Maintaining Routine Immunisation Programmes During COVID-19

Overview

The national NHS immunisation programme remains important to maintain the best possible vaccine uptake to prevent a resurgence of these infections. This will also prevent increasing further the numbers of patients requiring health services, as well as outbreaks of vaccine-preventable diseases, and allow the NHS to provide important protection to children and other vulnerable groups. 

This Guidelines summary provides the key points for primary care. Please refer to the full guideline for the complete set of recommendations.

Reflecting on Your Learnings

Reflection is important for continuous learning and development, and a critical part of the revalidation process for UK healthcare professionals. Click here to access the Guidelines Reflection Record.

General Practices

• The routine immunisation programme should be maintained
• Babies, toddlers, and pre-school children in particular need vaccinations to protect them from measles, mumps, rubella (MMR), rotavirus, diphtheria, whooping cough, meningitis, polio, tetanus, hepatitis B, and flu
• Some children will also need to be protected with neonatal BCG and complete course of hepatitis B vaccination. Both BCG and all doses of targeted hepatitis B vaccines should be offered in a timely manner
• Non-scheduled vaccinations should still be given, for example for control of outbreak(s) of vaccine preventable conditions as well as opportunistically, for example missing doses of MMR
• To reduce adverse impact on groups that experience particular health inequalities, healthcare workers such as midwives, health visitors, and general practice staff should encourage those from underserved communities and groups to engage with the vaccination programme
• Anyone who has missed their appointment because of COVID-19 or any other reason and would still clinically benefit from vaccination should be invited for vaccination as soon as possible
• Immunisation should proceed providing those attending for vaccination (including parents and carers) are well, are not displaying symptoms of COVID‑19 or other infections, and are not self-isolating because they are contacts of suspected or confirmed COVID-19 cases
• Anyone with an acute febrile illness should not be immunised until the condition has resolved.

Child Health Surveillance

• Neither the first set of childhood immunisations given at 8 weeks, nor the newborn and infant physical examination check at 6–8 weeks should be delayed given their importance.

Fielding Concerns About Immunisation

Advice for Healthcare Workers Where Parents/Patients Have Concerns About Immunisation in General Practice

• Parents, carers, and patients may be worried they or their baby or child may be exposed to COVID-19 when attending for vaccination. Individuals and carers should be informed that, despite the COVID-19 pandemic, starting and completing routine childhood immunisations on time is important
• The much-reduced incidence of infections such as invasive pneumococcal and meningococcal disease has only come about because of high levels of vaccination. To prevent resurgence, it is important that infants continue to be protected through vaccination
• Pertussis still circulates at elevated levels and pregnant women must continue to be offered the pertussis vaccine, and their babies vaccinated against this and other infections from 8 weeks of age
• Providers should reassure individuals that the most up-to-date guidance on maintaining social distance in waiting areas and decontamination of premises and equipment is being strictly followed in line with PHE guidance on infection prevention and control (IPC)
• Compliance with national advice on preventing spread of COVID-19 through appropriate infection control measures will help ensure children, parents, carers, and pregnant women feel confident that it is safe to attend for vaccination
• Further information on COVID-19 precautions for primary care is available.

Fielding Concerns About Infant/Child Immune Response

• Parents and carers may be concerned that their baby’s/child’s immune system cannot cope with both COVID-19 and immunisations and that in responding to vaccines, their ability to fight COVID-19 will be reduced/affected. Parents and carers should be reassured that as vaccines contain either weakened viruses or only a small amount of the inactivated organism or toxoid, the response uses only a tiny proportion of the capacity of an individual’s immune system. Vaccination will not overload their immune system, does not make them more susceptible to other infections and, if they do contract an infection in the immediate post-immunisation period, or were already incubating one when they were vaccinated, their immune system will still respond to it
• Vaccinating babies and children reduces the chances of co-infection with COVID-19 and a serious vaccine-preventable disease
• Both live and inactivated vaccines should continue to be given when due.

Infant Paracetamol and Primary Immunisations

• Parents and carers may be concerned that if their baby/child develops a fever following immunisation, they will not know if it is due to the vaccines or COVID-19. Parents and carers should be advised that the vaccines may cause a mild fever which usually resolves within 48 hours (or 6–11 days following measles, mumps, and rubella [MMR]). This is a common, expected reaction and isolation is not required, unless COVID-19 is suspected
• Fever is more common when the type B meningococcal bacteria (MenB) vaccine is given with other vaccines at 8 and 16 weeks of age. Where parents are able to obtain liquid infant paracetamol, they should follow existing PHE guidance on its prophylactic use following MenB vaccination
• As has always been recommended, any infant with fever after vaccination should be monitored and, if parents or carers are concerned about the infant’s health at any time, they should seek advice from their GP or NHS 111
• This advice applies to recently vaccinated people of all ages
• Given the risk of the serious infections that the vaccines protect against, PHE recommends that the routine primary immunisation schedule should not be delayed.

Parents may be Unable to Obtain Liquid Infant Paracetamol

• While parents should continue to try to obtain and administer infant paracetamol where possible, infant vaccines can and should still be given even if they do not have prophylactic paracetamol to hand
• Where parents have been unable to obtain infant paracetamol, the following advice is for clinical staff in primary care and parents
  • ibuprofen can alternatively be used to treat a fever and other post-vaccination reactions. Prophylactic ibuprofen at the time of vaccination is not effective. Ibuprofen is not licensed for infants under the age of 3 months or with a body weight under 5 kg. However, the BNF for Children advises that ibuprofen can be used for post-immunisation pyrexia in infants aged 2–3 months, on doctor’s advice only, using 50 mg for one dose, followed by 50 mg after 6 hours if required
  • information about treating a fever in children is available from the NHS UK webpage Fever in children
  • if an infant still has a fever 48 hours after vaccination, or if parents are concerned about their infant’s health at any time, they should be advised to seek help from their GP or ring NHS 111
  • the diseases that the vaccines protect against are very serious and therefore vaccination should not be delayed because of concerns about post-vaccination fever.

Vaccine Non-attendees

What About All Those Individuals Who Do Not Attend for Vaccination?

• Those who miss the opportunity to be vaccinated still require their missing vaccinations. Without these they remain unprotected against vaccine-preventable disease. This makes the retention of accurate records of unvaccinated individuals important, and their appointments should be rescheduled as soon as is reasonably practical 
• If a child is attending general practice for any reason, their immunisation status should be checked and, if there are no contraindications, the child should be immunised. This applies equally to adults, particularly for flu and pneumococcal vaccines, as people eligible for these vaccinations are also at high risk of COVID-19.

Personal Protective Equipment

What Personal Protective Equipment Should Be Worn When Administering Vaccines?

• Individuals who are well should attend for vaccination (with parents or carers) at premises that are following the recommended IPC guidance
• If further help is needed, vaccinators should consult with their infection prevention and control team.

Vaccine Supply and Usage

Can Practice Nurses Use Patient Group Directions in Primary Care Networks (PCNs) at Various General Practice Sites Where They Will Be Vaccinating Children?

• NHS Specialist Pharmacy Services has published guidance on patient group direction use in primary care networks.

What Should I Do About Vaccine Ordering During the COVID-19 Pandemic?

• Continue to order vaccines through the usual routes and ensure that no more than 2 weeks’ supply is maintained as stock in your vaccine fridge. This will help to avoid vaccine shortages and reduce wastage
• Vaccines near their expiry date should be used first.

How Do I Maintain Vaccine Cold Chain Across General Practices Where One Site May Be Closed?

• Cold chain guidance is available in chapter 3 of the Green Book and should be adhered to.

Can I Transfer Vaccines Between Different Branches of the Same Practice?

• Where the same practice has more than one site or branch, vaccines can be transferred to the operational site, providing the cold chain is maintained.

Can I Transfer Vaccines Between Completely Different Practices (Different Legal Entities)?

• NHS England has recently published guidance on transferring vaccine stock between providers. In summary, the Medicines and Healthcare Products Regulatory Agency has confirmed that it would not prevent the transfer of locally held vaccine stock from the NHS routine immunisation services during COVID-19, provided that:
  • the clinical commissioning group (CCG), PCN, or general practice believes the transfer of vaccines is necessary to support the continued delivery of routine immunisations in primary care during the COVID-19 response and will ensure the effective use of available resource
  • the CCG, PCN, or general practice holding the vaccine stock has assurance that the vaccine has been stored in the correct temperature-controlled conditions
  • confirmed daily record-keeping of temperature monitoring is available
  • the CCG, PCN, or general practice requiring locally held vaccine supply can verify the assurances given
  • the vaccines can be transported appropriately under the right cold chain conditions
• Regional NHS England and NHS Improvement commissioners should be informed of any incidents, including cold chain breaches during transfer of vaccines. CCGs, PCNs, and primary care providers should refer to PHE’s protocol for the ordering, storing, and management of vaccines.

Information for Parents/Carers

What Information Should I Provide Parents/Carers About Vaccinations Administered?

• It is important that parents and carers have a contemporaneous record of all immunisations administered. If the Red Book (personal child health record) is not brought to the appointment, the immuniser should provide sufficient information about the vaccines given to the parent or carer to update the record themselves. For example, a print-out, text message, or email with vaccine details.

Child Health Information Services

What Should I Do to Inform My Local Child Health Information Services About Vaccines Administered?

• It is important that all clinical colleagues contribute to ensuring that each child’s Child Health Information Services (CHIS) record is up to date by transferring data from clinical systems in a timely manner to the local CHIS provider. This will ensure those involved in the care of young children have access to the contemporaneous health record to support any rescheduling and catch-up programmes for those who miss appointments for public health programmes
• In the event of a cluster or an outbreak of a vaccine-preventable disease, CHIS is the primary source of information to help target resources.