hepatitis A vaccine

Adult:

• GSK: supply of Havrix Adult PFS singles is currently limited. Supply of packs of 10 are available

• Sanofi Pasteur: Avaxim PFS singles and packs of 10 are currently available

• MSD: VAQTA Adult is available

Paediatric:

• GSK: supply of Havrix Paediatric singles and packs of 10 is currently limited. Expected recovery mid-February

• MSD: VAQTA Paediatric is available

Hepatitis B vaccine

Adult:

• GSK: Engerix B PFS singles and packs of 10 are currently available

• GSK: supply of Fendrix is available

• MSD: HBVAXPRO 10 μg is available

• MSD: HBVAXPRO 40 μg is available

Paediatric:

• GSK: supplies of Engerix B Paediatric singles is currently 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 currently not available – expected recovery mid-March

• GSK: Ambirix is available

Combined hepatitis A and typhoid vaccine

• Sanofi Pasteur: Viatim is now a discontinued product and no longer available for sale

Typhoid vaccine

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

• Emergent: Vivotif is available

Rabies vaccine

• Valneva: Rabipur is currently available. Expiry of current stock – 31 March 2023. Further inventory available in March 2023

• Sanofi Pasteur: Rabies BP is now a discontinued product and no longer available for sale

Pneumococcal polysaccharide vaccine (PPV)

• MSD: supply of Pneumovax 23 (PPV23) PFS is available

Pneumococcal polysaccharide conjugate vaccine (PCV)

• Pfizer: Prevenar 13 is currently available

Varicella zoster vaccine

• GSK: VARILRIX is currently 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

• Sanofi Pasteur: Repevax is available to order with restrictions of 10 doses per customer per month until February 2023

MMR vaccine

• MSD: MMR Vaxpro is currently available

• GSK: Priorix is currently available

Meningitis ACWY vaccine

• GSK: Menveo is currently available

• Pfizer: Nimenrix is currently available

• Sanofi Pasteur: MenQuadfi is available

Yellow fever vaccine

• Sanofi Pasteur: Stamaril is available

HPV vaccine

• MSD: GARDASIL has been discontinued (please refer to ImmForm for NIP supply status)

• MSD: Gardasil 9 is currently available

• GSK: Cervarix has been discontinued

Cholera vaccine

• Valneva: Dukoral is currently unavailable. Further inventory available in March 2023

Japanese encephalytis vaccine

• Valneva: Ixiaro is available

1. Printed expiry date for batch PH3539 is 3 January 2023, please do not use after the updated expiry date. ↩

2. Printed expiry date for batch PH2004 is 27 December 2022, please do not use after the updated expiry date. ↩

3. Children in clinical risk groups aged 2 to under 18 years, healthy children aged 2 to 3 years, and those in eligible school age cohorts. ↩