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Immunisation

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.

Current issues

Flu vaccinations 2016-2017

RCN advice sheet on flu vaccinations for 2016-2017.

BCG

Public Health England has published a special edition of Vaccine Update. This update provides advice on new supplies of the BCG vaccine, and details all the administration guidance. See: Vaccine update: issue 247, June 2016, special edition. See also:

MMR / Measles

PHE has released new leaflets and posters designed to promote MMR vaccination, particularly to those who may have missed vaccination as children, and to alert people to symptoms of measles so they can minimise spread of infection. See:

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:

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.

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.

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.

RCN online advice provides additional information and advice available for RCN members (login only). By searching for ‘immunisations’ you can find information on:

  • 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.

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:

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.

Useful websites:

  • British Foreign and Commonwealth Office
  • Centre for Public Scrutiny (CfPS). The CfPS and Sanofi Pasteur MSK, have developed resources to support local authorities scrutinise immunisation services: 10 questions guide to scrutinising immunisation services. The report includes case studies of best practice.
  • European Centre for disease prevention and control
  • Health Protection Scotland
  • HSC Public Health Agency Northern Ireland:health protection
  • International Longevity Centre - Immuneresponse. Adult immunisation in the UK
  • Meningitis Research Foundation- has a range of information about meningitis and septicaemia. 'Vital Signs Vital Issues' is a useful resource and includes answers to many of the questions parents frequently ask about vaccination
  • NHS24 - health information and self care advice for Scotland.
  • NHS Choices: The NHS vaccination schedule - information from the NHS choices web site can be printed off to give to patients.
  • NHS Direct Wales
  • Oxford Vaccine Group (OVG): Vaccine KnowledgeProject - this site is aimed at informing parents about VPDs and has useful films on decision making
  • PHE Immunisation pages
  • PHE Health protection, infectious diseases
  • Public Health Wales: health protection
  • The Children’s Hospital of PhiladelphiaVaccination Education Centre
  • USCentres for Disease Control and Prevention - vaccines andimmunizations. This American website contains useful sources of information including Vaccine Information Statements, and Interpreting abbreviations on records
  • World Health Organization
  • WHO: Immunisation schedules by country