Child flu vaccine 'rationing' may force practices to turn away patients

Restrictions on orders of the child flu vaccine imposed by public health officials could force practices to turn away some patients when vaccination begins later this month, a senior RCGP figure has warned.

A child receives the 2013/14 Fluenz vaccine (Photo: SPL)
A child receives the 2013/14 Fluenz vaccine (Photo: SPL)

Public Health England (PHE) has announced a cap on orders of the nasal spray vaccine Fluenz Tetra from Wednesday 24 September to 'prevent more vaccine being held as stock in primary care than is necessary'.

Officials said the vaccine's short shelf life meant deliveries were being staggered to ensure there would be enough vaccine left for patients presenting later in the season.

Practices will initially be limited to just five packs, or 50 doses, of the vaccine per week. GP understands this situation will be in place for at least the first two weeks of the vaccination season.

But RCGP immunisation lead Dr George Kassianos said the cap would create 'huge problems' for medium and large-sized practices, and questioned why they had the same cap as smaller practices.

He said: 'We have been asked to be proactive. Practices have advertised in-practice, on their websites, have sent to parents the letter suggested by PHE, and many will open their doors on the last Saturday of September.

'What should medium and large practices do with just 50 doses of the Fluenz vaccine? We get 500-600 people walk through our doors on a Saturday morning. Obviously, it is "first come, first served".

'This is so unsatisfactory. In my practice, we shall be turning children away because of lack of vaccine.'

'Rationing'

He called for PHE to let practices decide how many vaccines they needed. 'We are working hard not only to reach the national targets but go well above. This sudden rationing of vaccines for children does not fit with the spirit of the campaign and it goes nowhere in helping us achieve our targets and beyond.'

Practices will also have to contend with a greater number of children than ever turning up to receive the flu vaccine this season. Four-year-olds have been added to the national programme for the first time, following the introduction of vaccination for two- and three-year-olds last year.

PHE has previously warned practices they must aim to vaccinate all eligible children before the Christmas holidays because the 18-week shelf life of the product, shorter than inactivated flu vaccines, means most stocks will expire by February 2015.

In the Vaccine Update bulletin from PHE, officials said: 'To ensure that vaccine is distributed equitably across the NHS in England for the children’s part of national flu programme, an initial restriction on the number of doses of Fluenz Tetra that can be ordered by each practice per week will be implemented from the start of ordering on Wednesday 24 September.

'The controls will allow practices to order 50 doses per week (five packs) initially. We will be monitoring the situation on a daily basis and as soon as we are in  receipt of sufficient quantities of vaccine we will lift the restriction.'

Ensuring sufficient doses

Practices were also warned not to order more than they need for the following week or two because of the short shelf life. Officials said the advice was ' to minimise vaccine wastage due to the vaccine passing its expiry date before it can be administered to patients', as unused vaccine cannot be returned.

A PHE spokesman told GP: 'The temporary order restriction is concerned with the gradual supply of the vaccine and the shorter shelf life of the flu nasal spray vaccine Fluenz Tetra, which means that it has been agreed with the manufacturer that deliveries will be staggered to ensure that there is sufficient in-date vaccine for patients who present later in the season.'

He said the lengthy manufacturing process and the limited timeframe for production meant it was 'not unusual' for a gradual supply of flu vaccine to be made available from end-September each year.

A spokeswoman for the manufacturer AstraZeneca said the decision to cap orders had been taken by PHE, but that there would be sufficient vaccine supplied for the campaign to cover all eligible children.

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