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PANDEMIC VACCINE PRIORITY FOR MOST AT RISK

News Release issued by the COI News Distribution Service on 13 August 2009

More than 11 million people in England will be targeted first

The priority groups who will be first in line for vaccination against swine flu will include pregnant women, frontline health and social care workers, and everyone in at-risk groups aged over six months, Health Secretary Andy Burnham announced today.

This follows advice from independent experts on who should be first in line for vaccination.

The Joint Committee on Vaccination and Immunisation reviewed the evidence and advised the Department of Health on the crucial risk groups to be offered vaccination in order to reduce the rate or possibility of serious illness.

This advice was also scrutinised and endorsed by the Scientific Advisory Group for Emergencies (SAGE).

The following groups will be prioritised in this order (numbers given are approximate and are for England only):

People aged over six months and under 65 years in current seasonal flu vaccine clinical at-risk groups (about 5 million people). All pregnant women, subject to licensing conditions on trimesters (about 0.5 million people).Household contacts of people with compromised immune systems e.g. people in regular close contact with patients on treatment for cancer (about 0.5 million people).People aged 65 and over in the current seasonal flu vaccine clinical at-risk groups (about 3.5 million people). This does not include otherwise healthy over 65s, since they appear to have some natural immunity to the virus.

Vaccination of frontline health and social care workers (approximately 2 million people) will begin at the same time as the first at-risk group, and will continue for as long as necessary. This group is at increased risk of infection and of transmitting that infection to susceptible patients. Protecting these people will help the NHS workforce to remain resilient and able to treat sick patients.

Preparations continue to be made to extend the programme beyond these initial priority groups, and the Joint Committee on Vaccination and Immunisation will consider this matter further and report back in due course.

Health Secretary, Andy Burnham, said:

"The UK will be one of the first countries in the world to receive a vaccine supply, thanks to contracts put in place by the Government in advance of the pandemic.

"Ministers from all four nations have today accepted the advice of the Joint Committee on Vaccination and Immunisation on priority groups for H1N1 vaccination.

"We are now working with BMA and NHS organisations to reach a comprehensive swine flu vaccine implementation plan for this first stage of the programme.

"Although the virus has so far proved to be mild in most people, for others it has been more serious. By vaccinating high risk groups first, we aim to protect those most vulnerable to this virus.

"Our decisions at all times are based on advice from the most eminent specialists, and this will continue to be the case as we go forward."

Details of how the vaccination programme will be delivered are being finalised, but listing the priority groups will enable the NHS and social care sector to plan for the vaccination programme.

Supplies will be delivered as soon as they become available but, due to natural limitations in vaccine production, the groups most vulnerable to this new strain of influenza need to be prioritised.

Licensing

The vaccination programme is expected to begin in the Autumn, subject to the vaccine being licensed by the European Medicines Agency. The EMEA has strict processes in place for licensing pandemic vaccines. The vaccine will not be used until it is licensed. Manufacturers anticipate that licenses may be granted in late September or October. Vaccination will commence as soon as possible once licences are granted.

Risk benefit analysis

Experts have advised on the most vulnerable groups and completed thorough risk benefit analyses. The virus has so far disproportionately affected people in the at-risk groups outlined. Therefore, our advice is that these groups would clearly benefit from this vaccine at an early opportunity.

Whilst children are also disproportionately affected by swine flu, the vast majority make a full recovery. As such, the experts do not advise that children, other than those in at-risk groups, should be vaccinated initially.

Next steps

Decisions on vaccinating the wider healthy population will depend on the evolution of the pandemic as well as new and emerging clinical data on the use of the vaccine. This will be kept under close review.

Further operational guidance to the NHS on the roll out of the programme will be made available in the next few weeks. The Department of Health is working with the BMA and NHS organisations to reach a comprehensive swine flu vaccine implementation plan.

People in the priority groups outlined do not need to take any action yet. Further announcements will be made when the vaccination strategy is ready, and people who need a vaccine will be contacted.

Notes to Editors

1. Frontline health and social care workers will offered the vaccine at the same time as the first clinical risk group as they are at increased risk of infection and of transmitting that infection to susceptible patients. Frontline healthcare workers eligible for this vaccination programme are those also eligible for seasonal influenza vaccination, as detailed in the Green Book here: The Green Book was last updated in full in 2006 and is available on line at http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_063632.pdf

2. Eligibility guidance for vaccination for frontline social care workers is

The definition for social care workers is: “social care staff who are employed to provide personal care to children and adults, both in care homes and in the community”.

The Government has agreed the following definition, that “Personal care" means:

physical assistance given to a person in connection with:eating or drinking (including the administration of parenteral nutrition),toileting (including in relation to the process of menstruation),washing or bathing,dressing,oral care, orthe care of skin, hair and nails (with the exception of nail care provided by a chiropodist or podiatrist); orthe prompting, together with supervision, of a person, in relation to the performance of any of the activities listed in paragraph (a), where that person is unable to make a decision for themselves in relation to performing such an activity without such prompting and supervision.

Some examples of staff who would be included in this definition are:

Care home staff in residential/nursing homes who provide personal care to residentsDomiciliary care workers employed by agencies who provide personal care to service users in their own homesPersonal assistants – staff employed to provide personal care to a single service userStudents and trainees in these disciplines

And examples of people who would not be included are:

· Social workers
· Informal carers – family members and/or friends
· Non care staff in residential/nursing homes
· Housing staff – those who work in managing sheltered and similar housing
· Staff working in child or adult safeguarding
· Foster carers

The Department of Health (DH) has placed orders for sufficient H1N1 swine flu vaccine for the UK population. The orders are with GSK and with Baxter. Clinical risk groups for seasonal flu, including examples (decisions are based on clinical judgement)

Chronic respiratory disease and asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission:

· Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD)
· Children who have previously been admitted to hospital for lower respiratory tract disease

Chronic heart disease

· Congenital heart disease
· Hypertension with cardiac complications
· Chronic heart failure
Individuals requiring regular medication and/or follow-up for ischaemic heart disease

Chronic renal disease

· Chronic renal failure
· Nephrotic syndrome
· Renal transplantation

Chronic liver disease

· Cirrhosis
· Biliary artesia
· Chronic hepatitis

Chronic neurological disease

· Stroke
· Transient ischaemic attack (TIA)

Diabetes

· Type 1 diabetes
· Type 2 diabetes requiring insulin or oral hypoglycaemic drugs
· Diet controlled diabetes

Immunosuppression

· Immunosupression due to disease or treatment
Patients undergoing chemotherapy leading to immunosuppression
· Asplenia or splenic dysfunction
· HIV infection
· Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day (any age) or for children under 20kg a dose of 1mg or more per kg per day.
· Some immunocompromised patients may have a suboptimal immunological response to the vaccine

For media enquiries only, please contact the Department of Health Newsdesk on 020 7210 5221. For all other enquiries, please contact the Customer Service Centre on 020 7210 4850.

Contacts:

Department of Health
Phone: 020 7210 5221
NDS.DH@coi.gsi.gov.uk