Influenza vaccination paediatric wards FAQ final

Paediatric flu vaccination 2022 FAQ for Paediatric nurses and doctors in hospitals in Aotearoa.

Kia ora, I am writing to you about flu vaccinations for tamariki aged from 6 months to 3 years. I would like to meet with senior paediatric nurses around the motu to explore options.

As you know, young tamariki are in the highest risk groups for hospitalisation and severe disease from influenza. Those who have been admitted to hospital with any respiratory illness or other health problems are the most likely to be hospitalised with influenza.

Our ‘flu season this year is tough and we appreciate paediatric wards are bearing the brunt of this and staff are working extremely hard. This is also the case out in general practice. tamariki under three can only be immunised for flu in general practice or hospital teams due to needing a different vaccine and having eligibility criteria.

While we have much improved uptake of the vaccine by the older population, almost reaching our highest rates ever, the opposite is true for the under 3s. We have given less than half the number of vaccines to this age group than usual. We know that almost 40,000 younger children are eligible for a free flu vaccine. We’ve only vaccinated about 3% of this eligible paediatric population. Some districts have given as few as 12 paediatric flu vaccines in the entire season.

As you know, vaccination is an effective health intervention even in the short term and paediatric wards have always given opportunistic vaccinations. Even in the midst of surging flu cases, immunising tamariki for the flu can make a tangible difference to readmissions over the next 2 months. It reduces their chances of catching and being sick from the flu even if they’ve had influenza, the vaccine can protect them from other flu strains that are circulating. There is also emerging evidence in adults that the flu vaccine can help reduce severity of COVID-19 infection.

We would like to encourage paediatric departments to give the seasonal flu vaccination to children on discharge with a particular priority for those under 3 years, who cannot access it at a community provider.

We are aware of a number of questions and perceived barriers to this and I’d like to address some of these here: Which children can have the flu vaccine this year? All tamariki aged 3-12 years can have the free AFLURIA QUAD Vaccine.

All children aged 6 months to 35 months who’ve been admitted to hospital with a respiratory condition, or have other underlying health problems, are eligible for AFLURIA QUAD Junior.

Link to the Pharmac eligibility criteria But we want to support opportunistic vaccination – if you don’t have access to a child’s records, please vaccinate. The programme supports whānau centred care, so again, if you are seeing other members of the whānau and aren’t sure if they are eligible for a free flu vaccine but think they might be, then please vaccinate.

Is it worth vaccinating children this late in the season? Yes – tamariki get good effects from a flu vaccination within 2 weeks. There are still winter months ahead and we may get a second wave of flu in early spring. Not only will it protect children, but it will also protect staff by reducing future admissions.

Many tamariki need two doses – is it worth it if they can’t have the second dose? Yes it is. The second dose improves the immune response, but one dose is better than no dose. Please encourage parents to make a booking with their GP for 4 weeks later for the second dose or help them make one if you have time. Maybe they could have it if they come back to outpatients for follow up. Put the expected date of recall on the discharge summary so the practice nurse can book them in early.

Is there enough junior vaccine stock? Yes. There is enough stock in the country, and if we run out of AFLURIA QUAD Junior, we can switch to our second line stock of FLUQUADRI There are no problems with distribution or delivery at the moment.

Does our hospital pharmacy have stock? We’ve talked to all the hospital pharmacy managers and they have agreed they can help enable this vaccine push. They all have stock or can get it in and they are happy to remind clinicians that it is available and help with prescribing. Although most paediatric wards don’t have cold chain accredited fridges, it can be rapidly dispensed from pharmacy when needed.

Which staff can vaccinate a child for flu? Any nurse or doctor who can give IM injections to tamariki can give a vaccine with a prescription. You only need to be an ‘authorised vaccinator’ if you are giving vaccines without a prescription. The prescription should read: Afluria Quad Junior influenza vaccine, IM, one pre-filled syringe, stat. (or replace with Afluria Quad for those 3 and over, or Fluquadri if that’s the brand available).

The dose volume is 0.25ml for Afluria Quad Junior and 0.5ml for Afluria Quad and Fluquadri.

Intramuscular vaccines are given in the lateral thigh of infants to age 12 months and for those aged >12 months are given in the upper arm (deltoid in line with the armpit) – check out all the information and images on administering in the Immunisation Handbook.

How do I record the vaccine? Access to the NIR can be difficult in the hospital. This should be solved with the roll out of the AIR (Aotearoa Immunisation Record) later in the year. In the meantime, please do two things. We recommend putting this info on a little ‘cheat sheet’ in your clinical area for the RMOs to follow.

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Write it on the discharge summary so the GP knows the child has had it – they can record it in their PMS and in the NIR. Make it very clear there is a follow up action and ask the GP to tell their practice nurse.

Write something like: Dear Practice Nurse, XXX had their first flu vaccination on discharge.

It was Afluria Quad Junior (or other). Please can you record the first dose of this influenza vaccine in the NIR as we don’t have access in the hospital. [if possible, add batch number, expiry date and site on body - but not essential] Please can you recall XXX for their second dose on [date].

Alternatively, you can fill in an NIR 3 manual form. This can be provided by your immunisation coordinator or printed from the MoH website, and then sent to the NIR admin team who will kindly input the data when they can. NIR 3 forms can be kept on the wards and in other places for easy access. They can be batched and sent to the NIR team the next

working day by the ward administrator. https://www.health.govt.nz/system/files/documents/pages/nir3-form-november-2020.pdf

Tamariki on the ward are sick and I can’t give a flu vaccine if they have a fever. Having a mild fever is not a contraindication to a flu vaccine. The vaccine won’t make a child’s illness worse, nor will the illness make the vaccine less effective. If the child is recovering from their acute febrile or respiratory illness, then it is safe to vaccinate if the temperature is under 38.

If you have concerns, talk to the paediatrician or please help the whānau make an appointment with their practice nurse for a flu vaccination and other immunisations immediately after discharge.

Can a child have the flu vaccine and other vaccines at the same time? Yes – all vaccines on the routine childhood immunisation schedule can be administered concurrently, so you can give a flu vaccine and other vaccines they need at the same time using different injection sites. (But don’t give flu vaccine concurrently with PCV13 if the child has a history of febrile convulsions).

What is the observation or waiting period after vaccines? Tamariki and young infants need to remain for 20 minutes under observation in the ward or clinic waiting room after immunisation.

Parents are very vaccine hesitant and don’t want their children immunised. Research shows that most parents across the motu do want to vaccinate and protect their tamariki. Please offer it to those who are open. Sometimes parents just need to know it’s something we are going to offer on discharge, so it doesn’t come as a surprise. They need reassurance that it’s safe and effective, even when their child is recovering. Having the conversation and leaving the door open to them is also effective.

We are too busy providing immediate care to do extra vaccinations as well. We know you are really busy and appreciate the work you are doing. Seasonal flu vaccination, especially in the middle of an outbreak can be as important for a child as antibiotic treatment for their acute illness. Adding it systematically to a child’s care can make a huge difference. Thank you for taking on this important extra work.

Ngā mihi nui Dr Marion Leighton Consultant Physician and Principal Clinical Advisor with the National Immunisation Programme.

Links: Aotearoa KidsHealth influenza vaccination information https://www.kidshealth.org.nz/flu-immunisation Vaccines when my child is sick, CDC https://www.cdc.gov/vaccines/parents/visit/sick-child.html https://immunizebc.ca/ask-us/questions/it-safe-my-child-get-vaccinated-when-they-are-sick

Flu vaccine may protect against severe COVID-19 https://www.nature.com/articles/d41586-022-01315-9 https://www.medrxiv.org/content/10.1101/2022.05.09.22274802v1

Afluria Quad Junior vaccine information: https://www.medsafe.govt.nz/profs/Datasheet/a/Afluriainj.pdf https://www.medsafe.govt.nz/Consumers/cmi/a/AfluriaQuad.pdf https://www.immune.org.nz/vaccines/available-vaccines/influenza-vaccine

Flu Kit 2022: https://assets.websitefiles.com/61f35aaad08e65b4f5a55423/62c4c17aefa022642913a543_IMAC_Flu_Kit_2022_05-072022.pdf