Practice Managers

Help guard against flu in

children

Get equipped to run a successful flu vaccination

programme2020/21

The content of this leaflet is intended for UK Healthcare Professionals and Practice Managers

Prescribing Information can be found on the final page.

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to AstraZeneca

by visiting https://aereporting.astrazeneca.com or on 0800 783 0033.

• In the 2019/20 season, for 2-3 year olds vaccinated in GP surgeries, an estimated 590,041 out of 1,346,654 eligible children were vaccinated with an influenza vaccine.*1 This means 43.8% of eligible children in this group were vaccinated.1 This compares with 44.9% in the 2018/19 season.1

• Vaccination is seasonal and should be administered annually, usually during the autumn, ahead of the flu season.2 This helps guard against flu every year2

* This figure includes children who were vaccinated with either the nasal spray vaccine or an injection given to those unsuitable for a nasal spray vaccine.

As the Practice Manager, you and your GP practice team are important in the fight against flu.

We recognise that implementing an effective childhood flu vaccination programme is all about surgery team support, being armed with the facts about flu, and having engaging surgery materials so you can plan, train, and carry out successful children’s flu clinics.

You will find a range of materials and resources to order or download, free, on our Fluenz® Tetra dedicated healthcare professional (HCP) website: www.fluenztetra.co.uk

You are in command this flu season

The Joint Committee on Vaccination and Immunisation (JCVI) recommends flu vaccination for children4

Your GP practice has a key role to playFluenz Tetra is a needle-free, nasal spray flu vaccine licensed for the prophylaxis of influenza in children and adolescents from 24 months to less than 18 years of age.3 The use of Fluenz Tetra should be based on official recommendations.

The NHS Seasonal Flu Immunisation Programme offers a free nasal spray flu vaccine to all eligible children in England aged 2 and 3 years old, school children in Reception to Year 7, and those clinically at risk aged 2-17 years.*4

There may be some variance across the UK within the other devolved nations: please check the respective communications for Wales, Northern Ireland and Scotland.

If a child is not eligible for the nasal spray flu vaccine, they may be offered an alternative injectable vaccine.4

* For definitions of clinically at-risk please refer to Chapter 19 of The Green Book.5 Age eligibility as of 31st August 2020.

*Payment applies to England only and is correct as of 07 July 2020. **GP consultations were logged using READ codes combined into respiratory diagnoses consistent with recognised ICD-10 groupings. Flu-attributable consultations included all disorders in the ICD-10 respiratory disease chapter, otitis media and selected presenting symptom codes that were used in some GP surgeries in lieu of specifying a clinical diagnosis.7

Why vaccinate against flu?Surgery paymentUnder NHS England’s Enhanced Service Specification for 2020/21, participating surgeries are eligible for payment of £10.06 per dose in England.*6

Reduces burden on surgeriesA study across 14 flu seasons from 1995–2009 used Clinical Practice Research Datalink (CPRD) and Public Health England data to show the burden of flu in primary care.Seasonal mean estimates of flu-attributable GP consultations in the UK were 857,996 for respiratory disease** (including middle-ear infection), of which around 75% were for Influenza A. The highest rates of GP consultations for Influenza A were seen in children <5 years old.7 The national flu immunisation programme contributes to reducing illness and deaths caused by the influenza virus.8

To increase vaccine uptake ratesNHS England is aiming to increase vaccine uptake rates, to a target of at least 75% in eligible pre-school children, and at least 75% in eligible school-aged children.4

Flu can be a serious illnessFlu can be serious for any child that catches it and can be dangerous if passed on to children who have asthma or a weakened immune system.2

Helps protect children and aims to prevent the spread of fluVaccinating children each year, as part of the national flu immunisation programme, means that not only does it help protect the children themselves but aims to reduce transmission across all age groups, lessening levels of flu overall and reducing the burden of flu across the population.4

Could reduce transmission in the population as part of a national immunisation programmeChildren under five years old have the highest rate of hospital admissions for flu of all age groups.9 Improving uptake in these children and children with an underlying clinical risk factor provides individual protection as well as helping to protect the wider community.4

Supporting and equipping you for flu season 2020/21www.fluenztetra.co.uk provides a one-stop-shop of free materials (to order or download), information and training to help you and your surgery team deliver a successful childhood flu vaccination programme this year. It includes:

• Patient information and awareness materials for your surgery

• Royal College of Nursing accredited e-learning module for surgery HCPs

• Step-by-step nasal spray flu vaccine administration guide

• A wide range of HCP support materials for your surgery team

NHS CHILDHOOD SEASONAL FFLLUU IMMUNISATION PROGRAMME*The NHS Seasonal Flu Immunisation Programme offers a free nasal spray flu vaccine to all

eligible children in England aged 2 and 3 years old, school children in Reception to Year 7, and

those clinically at risk aged 2-17 years. There may be some variance across the UK within the

other devolved nations; please check with your GP, nurse or pharmacist.**

A FREE nasal spray flu vaccine is available for eligible children*

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any

possible side effects not listed in the package leaflet. You can also report side effects directly

via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects

you can help provide more information on the safety of this medicine.Produced and provided by

©AstraZeneca 2020August 2020. GB-22529

www.ShareGoodTimesNotFlu.co.uk**Age eligibility as of 31st August 2020.

Children are often great at spreading flu to each other and around the family

HAS YOUR CHILD HAD THEIR ANNUAL FLU VACCINATION?

THIS CAN HELP PROTECT YOUR CHILD FROM FLU

Ask at reception for more informationabout flu vaccination for your child

BOOK AN APPOINTMENTBEFORE FFLLUU FINDS YOU

www.ShareGoodTimesNotFlu.co.uk

Produced and provided by

©AstraZeneca 2020August 2020. GB-22529

Produced and provided by

F is for... Can you match the virus gang? Draw a line to link them

that’s why you need a new vaccination every year

Colour in Vince the Virus

Colour in Vince the Virus

Flu is an unpleasant and sometimes serious illness

Can you draw how Vince feels

when he sees you feeling poorly?

Activity sheet for you to use with your child

NHS Childhood Seasonal Flu Immunisation Programme

ask at reception or visit

v is for...

Fluwhich can make you poorly

Virus

©AstraZeneca 2020 Date of preparation: August 2020. GB-22548

Eye-catching materials to decorate your practicewww.fluenztetra.co.uk provides you with free flu awareness materials to download/order including:

• Children’s activity sheets

• Wall clings

• Children’s stickers

• Patient information post-administration leaflet

A few flu facts to share with your patients/receptionistsFlu spreads through coughs and sneezes… Droplets released in coughs and sneezes may travel up to about 6-8 metres and stay suspended in the air for up to approximately 10 minutes 10

...and talking and breathingInfectious flu particles has been detected in air that is simply breathed out 10,11

Causes earacheAround 1 in 3 children under the age of 3 who catch flu get very painful earache which may need to be treated with antibiotics12

Can result in serious complicationsFlu in children can result in serious complications, such as pneumonia, and can result in hospitalisation 2,9

Serious in chronic (long-term) conditionsFlu can be serious for children with chronic heart disease, kidney disease, liver disease, neurological disease, asthma or diabetes 2,4

Prescribing Information

©AstraZeneca 2020Date of preparation: September 2020. GB-22545

References1. Public Health England. Seasonal influenza vaccine uptake in GP patients: winter season 2019 to 2020. Final data for 1 September 2019 to 29 February 2020. June 2020. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/894970/Annual-Report_SeasonalFlu-Vaccine_GPs_2019-20_FINAL.PDF. 2. Public Health England, NHS. Protecting your child against flu. Information for parents and carers. July 2020. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907433/Protecting_Child_Against_Flu_DL_leaflet_2020.pdf. 3. Fluenz Tetra nasal spray suspension Influenza vaccine (live attenuated, nasal) Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/3296/smpc. 4. Whitty C, Doyle Y & Powis S. The national flu immunisation programme 2020 to 2021- update. 05 August 2020. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907149/Letter_annualflu_2020_to_2021_update.pdf. 5. Department of Health. Immunisation Against Infectious Disease. (The Green Book.) Chapter 19: Influenza. London: The Stationery Office. 2019. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/733840/Influenza_green_book_chapter19.pdf. 6. NHS England. Enhanced Service Specification. Childhood seasonal influenza vaccination programme 2020/21. April 2020. Available at: https://www.england.nhs.uk/wp-content/uploads/2020/03/20-21-VI003-Childhood-Flu-Final-Version.pdf. 7. Fleming DM et al. Epidemiol Infect. 2016;144(3):537-547. 8. Van-Tam J, Cosford P & Powis S. The national flu immunisation programme 2019/20. 22 March 2019. Available at: https://www.england.nhs.uk/wp-content/uploads/2019/03/annual-national-flu-programme-2019-to-2020-1.pdf. 9. Cromer D et al. J Infect. 2014;68(4):363-371. 10. Lok C. Nature. 2016;534:24-26. 11. Yan J et al. Proc Natl Acad Sci USA. 2018 Jan 30;115(5):1081-1086. 12. Heikkinen T et al. J Infect Dis. 2004;190(8):1369-73.

FLUENZ® TETRA nasal spray suspension Influenza vaccine (live attenuated, nasal)Consult Summary of Product Characteristics before prescribing.Indication: Prophylaxis of influenza in individuals 24  months to less than 18 years of age. Presentation: Nasal spray, suspension. Dosage and administration: 0.2ml (administered as 0.1ml per nostril). Children not previously vaccinated against seasonal influenza should be given a second dose after an interval of at least 4 weeks. Should not be used in individuals below 24 months of age because of safety concerns. Method of administration: Nasal administration only. Do not inject Fluenz Tetra. Contraindications: Hypersensitivity to the active substances, any of the excipients (e.g. gelatin), gentamicin (a possible trace residue). Severe allergic reaction (e.g. anaphylaxis) to eggs or to egg proteins (e.g. ovalbumin). Children and adolescents who are clinically immunodeficient due to conditions or immunosuppressive therapy: (acute and chronic leukaemias; lymphoma; symptomatic HIV infection; cellular immune deficiencies; and high-dose corticosteroids). Not contraindicated for use in individuals with asymptomatic HIV infection; or individuals who are receiving topical/inhaled corticosteroids or low-dose systemic corticosteroids or those receiving corticosteroids as replacement therapy, e.g. for adrenal insufficiency. Contraindicated in children and adolescents younger than 18 years of age receiving salicylate therapy because of the association of Reye’s syndrome with salicylates and wild-type influenza infection. Warnings and precautions: Clearly record name and batch number of administered product to improve traceability. Medical treatment and supervision should always be readily available in case of an anaphylactic event following administration. Fluenz Tetra should not be administered to children and adolescents with severe asthma or active wheezing because these individuals have not been adequately studied in clinical studies. Do not administer to infants and toddlers below 24 months of age because of safety concerns regarding increased rates of hospitalisation and wheezing in this population. Vaccine recipients should be informed that Fluenz Tetra is an attenuated live virus vaccine and has the potential for transmission to immunocompromised contacts. Vaccine recipients should attempt to avoid, close association with severely immunocompromised individuals (e.g. bone marrow transplant recipients requiring isolation) for 12  weeks following vaccination. Where contact is unavoidable, the potential risk of transmission of the influenza vaccine virus should be weighed against the risk of acquiring and transmitting wild-type influenza virus. No data exists regarding the safety in children with unrepaired craniofacial malformations. Drug  interactions: Salicylates must not be used for 4  weeks following vaccination unless medically indicated. Co-administration of trivalent Fluenz with the live attenuated

vaccines: No clinically meaningful changes in immune responses to measles, mumps, varicella, orally-administered poliovirus or trivalent Fluenz have been observed. Immune response to rubella vaccine was significantly altered. This might not be of clinical relevance with the two dose immunisation schedule of the rubella vaccine. Fluenz Tetra (influenza vaccine-live attenuated, nasal) is identical to trivalent Fluenz with the only difference being the addition of a fourth strain (a second B strain) to Fluenz Tetra. Co-administration of Fluenz Tetra with inactivated vaccines has not been studied. Concurrent use with antiviral agents active against influenza A and/or B viruses has not been evaluated. Based upon the potential for influenza antiviral agents to reduce the effectiveness of Fluenz Tetra, it is recommended not to administer the vaccine until 48  hours after the cessation of influenza antiviral therapy. Administration of influenza antiviral agents within two weeks of vaccination may affect the response of the vaccine. If influenza antiviral agents and Fluenz Tetra are administered concomitantly, revaccination should be considered based on clinical judgment. Fertility, Pregnancy and Lactation: Not recommended during pregnancy. Should not be used during breast-feeding. No data on the effects of Fluenz Tetra on male and female fertility. Undesirable effects: Refer to SmPC for complete information on side effects. Very common: decreased appetite, nasal congestion/rhinorrhoea, malaise. Common: headache, myalgia, pyrexia. Uncommon: hypersensitivity reactions (including facial oedema, urticaria and very rare anaphylactic reactions), epistaxis, rash. Very rare reports of Guillain-Barré syndrome and exacerbation of symptoms of Leigh syndrome (mitochondrial encephalomyopathy) have also been observed in the post-marketing setting. Legal category: POM. Marketing authorisation number: EU/1/13/887/004 Presentation & basic NHS cost: Fluenz Tetra nasal spray suspension pack of 10: £180.00 Marketing Authorisation Holder: AstraZeneca AB, SE-151 85 Södertälje, Sweden Further information is available from: AstraZeneca UK Limited, 600 Capability Green, Luton, LU1 3LU, UK. FLUENZ is a trademark of the AstraZeneca group of companies. Date of preparation: 03/2020 INF 20 0002

Adverse events should be reported. Reporting forms and information can be found at

www.mhra.gov.uk/yellowcard. Adverse events should also be reported to AstraZeneca by visiting

https://aereporting.astrazeneca.com or by calling 0800 783 0033.