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Overview

This Guidelines summary provides the key points for primary care. Please refer to the full guideline for the complete set of recommendations.

View the full summary at guidelines.co.uk/455521.article.

General practices

  • The routine immunisation programme should be maintained
  • As well as protecting the individual, this will avoid outbreaks of vaccine-preventable diseases that could further increase the numbers of patients requiring health services
  • Non-scheduled vaccinations should still be given, e.g. for control of outbreak(s) of vaccine preventable conditions as well as opportunistically, e.g. missing doses of MMR
  • Anyone who has had their appointment cancelled as part of the COVID-19 response should be invited for vaccination as soon as possible
  • Immunisation should proceed providing those attending for vaccination (including parents and carers) are well, are not displaying symptoms of COVID‑19 or other infections, and are not self-isolating because they are contacts of suspected or confirmed COVID-19 cases
  • Anyone with an acute febrile illness should not be immunised until the condition has resolved
  • Post-immunisation fever is not a reason to self-isolate.

Child health surveillance (NIPE infant check)

  • To reduce the number of visits to the general practice, consideration could be given to carrying out the 6 to 8-week newborn infant physical examination (NIPE) check at the same time as the 8-week scheduled vaccinations. Please note if the 6 to 8-week baby check has not been completed, immunisation should still start at 8 weeks of age.

Advice for healthcare workers where parents/patients have concerns about immunisation in general practice

  • Individuals and carers should be informed that, despite the COVID-19 pandemic, starting and completing routine childhood immunisations on time remain important. This will help protect the infant or child from a range of serious and sometimes life-threatening infections
  • Pertussis still circulates at elevated levels and pregnant women must continue to be offered the pertussis vaccine, and their babies vaccinated against this and other infections from 8 weeks of age
  • Practices should reassure individuals that the most up-to-date guidance on maintaining social distance in the waiting room (e.g. separating individuals by 2 metres) and decontamination of premises and equipment is being strictly followed in line with Public Health England (PHE) guidance on Infection Prevention and Control (IPC)
  • Further information on COVID-19 precautions for primary care is available.

Parents and carers may be concerned that their baby’s/child’s immune system cannot cope with both COVID-19 and immunisations and that in responding to vaccines, their ability to fight COVID-19 will be reduced/affected

  • Parents and carers should be reassured that as vaccines contain either weakened viruses or only a small amount of the inactivated organism/toxoid, the response uses only a tiny proportion of the capacity of an individual’s immune system. Vaccination will not overload their immune system, does not make them more susceptible to other infections and, if they do contract an infection in the immediate post-immunisation period, or were already incubating one when they were vaccinated, their immune system will still respond to it
  • Vaccinating babies reduces the chances of co-infection with COVID-19 and a serious vaccine-preventable disease
  • Both live and inactivated vaccines should continue to be given when due.

Infant paracetamol and primary immunisations

Parents and carers may be concerned that if their baby/child develops a fever following immunisation, they will not know if it is due to the vaccines or COVID-19

  • Parents and carers should be advised that the vaccines may cause a mild fever which usually resolves within 48 hours (or 6 to 11 days following measles, mumps, and rubella [MMR]). This is a common, expected reaction and isolation is not required, unless COVID-19 is suspected
  • Fever is more common when the type B meningococcal bacteria (MenB) vaccine (Bexsero) is given with other vaccines at 8 and 16 weeks of age. Where parents are able to obtain liquid infant paracetamol, they should follow existing PHE guidance on its prophylactic use following MenB vaccination
  • As has always been recommended, any infant with fever after vaccination should be monitored and, if parents or carers are concerned about the infant’s health at any time, they should seek advice from their GP or NHS 111
  • This advice applies to recently vaccinated people of all ages
  • Given the risk of the serious infections that the vaccines protect against, PHE recommends that the routine primary immunisation schedule should not be delayed.

Parents may be unable to obtain liquid infant paracetamol

  • While parents should continue to try to obtain and administer infant paracetamol where possible, infant vaccines can and should still be given even if they do not have prophylactic paracetamol to hand
  • Where parents have been unable to obtain infant paracetamol, the following advice is for clinical staff in primary care and parents
    • in infants who do develop a fever after vaccination, this tends to peak around 6 hours after vaccination and nearly always resolves completely within 2 days
    • ibuprofen can alternatively be used to treat a fever and other post-vaccination reactions. Prophylactic ibuprofen at the time of vaccination is not effective. Ibuprofen is not licensed for infants under the age of 3 months or with a body weight under 5 kg. However, the BNF for Children advises that ibuprofen can be used for post-immunisation pyrexia in infants aged 2 to 3 months, on doctor’s advice only, using 50 mg for one dose, followed by 50 mg after 6 hours if required. See the BNF for Children for more details
    • information about treating a fever in children is available from the NHS UK webpage ‘Fever in children
    • if an infant still has a fever 48 hours after vaccination, or if parents are concerned about their infant’s health at any time, should be advised to seek help from their GP or ring NHS 111
    • the diseases that the vaccines protect against are very serious and therefore vaccination should not be delayed because of concerns about post-vaccination fever
  • As a temporary measure, PHE have secured a small supply of liquid infant paracetamol in sachets which can be ordered from Immform. To support their use a protocol for health professionals to follow has been published (see PHE guidance on MenB vaccine and paracetamol).

What about all those individuals who do not attend for vaccination?

  • Those who miss the opportunity to be vaccinated still require their missing vaccinations. Without these they remain unprotected against vaccine-preventable disease. This makes the retention of accurate records of unvaccinated individuals important, and their appointments should be rescheduled as soon as is reasonably practical.

What personal protective equipment (PPE) should be worn when administering vaccines?

  • Well individuals should attend for vaccination (with parents or carers) at premises that are following the recommended IPC guidance
  • Those displaying symptoms of COVID-19, other infections, or who are self‑isolating because they are contacts of suspected or confirmed COVID-19 cases, should not attend
  • There is no evidence that crying or screaming is aerosol generating. Coughing and sneezing which may occur following administration of live attenuated influenza vaccine (LAIV) are not included as high-risk aerosol generating procedures, see PHE guidance on COVID-19 PPE
  • Coughing and sneezing are droplet forming. The recommended PPE for administering all vaccines, including LAIV, is gloves, apron, fluid resistant (type IIR) surgical mask and eye protection
  • Gloves and aprons are single use. Between vaccination of individuals they should be disposed of and hand hygiene performed. Fluid resistant (type IIR) surgical facemasks and eye protection can be subject to single session use, as outlined in the guidance linked below. Reusable eye and face protection is acceptable if decontaminated between single or single sessional use, according to the manufacturer’s instructions or local infection control policy
  • Further guidance on the use of PPE is available, it is recommended this guidance is read in full and in conjunction with the NHS England IPC guidance.

What information should I provide parent/carer about vaccinations administered?

  • It is important that parents and carers have a contemporaneous record of all immunisations administered. If local advice is to not bring the Red Book (personal child health record), the immuniser should provide sufficient information about the vaccines given to care giver to update the record themselves. For example, a print-out, text message, email with vaccine details.

What should I do to inform my local Child Health Information Services (CHIS) about vaccines administered?

  • It is important that all clinical colleagues contribute to ensuring that each child’s CHIS record is up to date by transferring data from clinical systems in a timely manner to the local CHIS provider. This will ensure those involved in the care of young children have access to the contemporaneous health record to support any rescheduling and catch-up programmes for those who miss appointments for public health programmes.

What do I need to do to prepare for the next flu season?

Full guideline:

Public Health England and NHS England. Clinical guidance for healthcare professionals on maintaining immunisation programmes during COVID-19. June 2020. Available at: www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/06/clinical-guidance-for-hcps-on-imms-for-covid-19.pdf

Contains public sector information licensed under the Open Government Licence v3.0

Published date: June 2020.