Immunisation Resources

The national influenza vaccination programme of the United Kingdom is highly successful, changeable and progressive and can feel relentless in its delivery. When the national flu immunisation programme plan for 2024 to 2025 (as known as ‘the annual letter’) was published on 12th March 2024, initially it seemed that this year would have very few changes to the programme, when compared to those of the last few years (UK Health Security Agency [UKHSA], 2024). However, since then there have been two versions of a statement of amendment, the second due to loss of a valuable vaccine type (UKHSA, 2024), and a pertinent letter from NHS England concerning the start dates for the programme (NHS England, 2024). These changes should not be a surprise to any immuniser, especially those who have been involved in the flu vaccination programmes in previous years. Changes often happen in the lead up to, and even after, the start of the
programme. Our national immunisation programmes (NIPs) are never static for long. They are changeable due to such things as changing epidemiology, differing vaccine types or supply, new evidence, national advice or recommendations being implemented and shared with the field regularly.

The United Kingdom (UK) has a comprehensive national immunisation programme which comprises both routine and selective immunisation schedules (UK Health Security Agency [UKHSA], 2023). The routine programme includes those vaccines offered to the population, with eligibility predicated on age. For the last few years, vaccine coverage has been
falling in the majority of children’s and young people’s immunisation programmes (UKHSA, 2022; UKHSA 2023a; UKHSA 2023b; UKHSA 2023c). The decline in coverage has been made worse by the Covid-19 pandemic and consequent lockdowns, illness among recipients, and confusion and hesitancy about vaccines in general. This article discusses the drop in coverage of the adolescent immunisation programmes in England, and the role that general practice nurses (GPNs) and primary care immunisers can play in ensuring that young people are offered missing vaccines. The benefit of this catch-up activity is seen in reduced risk of morbidity and mortality from vaccine preventable illness in both individuals
and those around them.

Vaccination and immunisation are slightly different things. Vaccination is the giving of a dose of antigen, for example, intranasally (the children’s ‘flu vaccine) or an intramuscular injection (the baby six-in-one vaccine). Immunisation refers to the process of receiving the vaccine and then becoming immune to the disease following this. Immunity can be developed after having the disease itself, but there is the risk of post-disease sequelae such as Ramsey-Hunt syndrome after ophthalmic shingles or severe epiglottitis with haemophilus influenzae type b (Hib)

The influenza immunisation programme in the UK started in the 1960s and has since been extended to offer protection to those groups most vulnerable to the infection. The extension of the programme to children aims to directly protect them and reduce transmission of the virus to those around them. General practice nurses (GPNs) are among those most trusted in informing and reassuring parents about the benefits of immunisation. This article will primarily describe arrangements for the flu immunisation programme 2021–22 in England. The programme is, of course, delivered in Scotland, Northern Ireland and Wales and there may be subtle differences in programme delivery in the devolved nations. Nurses working in countries other than England should ensure that they are following relevant guidance specific to the area in which they practice (Scottish Government, 2021; Public Health Agency Northern Ireland, 2021, and Welsh Government, 2021).

Delivering the flu vaccination programme this coming season will be a greater challenge than ever before. The impact of COVID-19 on all healthcare services will also be felt when trying to deliver a vaccination programme in a short period of time to numerous patients, and perhaps an even greater number of patients than in previous years. There are various options in terms of delivery models and plans, but it is important that those who give the majority of vaccines in general practice, general practice nurses (GPNs), are involved in the planning of a delivery model which best suits the practice and the practice population. Careful risk assessment and documentation of decisions is important, as well as the ability to be flexible during the season and ready to offer flu vaccine to other eligible groups as the season progresses.

Influenza is an important vaccine preventable infection, which is an annual global health threat. Huge advances have been made in our knowledge of the influenza virus and as a consequence the ability to produce more effective influenza vaccines. In the last few years, the Joint Committee on Vaccination and Immunisation (JCVI) has considered newly licensed influenza vaccines for use in the UK population. The UK now has a differentiated influenza immunisation programme with different vaccines being advised for different risk groups. Currently, the various vaccines are differentiated by age, but in the future may also be differentiated by risk group. General practice nurses (GPNs) need to understand how these various influenza vaccines differ, what are their advantages in terms of the increased protection they offer to patients, and, in turn, be able to explain these advantages to patients.

Shingles is a painful and debilitating disease which disproportionately affects older adults. Despite an effective vaccine, the use of which has reduced cases of shingles and the subsequent complication of postherpetic neuralgia, many eligible older adults are not receiving the vaccine. Uptake is lower than would be hoped for and has declined each year since the programme was introduced in 2013. This year, efforts are being made to reinvigorate interest in the vaccination programme and to provide supporting literature and information. General practice nurses (GPNs) are instrumental in advising patients about vaccination and will deliver the majority of vaccines. This article provides an overview of the disease, its cause, the role of immunity, risk and incidence, disease course, treatment, prevention and how to improve uptake by employing best practice initiatives. GPNs can use this information to advocate shingle vaccination and improve uptake and protection for the vulnerable older adults in the population.

The routine national vaccination programme protects against a number of diseases that can have a significant impact on health. Not only does vaccination save lives, it can also mitigate disease severity and provide some protection for unvaccinated individuals.The UK schedule is also now a lifelong programme, with some neonates, such as those at risk of hepatitis B infection, being offered their first vaccine on their day of birth, and other vaccines, such as the influenza vaccine, being recommended every single year for those eligible. Although several new vaccines have been added to the schedule over recent years, clinicians can expect programmes such as the influenza one to continue to expand. To ensure that the optimum benefits of vaccination are achieved, it is essential to maintain high vaccine coverage in communities to protect both the individual vaccinated and offer some indirect protection for those who remain unvaccinated. This article reviews the current schedule, considers the impact of vaccination and highlights actions that can be put in place to achieve high coverage.