Exclusive GPs will be expected to order their own supplies of the nasal flu vaccine recommended for the ongoing programme in two- and three- year olds from January, as all central stocks will expire.
Public Health England has contradicted advice given by NHS Employers that inactivated flu vaccines can be used in children ‘as appropriate’ after all centrally ordered supplies of the nasal vaccine expire on the 16 January.
PHE experts told Pulse that there will be no more central supplies will be available after the 16 January – with some batches expiring in mid-December - and that GP practices should make their own arrangements with the manufacturer of the nasal vaccine if they need additional doses.
They said that inactivated flu vaccine should only be used if the child has a contraindication and that it was important to ensure that ‘efforts are made to vaccinate children before the Christmas holidays’.
Despite this practices will be paid whether or not they use the nasal or the injectable vaccine and have been given until the 31 March 2014 to complete the programme in two- and three- year olds.
The intervention came as the vaccination programme began in children aged two to three years this month. The programme is intended to be rolled out to all primary and preschool aged children next year.
Guidance issued by NHS Employers says that after supplies expire on the 16 January practices are able to offer the inactivated vaccine ‘as appropriate’.
It recommends: ‘If a GP is presented with a child after mid-January who he or she feels would still benefit from vaccination then they can offer the inactivated vaccine as appropriate.’
But Professor Nick Phin, head of the respiratory disease department at Public Health England said this advice was not correct. He said: ‘We do not recommend that inactivated flu vaccines are used for healthy two to three year olds, unless there is a contraindication.
‘The rationale for the universal programme in healthy children is based around the use of Fluenz. This is because this vaccine provides better protection with a single dose, does not require injection and should be better able to interrupt spread of the influenza.’
He said that children aged two and three years in risk groups can receive inactivated vaccine as in previous years, but said that they would need a second dose four weeks later unless they have been vaccinated before.
He added, ‘PHE vaccination orders are placed a year in advance. The current stock of Fluenz is available until all have been administered or expire. GPs acquiring additional supplies for risk groups are advised to order direct from the manufacturer.’
The official service specification for the child influenza vaccination programme states that ‘in order to achieve the maximum impact of the programme before influenza starts to circulate’ GPs should try to ensure all children aged two- to three- years are vaccinated by the 31 December.
But it adds: ‘As with the current seasonal influenza programme, practices may continue to vaccinate eligible patients until 31 March 2014, for whom they will receive payment.’
Dr Chaand Nagpaul, GPC chair, said, ‘I think that we really do need to have by now found consistency between guidance that has been issued to GPs and the logistics of vaccinating children with flu vaccinations. So we do need to look at some issues around the Fluenz programme.’
Please note: Professor Phin has issued the following clarification on this story: ‘Although Public Health England does not recommend that inactivated flu vaccines are used for healthy two and three year olds unless there is a contraindication, in the event that a child presents for flu vaccination after mid-January 2014, and they are in the two and three year old cohort, or in an at risk group, as stated in the NHS guidance the inactivated vaccine is an option at the clinical discretion of the GP.’