The seasonal influenza vaccination and COVID-19 vaccination programmes have now transitioned to an Autumn/Winter Vaccination Campaign which allows for the administration of both influenza and COVID-19 vaccines, as well as a Spring Campaign for COVID-19 only, in line with National Immunisation Advisory Committee (NIAC) guidance. Co-administration is encouraged where clinical guidance permits, as it offers individuals the greatest convenience and represents the most logical operational model.
Influenza and COVID-19 are completely different viruses but can cause similar symptoms, such as fever or cough. Because the symptoms of both COVID-19 and flu can be very similar, it can be difficult to identify the disease based on the symptoms alone. Laboratory tests are needed to determine whether someone has COVID-19 or another viral illness, such as flu. However, both viruses represent a large burden of disease worldwide and Ireland is no exception. Since March 2020, there have been 63,247 people who have required hospitalisation due to COVID-19 and over 100,00 cases have been confirmed in healthcare workers. During the 2022/23 influenza season the Health Protection Surveillance Centre (HPSC) reported that 4,604 patients were hospitalised in Ireland with confirmed influenza. Australia is experiencing a significant influenza season and notification rates are highest in people aged 05–09 years, followed by those aged 0–04 years, and 10–14 years. Irelands influenza season tends to follow that which Australia experiences.Children and healthcare workers (HCWs) in Ireland have been identified as groups with low vaccination uptake rates. Communications will be tailored to encourage uptake within these groups for the upcoming campaign.
Vaccination helps to prevent the spread of these viruses in our communities, protects the most vulnerable and reduces pressure on our health system.
There will be two seasonal influenza vaccines available free of charge for eligible individuals through the National Immunisation Office Vaccination Programme. They are:
** Only household contacts or carers of people who have an underlying chronic health condition or have Down syndrome are eligible to receive an influenza vaccine. A carer is described as someone who is providing an ongoing significant level of care to a person who is in need of care in the home due to illness or disability or frailty, for example those in receipt of a carer’s allowance. Household contacts of people aged 65 years and older (who do not also have a chronic health condition), pregnant women, children aged 2-12 years or of healthcare workers or carers are not recommended the influenza vaccine.
Chapter 5a – COVID-19 of the NIAC Immunisation Guidelines contains a table that provides recommendations for COVID-19 vaccines by age and immune status, Table 5a.1. This table can be found on the Royal College of Physicians of Ireland website at rcpi.ie > Healthcare Leadership > National Immunisation Advisory Committee (NIAC). Community pharmacies continue to provide COVID-19 vaccinations for those aged 12 years and older.
Patients eligible for a free influenza vaccine, and recommended for a COVID-19 booster, are a similar cohort, but differences exist. For instance, those aged 65 years and older are eligible for a free influenza vaccine, while all those 50 years and older are recommended a COVID-19 booster in the autumn. During pregnancy an influenza and COVID-19 vaccine can be given at any stage, however guidance stipulates that the COVID-19 booster should ideally be given between 20-34 weeks gestation. People with a BMI of >35kg/m2 are deemed to be at high-risk from COVID-19, and therefore recommended to get an autumn COVID-19 booster, while only those with a higher BMI >40m2 are eligible for a free influenza vaccine. Patients with severe mental illness such as schizophrenia or bipolar disorder, are recommended to get a COVID-19 booster vaccine, while they are not included in those eligible for a free influenza vaccination. Carers and household contacts, as well as people in regular contact with pigs, poultry or water fowl, are entitled to a free influenza vaccine, but no such recommendation is currently made for an autumn COVID-19 booster dose. The HSE has made the decision to stand down COVID-19 Vaccination Centres (CVC’s). As a result, it is anticipated that reliance on access to vaccinations through community pharmacy will increase during the upcoming campaign.
Patients may still present to have their COVID-19 primary course, additional dose or first booster administered in line with NIAC Guidance. Patients may also opt to pay privately for an influenza vaccine should they not fall into an eligible category, for the free flu vaccine.
Eligibility for the nasal flu vaccine has narrowed, with all children aged 2-12 years at the time of vaccination being offered a vaccine free. For children aged 13 to 17 years, only those in an at-risk group are eligible in the 2023/24 season cohort.
There is concern at the low uptake rates of the nasal flu vaccine amongst children. The 2022/23 influenza season saw only 15.4% of the population aged 2 to 17 years vaccinated, which fell far below the target that was set of 40%.
This is a public health concern, as vaccination not only protects the child who had a vaccine administered from the virus, but also helps to stop them from spreading the virus to the more vulnerable in our society. Many people do not realise that children are more likely than adults to get the flu, and also carry the flu virus in their system longer than adults do. It can thus spread easily to other children, like those in day-care centres and schools, and to older and vulnerable people around them.
Flu can cause serious illness in children, and also lost time at school. While most children who get the flu will have mild symptoms, some can get complications such as pneumonia or bronchitis and may need to be hospitalised. Children, especially younger children, are also more likely than adults to get severe complications of flu.
There is strong international evidence that the administration of vaccines in school settings increases vaccination uptake, and that a school setting is an appropriate and safe setting to enable the vaccination of a large number of students. A HSE pilot which offered the nasal flu vaccine within three primary schools, showed that when the service was provided in a school setting, uptake rates increased significantly. Uptake rates within the participating school populations rose from 12.4% to 76.3%. Depending on local circumstances, the nasal flu vaccine could be administered in other community settings outside of schools, for example in sports clubs or youth centres.
In 2020 legislation was introduced that permits appropriately trained pharmacists to supply and administer COVID-19 and influenza vaccines at any suitable and appropriate place, (i.e. within or offsite from the retail pharmacy business premises), having regard to the public convenience and the need to protect the health and safety of the public. The Pharmaceutical Society of Ireland (PSI) issued Guidance to Support Pharmacies in Providing Safe Vaccination Services Offsite from the Pharmacy Premises which is available on their website (psi.ie), and the IPU Flu Hub. In addition to this guidance, the National Immunisation Office (NIO) developed a Toolkit to Support the Administration of Flu Vaccination to Children and Young People in School or Community Settings for the 2022/23 season. This is currently being reviewed, and the IPU will notify you when an updated version is available. The Professional Team are also developing resources to assist members with the upcoming vaccination campaign, and these will be available on the IPU website.
Pharmacies are not yet included in the PPV23 vaccination programme, however pharmacists can administer and supply PPV23 privately in line with NIAC Guidance. Administration of PPV23 is recorded on HSE PharmaVax, which allows both GPs and pharmacists to have visibility of vaccinations administered. The HSE will also be running a national PPV23 during this autumn/winter vaccination campaign, for those eligible. Further details can be found on hse.ie/ immunisation > Healthcare Worker Information > Other Vaccines > Pneumococcal Disease.
Influenza and COVID-19 vaccines can be ordered from the HSE National Cold Chain Service (NCCS) using the online ordering system ordervaccines.ie, where your calendar is available, indicating order dates and delivery dates. You will receive communication from NCCS when orders are open. It has been indicated that deliveries of influenza vaccines will commence on 18 September 2023 with all sites receiving vaccines by 29 September 2023 (once ordered on time). Deliveries will be fortnightly for both influenza and COVID-19 vaccines, and these fortnightly deliveries will continue until the end of January 2024. Patient-held vaccination record cards will be delivered with the influenza vaccine, which should be completed and given to your patients after vaccination.
Launched in April 2021, HSE PharmaVax was first used to support the COVID-19 vaccination programme in community pharmacies, and is now also used for influenza and pneumococcal vaccinations. Ahead of the 2023/2024 vaccination season, members should be aware of recent updates to the system.
HSE PharmaVax is a secure, online portal developed by the HSE that allows community pharmacies to record details of, and claim reimbursement for, the COVID-19, influenza and pneumococcal vaccinations that they administer. The functionality of HSE PharmaVax is continuously being reviewed and improved. Throughout 2023 the system was further developed and enhanced to meet with pharmacist requirements and deliver more efficiencies. Vaccinating pharmacies are notified of new versions of HSE PharmaVax or changes via their Healthmail account.
It is now possible to change vaccinator details. Where vaccinations have yet to be administered, all vaccinator details are available for update, (except pharmacist PSI registration number); however, once a vaccination event has been recorded for a vaccinator then updates are restricted to ‘Email’ and ‘Mobile Phone Number’. Furthermore, the Active/Inactive flag has been moved from the ‘Add/View Vaccinator’ screen to the ‘Update Vaccinator’ screen.
Users of HSE PharmaVax can now edit client demographics of future vaccinations only. Currently any amendments made will only be visible in the user’s HSE PharmaVax account. No other user will have visibility of the changes made. This visibility will be rolled out at a later stage. Identifying the patient by their Individual Health Identifier (IHI) in the ‘Add Client’ or ‘Update Client’ screen ensures any changes to demographics will not impact the patients full vaccination history. To preserve the vaccination history multiple IHI-related data cannot be changed simultaneously.
Pre-configured public COVID-19 and Influenza batches are now available for selection from a dropdown menu in the ‘Add Batches’ screen (with Batch/Lot Number & Expiry Date pre-configured). Prior to the commencement of the autumn/winter vaccination campaign 2023/2024, a number of vaccine types and batches from previous seasons and campaigns are being removed from HSE PharmaVax as they are no longer in use. New products will be uploaded in preparation for the upcoming season around the same time.
The HSE has established a Vaccination Primary Care Contractors (VPCC) team which oversee and co-ordinate all operational aspects of vaccination campaigns with service providers, (i.e. Pharmacies and GPs). Operational Guidance for Vaccination in Community Pharmacy mRNA Vaccines is available within IPU COVID-19 Vaccination Hub. This is currently being reviewed by the VPCC Team. The updated version will be available in advance of the upcoming autumn/winter vaccination campaign.
Pharmacists have already been notified of one significant change in relation to support contacts. The HSE has engaged JMC as their distribution partner. JMC will take over the management of email queries relating to orders of COVID-19 vaccine consumables. Vaccine consumables will continue to be delivered in the required quantities to match the quantity of vaccines ordered. There is no requirement to place a separate order for consumables. If you have queries relating to consumable deliveries, or wish to order additional items, the new email address is vaccine.support@jmc.ie. This email will be monitored on a Monday- Friday basis from 9.00am – 5.00pm. Telephone queries will continue to be managed by the VPCC Relationship Management team, on 081 800 8811.
In the past, details of pharmacies providing an influenza vaccination service and those providing a COVID-19 vaccination service were held on two different public facing websites, Pharmacy Finder and Flu Finder, managed by the HSE. For the upcoming autumn/winter vaccination campaign, the HSE Pharmacy Finder is being relaunched, and it will now provide details of pharmacies providing COVID-19 vaccination services as well as influenza. As a result, pharmacies will only be required to fill out one form to indicate the vaccination service(s) they are providing, and further details such as location, opening hours etc. The HSE will confirm shortly the process for having pharmacy details added to this page. The Pharmacy Finder is a very important part of the communications around the vaccination campaign as it is where the general public will be directed by the HSE to establish what pharmacies are providing vaccination services in their area. It is also used by HSE Live when assisting members of the public.
A new landing page specifically for primary care contractors providing vaccination services within the community on behalf of the HSE is being rolled out. This landing page will house all non-clinical information in relation to the provision of vaccination services such as FAQ’s, links to relevant operational information as well as a form to allow contractors to provide feedback easily to the VPCC team.
Further details of how to register for the Pharmacy Finder and the Primary Care Contractors landing pages, will be communicated shortly by the HSE.
The NIO have developed materials to support healthcare professionals when providing a vaccination service. These are available for flu and COVID-19. The materials are available in PDF format, various languages and devised for a variety of groups, such as at-risk groups, HCWs, pregnant women, and children. These materials can be accessed on this website hse.ie/immunisation > Information Materials, and ordered from healthpromotion.ie.
Community pharmacists are a trusted source for information, and every conversation with a patient or customer is an opportunity to promote vaccination. Pharmacists should take that opportunity to ensure that patients, especially healthcare workers and children, are protected from the risks of influenza and COVID-19.
1,344 pharmacies provided an influenza vaccination service during the 2022/23 season, (1,215 nasal flu vaccine), while approximately 900 pharmacies engaged with the COVID-19 programme during a similar timeframe. This autumn/winter vaccination campaign allows for co-administration, and the HSE would like patients who are eligible for both vaccines to be able to access them within community pharmacy. With the closure of CVCs, community pharmacies have an increased importance in providing accessibility to vaccinations and facilitating patient choice.
If to date a pharmacy has not provided both vaccination programmes, now would be an ideal time to engage. Further details can be found on the IPU Vaccination Hubs.
The IPU Professional Services team will provide updates in the coming weeks, and throughout the autumn/winter vaccination campaign. These will be found in the weekly newsletter, on the IPU COVID-19 Vaccination Hub and the IPU Flu Vaccination Hub.
The IPU will host a webinar. Further details will be made available shortly.
Jonathon Morrissey, Superintendent Pharmacist, Marrons Pharmacy, Clane, Co. Kildare, told IPU Review, that in his pharmacy; “there has been a lot of interest from people in getting the flu vaccine and COVID-19 booster in the one appointment”. Mr Morrissey said it is great to see the programme evolving to offer co-administration for the appropriate patient; “being able to administer two vaccines in the one appointment helps to provide a better service to patients, and establishes the pharmacy as a cornerstone for their vaccination needs”.
“I really enjoy the interaction around the vaccination event as you get the opportunity to chat to the patient and gain insight into their lives. I find that talking with them helps to distract the patient from any needle anxiety they may experience.”
He also said that he has had a fantastic response from the local community with regard to his nasal flu vaccination service for children. He makes the atmosphere around these appointments very positive, relaxed and fun. He has found that convenience for parents/guardians of children is key to increasing uptake of the nasal flu vaccine — arranging clinics to coincide with the end of the school day, mid-term breaks and advertising them within the school with a poster works very well, as well as walk-in appointments; “Using the nasal flu vaccine is extremely straight forward and I hope to expand this service into the local primary school for the coming season.”
References available on request“The IPU will host a webinar on the 2023/24 autumn/winter vaccination campaign in conjunction with the NIO on 6 September.”
Susan O Donnell
Professional Services Pharmacist, IPU
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