Immunisation

Immunisation is a cost effective and critical element of preventive care around the world. The World Health Organization (WHO) estimate that it prevents between two and three million deaths each year.

Nurses have a major role in advising and promoting immunisation. This includes administering vaccinations included in the childhood immunisation programme and those recommended for adults, including travel vaccines and the annual influenza vaccination.

Immunisation policy for the UK is available in Immunisation against infectious diseases – the Green Book. The book includes the rationale for the policy. It also has the individual disease epidemiology and evidence on the efficacy and safety of the appropriate vaccines. It also contains general information on immunisation administration and best practice.

The book is written and updated by the Department of Health in conjunction with the public health agencies across the UK. All health care professionals involved in immunisation should have access to the online version.

The Joint Committee on Vaccination and Immunisation (JCVI) advises the UK health departments on immunisations for the prevention of infections and/or disease following due consideration of the evidence on; the burden of disease, on vaccine safety and efficacy and on the impact and cost effectiveness of immunisation strategies.

Administration of vaccines

The Green Book - Immunisation against infectious diseases contains advice on all aspects of vaccine administration.

The RCN position in relation to the role of health care assistants / health care support workers (HCSW) and vaccine administration see:

• HCSW and adult vaccination (Version: July 2015) (PDF 299KB)
• HCSW and Live Attenuated Influenza Vaccination [LAIV] for children and young people (Version: July 2015)

Please ensure if you are using a hard copy of these documents that you are using the most recent version.

For more information on the administration of vaccines in relation to Patient Specific Directions (PSD) and Patient Group Directions (PGD) please visit the medicines optimisation resource.

RCN online advice provides additional information and advice, see: Immunisations.

• vaccine administration
• the employer's responsibility to ensure they have an immunisation programme in place for health care employees
• the involvement of HCAs/APs in the provision of medication and immunisations
•  training for healthcare staff involved in immunisations to ensure they maintain skills and competence
•  immunisation policy throughout the UK
• the prescription and administration of vaccines by independent prescribers, nurses and midwives who are not prescribers and HCAs
• guidance for health care practitioners involved in travel health vaccination.

The RCN has also produced for registered nurses working in a range of health care settings, in particular those involved in women’s health, cervical screening and public health. This guidance focuses on an overview of HPV (including the current vaccination recommendations), the national cervical screening programme, information about colposcopy and some key facts on cervical cancer. See: Human Papillomavirus (HPV), Cervical Screening and Cervical Cancer.

Immunisation training

All staff involved in administering vaccines should be suitably trained and competent to fulfil the role and be able to answer questions with accuracy and confidence in line with nationally agreed standards.

• Public Health England. National Minimum Standards and Core Curriculum for Immunisation Training for Registered Healthcare Practitioners. The aim of the national standards is to describe the training that should be given to all practitioners engaging in any aspect of immunisation so that they are able to confidently, competently and effectively promote and administer vaccinations. For health care support workers please see National minimum standards and core curriculum for immunisation training of health care support workers.
• RCN: competence assessment framework, Immunisation knowledge and skills competence assessment tool, is now also incorporated within the National minimum standards guidance. It is designed to be used in the workplace to support the training and the assessment of registered and non-registered health care workers who have a role in immunisations.
• The PHE immunisation training resources for health care professionals across the UK, includes many resources and Q&A documents for a range of vaccine programmes and a useful animation explaining how the immune system works for immunisers.
• Health Protection Scotland's Immunisation Education and Training has some additional resources for staff in Scotland
• There is a specific e-learning programme for flu vaccination, with open access to anyone involved in delivering the flu programme/vaccine.
• Information and resources on travel health, see: Jane Chiodini, Travel Health Specialist Nurse.

New e-learning resource resource for Immunisation 

A new interactive e-learning programme has been developed to support the training of healthcare practitioners involved in advising on and/or delivering immunisation accross the life course. The programme is free to access, just register to use the e-lfh portal. The course is designed around the updated National Minimum standards and the competency assessment tool.

View the Immunisation e-learning programme.

Storage and Cold Chain 

The Green Book, chapter three provides information on the correct storage of vaccines. As biological substances, vaccines may lose their effectiveness quickly if they become too hot or too cold at any time, especially during transport and storage. Incorrect storage may result in the failure of the vaccine to protect, as well as resulting in vaccine wastage.

Vaccine wastage has significant cost implications estimated at approximately £2million per year.

Jane Chiodini reviews the best practice guidance to provide clinicians with knowledge to effectively enhance local storage and handling protocols.

Keeping up to date

The immunisation programme in the UK is constantly evolving to best protect the public by controlling vaccine preventable diseases. Health professionals must keep up to date with these changes.

The vaccine supply newsletter, ‘Vaccine Update’ comes out approximately every four to six weeks and can be emailed directly to individuals upon request. Email: Vaccine.Supply@dh.gsi.gov.uk. This newsletter gives advice on current vaccine availability, any changes to the schedule and updates to the Green Book.

‘Vaccine Update’ is available to health care professionals across the UK. However, for country specific information, see:

• England: Public Health England immunisation pages.
• Northern Ireland: Public Health Agency: Immunisation / vaccine preventable diseases.
• Scotland: NHS Scotland Immunisation and vaccine preventable diseases pages. Health Protection Scotland produces a 'Scottish Vaccine Update' with similar information to the general version but it reflects the different vaccine supply arrangements. Contact NSS.HPS-SVU@nhs.net to subscribe to the mailing list.
• Wales: Welsh Government Immunisation pages

Travel health vaccination

UK figures for overseas travellers have more than tripled since 1981 (Office for National Statistics, 2012) and travel health medicine is a fast growing specialist area of practice. The RCN guidance ‘Travel health nursing: career and competence development' defines the standards of care expected for a competent registered nurse, experienced/proficient nurse and a senior practitioner/expert nurse working in travel health nursing.

Additional information

It is good practice to support any advice you give with written information. Check that the information printed from websites is up to date, evidence based and from a credible source.

As a general guide when searching the web for information, ask yourself and encourage patients, parents and carers to ask the following questions:

• who or what is behind the information?
• is the information biased, or possibly selected to present one view point?
• does the author have a vested interest in the information they are presenting?
• is it dated? There may be more current advice available.
• is it referenced and are uncertainties acknowledged?

In addition look for websites providing reliable and trustworthy health information which have the Health on the net HONcode.