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.

Webinar: Testing infants born to mothers with hepatitis B

This recording is intended for use both by women with hepatitis B and health professionals caring for women with hepatitis B.

• Public Health England, Hepatitis B: the green book, chapter 18
• Public Heath England, Infants born to hepatitis B infected mothers
• Public Health England, Hepatitis B: vaccination guidance, data and analysis

Immunisation policy for the UK is available in the Department of Health (DH) publication Immunisation Against Infectious Diseases: The Green Book.

Immunisation policy in the UK is informed by the Joint Committee on Vaccination and Immunisation (JCVI). The JCVI's remit is to advise UK health departments on immunisations 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

See: Practical and clinical guidance for vaccine administration.

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.

It is recommended that immunisation training should be either through a face to face taught course or a blended approach of both e-learning and a face to face taught course.

New immunisers should also have a period of supervised practice and support with a registered healthcare practitioner who is experienced, up to date and competent in immunisation.

See:

• Public Health England (PHE). 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.
• 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.
• PHE. Guidance from PHE on immunisation training and disruption to face to face training opportunities on immunisation
• 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.
• Health Protection Scotland's Immunisation Education and Training has some additional resources for staff in Scotland. See ‘Promoting Effective Immunisation Practice’. For Wales see: Immunisation and vaccines and and Public Health Wales e-learning. 
• There is a specific PHE 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.

Immunisation e-learning resource 

Interactive e-learning programme to support the training of healthcare practitioners involved in advising on and/or delivering immunisation across 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.

See the specific flu e-learning resource.

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: Public Health Wales - immunisation and vaccines

Travel health vaccination

There were 72.8 million visits overseas by UK residents in 2017, an increase of 3% on 2016 and the highest recorded (Office for National Statistics 2018). Travel health medicine is a fast growing specialist area of practice. The RCN guidance, 'Competencies: travel health nursing: career and competence development' (RCN, 2018) provides information on current guidelines and standards and 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.

The National Travel Health Network and Centre (NaTHNaC) provides advice on travel health, including travel vaccination.

TRAVAX (LOGIN REQUIRED) and fitfortravel from Health Protection Scotland (HPS) provides similar information to NaTHNaC.

NHS Wales has an organisational subscription to TRAVAX which is therefore freely available to NHS Wales users (via HOWIS (Health of Wales Information Service)).

The British Medical Association (BMA) publication, Focus on Travel Immunisation offers clarity around the immunisation issues within the General Medical Services (GMS) contract and how travel immunisations may be funded.

More people in the world are migrating today than at any other point in human history and the Health Protection Agency (now part of Public Health England) has produced a Migrant Health Guide, which supports practitioners making decisions around best protecting the health of migrants. An accompanying video looks at how to catch up immunisations for migrants to the UK.

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.