Vaccine update: issue 336, March 2023

Question 1

COVID-19 spring 2023 booster

Accepted Answer

On 8 November 2022, Joint Committee on Vaccination and Immunisation (JCVI) formulated interim advice on coronavirus (COVID-19) vaccination for 2023, published on 25 January 2023. The current advice, developed following meetings on 24 January 2023 and 14 February 2023, sets out further detail regarding the spring 2023 booster programme.

The primary aim of the COVID-19 vaccination programme continues to be the prevention of severe disease (hospitalisation and mortality) arising from COVID-19. Older persons, residents in care homes for older adults, and those who are immunosuppressed continue to be at highest risk of severe COVID-19.

As a precautionary measure, JCVI advises that an extra booster vaccine dose in spring 2023 should be offered to:

adults aged 75 years and over
residents in a care home for older adults
individuals aged 5 years and over who are immunosuppressed, as defined in tables 3 or 4 in the COVID-19 chapter of the Green Book

The spring booster dose should be offered around 6 months after the last vaccine dose, although operational flexibility around the timing of the spring dose in relation to the last vaccine dose is considered appropriate. More information on operational flexibility will be provided in the ‘Green Book: immunisation against infectious disease’.

There is an updated suite of resources to facilitate the delivery of the 2023 Spring booster campaign available to order.

Copies of printed publications and the full range of digital resources to support the immunisation programmes can now be ordered and downloaded online. Log in to register and place your order or telephone: 0300 123 1002.

Spring 2023 booster resources

Patient facing:

For vaccinators:

Further information:

Question 2

Yes! We can end TB

Accepted Answer

World TB Day 2023 Friday 24 March

The BCG vaccine is used to prevent tuberculosis (TB). The BCG vaccine is named after Dr Albert Calmette and Dr Camille Guerin, who developed the vaccine from a bacteria called Mycobacterium Bovis, which is similar to TB.

The BCG vaccine is made from a weakened strain of the TB bacteria. Because the bacteria in the vaccine is weakened it is not harmful to individuals with healthy immune systems.

The vaccine helps to trigger the immune system protecting against TB. It provides babies and young children consistent protection, showing 70 to 80% efficacy against the most severe forms of TB, such as TB meningitis and disseminated disease in babies and young children.

BCG eligibility

Eligible babies include all newborns whose parent/s or grandparent/s was born in a country where the annual incidence of TB is 40 per 100,000 or greater; or newborn babies living in areas of the UK where the annual incidence of TB is 40 per 100,000 or greater.

Timing of BCG vaccination for newborns

The vaccine should be given to eligible babies by 28-days. There may an earlier opportunity providing an appropriate Severe Combined Immunodeficiency (SCID) screening outcome is available. Only one dose of the BCG Vaccine is required.

A BCG/SCID flowchart is available for health professionals to support timely BCG vaccination through early identification and recording of eligible babies who are at increased risk of developing TB.

TB action plan

The TB action plan for England 2021 to 2026 sets out specific actions and indicators (see 2.8 and 2.8.1) for NHS and local providers to improve BCG vaccine provision.

These indicators, (i) the offer of BCG to eligible babies and (ii) uptake of the BCG vaccination by 28-days will be monitored and annually reported on.

Other eligible individuals

Other individuals eligible for BCG vaccination are:

previously unvaccinated children aged 1 to 5 years with a parent or grandparent who was born in a country where the annual incidence of TB is 40 per 100,000 or greater – these children should be identified at suitable opportunities and can normally be vaccinated without tuberculin testing
previously unvaccinated, tuberculin-negative children aged from 6 to under 16 years of age with a parent or grandparent who was born in a country where the annual incidence of TB is 40 per 100,000 or greater – these children should be identified at suitable opportunities, tuberculin tested and vaccinated if negative (please see Green Book section on tuberculin testing prior to BCG vaccination
previously unvaccinated tuberculin-negative individuals under 16 years of age who are contacts of cases of respiratory TB (following the National Institute for Health and Care Excellence (NICE) recommended contact management advice)
previously unvaccinated, tuberculin-negative individuals under 16 years of age who were born in or who have lived for a prolonged period (at least 3 months) in a country with an annual TB incidence of 40 per 100,000 or greater
previously unvaccinated, tuberculin-negative individuals under 16 years of age who are going to live or work with local people for more than 3 months in a country where the annual incidence of TB is 40 per 100,000 or greater
individuals at occupational risk

TB: training advice and guidance

Further details on BCG vaccination can found in the Green Book chapter 32

Country information on TB prevalence

NHS National BCG service schedules 2, 4 and 6

TB and BCG training slide sets are available to download:

Essential immunisation training standards for healthcare practitioners

Patient information leaflet for BCG AJV vaccine

A Patient Group Direction (PGD) template is available to support health professionals to administrator BCG Vaccine AJV to individuals under 16 years of age who are at increased risk of TB.

The BCG vaccine is available to order through the ImmForm website. Please remember you have an ImmForm account to enable access. For information on registering for an ImmForm account please take a look at the ImmForm help sheet.

TB and BCG vaccine resources

Leaflets

The ‘TB, BCG vaccine and your baby’ leaflet contains the current information on tuberculosis and the BCG vaccine including the benefits and contraindications for BCG immunisation in infants.

Paper copies of this leaflet are available to order for free or download in the following languages:

English, Bengali, Farsi, Gujarati, Hindi, Kurdish, Nepali, Panjabi, Pashto, Romanian, Romany, Somali, Tamil, Turkish, Ukrainian and Urdu

There is a new BCG flyer available to download or order as paper copy from the Health Publications or call 0300 123 1002 to place orders using product code C23TBFEN.

Poster

Paper copies of the TB, BCG and your baby poster are also available free to order.

Videos

What is tuberculosis TB? video

What is TB? YouTube video

Facts about TB video

Facts about TB YouTube video

TB, BCG and your baby animation

A new animation is available which can be downloaded to share on websites, WhatsApp groups and social media.

TB,BCG animation

Question 3

Fundamentals of Immunisation course

Accepted Answer

Date of event: 22 and 23 May 2023

Venue:

UCL Great Ormond Street Institute of Child Health
30 Guilford Street
London
WC1N 1EH

Course fee: £200 for 2 days (£100 for one day)

The UK Health Security Agency (UKHSA) and UCL Great Ormond Street Institute of Child Health are running a Fundamentals of Immunisation course. This 2-day intense theoretical course is designed for those new to a role in immunisation and is most suited to those who give or advise on a range of different vaccines.

The course comprises of a series of lectures from national immunisation experts and will provide delegates with the latest information on the range of topics included in the ‘Core Curriculum for Immunisation Training’ . A basic level of prior immunisation knowledge and familiarity with the Green Book (Immunisation against infectious disease) will be assumed.

The programme includes the following topics:

why immunisation matters
the scientific basis of national vaccine policy: designing, informing and monitoring immunisation programmes
immunology of immunisation
vaccine manufacture and vaccine trials
monitoring vaccine safety
current issues in vaccine preventable diseases
vaccine coverage data collections
maximising immunisation uptake
talking with parents about immunisation
legal issues including consent
practical issues: storage and administration

Booking details to follow

If you have any queries, please do not hesitate to contact Lisa Etamoje at l.etamoje@ucl.ac.uk

Question 4

‘Back to school’ resources for nursery, primary and secondary school starters

Accepted Answer

Starting nursery or primary school is an exciting time for all children. They will be mixing more with new children and making sure they are up to date with their routine immunisations gives children the best protection from infectious disease.

We have reminder postcards which can be sent to parents whose children are due to start in the summer term. Posters can be put up in the school in traffic areas, on notice boards and doors or in GP practices to remind parents. There can be many reasons why children have missed out on their vaccines during the pandemic.

Reminding parents now and before their children return for the summer term or start in September gives them time to prioritise making appointments at their GP for their child to catch up with their pre-school booster, MMR and make sure they know the signs and symptoms of meningitis and septicaemia. Have stocks of the postcards and posters for nursery or childminder settings, primary schools and secondary schools and Immunisations for children aged 3 years 4 months and Immunisations for young people for parents to read.

Posters

Primary school poster

Secondary school poster

Nursery poster

Postcards

Primary school postcard

Secondary school postcard

Nursery postcard

Question 5

All influenza vaccines marketed in the UK for the 2023 to 2024 season

Accepted Answer

An updated table with all of the vaccines that are marketed in the UK for the 2023 to 2024 flu vaccination season, including ovalbumin content, is available to download.

Question 6

Vaccine supply for routine vaccination programme

Accepted Answer

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

All batches of Fluenz® Tetra issued for the 2022 to 2023 children’s flu programme have now expired.

Any remaining stock should be disposed in line with local policies and recorded through the ImmForm stock incident page.

Inactivated flu vaccine and availability and ordering

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

The table below shows the 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 1]} for whom live attenuated influenza vaccine (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

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.

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 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.

Easter and May Bank Holiday deliveries warning notice

Easter Bank Holiday

Due to the Easter Bank Holiday, there will be no deliveries or order processing by Movianto UK on Friday 7 April and Monday 10 April 2023. Please see the table below for revised order cut-off and delivery dates.

For customers with standard delivery days of Friday or Monday, please be aware that:

after Friday 31 March, your next available delivery day will be Friday 14 April
after Monday 3 April, your next available delivery day will be Monday 17 April

You are reminded to be prepared for the break in deliveries and to order accordingly. Please make sure you have sufficient room in your fridge for any additional vaccine you wish to stock over this holiday period, bearing in mind the recommendation that only 2 to 4 weeks of vaccine stock be held at any one time.

Easter Bank Holidays Friday 7 April to Monday 10 April 2023

Delivery day	Order cut-off date	Order cut-off time
Friday 31 March 2023	Wednesday 29 March 2023	11:55am
Weekend
Monday 3 April 2023	Thursday 30 March 2023	11:55am
Tuesday 4 April 2023	Friday 31 March 2023	11:55am
Wednesday 5 April 2023	Monday 3 April 2023	11:55am
Thursday 6 April 2023	Tuesday 4 April 2023	11:55am
Friday 7 April 2023	Closed – no deliveries or order processing
Weekend
Monday 10 April 2023	Closed – no deliveries or order processing
Tuesday 11 April 2023	Wednesday 5 April 2023	11:55am
Wednesday 12 April 2023	Thursday 6 April 2023	11:55am
Thursday 13 April 2023	Tuesday 11 April 2023	11:55am
Friday 14 April 2023	Wednesday 12 April 2023	11:55am
Weekend
Monday 17 April 2023	Thursday 13 April 2023	11:55am

Please be advised that Emergency or ‘Out of Schedule’ deliveries cannot be arranged for failure to place orders in good time. The ImmForm Team, helpdesk@immform.org.uk, 0844 376 0040.

May Day, Coronation Day and Late May Bank Holidays

Due to the May Day, Coronation Day and Late May Bank Holidays, there will be no deliveries or order processing by Movianto UK on Monday 1 May, Monday 8 May and Monday 29 May. Please see the table below for revised order cut-off and delivery dates.

For customers with a standard delivery day of Monday, please be aware that:

after Monday 24 April, your next available delivery day will be Monday 15 May 2023
after Monday 22 May, your next available delivery day will be Monday 5 June 2023

You are reminded to be prepared for the break in deliveries and to order accordingly. Please make sure you have sufficient room in your fridge for any additional vaccine you wish to stock over this holiday period.

May Day and Coronation Day Bank Holidays: Monday 1 May and Monday 8 May 2023

Delivery day	Order cut-off date	Order cut-off time
Monday 24 April 2023	Thursday 20 April 2023	11:55am
Tuesday 25 April 2023	Friday 21 April 2023	11:55am
Wednesday 26 April 2023	Monday 24 April 2023	11:55am
Thursday 27 April 2023	Tuesday 25 April 2023	11:55am
Friday 28 April 2023	Wednesday 26 April 2023	11:55am
Weekend
Monday 1 May 2023	Closed – no deliveries or order processing
Tuesday 2 May 2023	Thursday 27 April 2023	11:55am
Wednesday 3 May 2023	Friday 28 April 2023	11:55am
Thursday 4 May 2023	Tuesday 2 May 2023	11:55am
Friday 5 May 2023	Wednesday 3 May 2023	11:55am
Weekend
Monday 8 May 2023	Closed – no deliveries or order processing
Tuesday 9 May 2023	Thursday 4 May 2023	11:55am

DTaP/IPV/Hib/HepB vaccine ordering

Supplies of DTaP/IPV/Hib/HepB vaccines 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) issued via ImmForm in Great Britain, 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 helpsheet – how to register.

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

The EU Falsified Medicines Directive 2011/62/EU (FMD) and Delegated Regulation ((EU) 2016/161) (The 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 Falsified Medicines Directive.

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.

Question 7

Vaccine supply for non-routine vaccination programme

Accepted Answer

Hepatitis A vaccine

Adult:

GSK: supply of Havrix Adult pre-filled syringe (PFS) singles and packs of 10 are currently 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 are currently available
MSD: VAQTA Paediatric is available

Hepatitis B vaccine