Public Health for Berkshire Working together for health and wellbeing Berkshire Flu Workshop 2018/19
Time Item Speaker/Lead 09.45 Registration and coffee 10.00 Welcome & Aims of the day Jo Jefferies , Shared Public Health Team 10.05 Kitty Mohan, Thames Valley Flu Activity and impact in Berkshire Winter 2018/19 Health Protection Team, PHE South East 2018/19 flu vaccine uptake and system performance 10.20 NHSE Screening and Immunisation team 10.40 Berkshire East / West Flu Action Key learning from across Berkshire Groups and providers 11.10 Commissioning Intentions NHSE Screening and Immunisation team Group work – preventing flu and improving 11.40 ALL vaccination uptake in eligible groups • Task 1 • Task 2 12.10 Feedback and next steps ALL 12.30 Summing up and close Jo Jefferies Public Health for Berkshire Working together for health and wellbeing
Aims ➢ Review and reflect on 2018/19 flu season • what went well? • what did not go so well? ➢ Understand local commissioning intentions for 2019-20 • What has changed • Focus on priority groups ➢ Consider how we can improve uptake and reduce practice variation between practices • What can practices do? • What can CCGs do? • What can commissioners do? • 3 What can Local Authorities do?
Influenza 2018-2019 Season Dr. Kitty Mohan PHE South East – Thames Valley HPT
2018-19 season H1N1 well matched by the H1N1 main strain vaccine (H3N2 was not) New aTIV Very little flu B vaccine for older (good vax adults match) 5
GP consultations
ICU/HDU admissions
10 15 20 25 30 35 40 0 5 Thames Valley – Flu/RTI in the last 3 years September October November 16/17 December January February March September October November 17/18 ILI December RTI January February March September October November December 18/19 January February March April
Berkshire • Highest number of outbreaks reported in Wokingham (3) • 7 of 8 outbreaks confirmed at flu A, additional 7 RTI outbreaks 18 16 14 12 10 8 6 4 2 0 16/17 17/18 18/19 Bracknell Forest RBWM Reading Slough West Berkshire Wokingham
Challenges for 2018/19 season • 83 enquiries received about flu vaccines, common themes: • Errors – wrong vaccines given • Supply issues • Latex allergy • Usual questions about LAIV and immunosuppressed contacts, contraindications, etc • Vaccine uptake
Feedback on local uptake of flu immunisation 2018-19 • (data is provisional for 2018/19) 11
Picture in Thames Valley and Nationally 12 Data source: https://www.gov.uk/government/statistics/seasonal-flu-vaccine-uptake-in-gp-patients-monthly-data-2018-to-2019
CCG Level Two Year Comparison of Seasonal Influenza Vaccination Uptake Rates 65 and over (%) Under 65 at Pregnant All Aged 2 All Aged 3 risk (%) women (%) (%) (%) CCG missioning: Screening 18-19 17-18 Variation 18-19 17-18 Variation 18-19 17-18 Variation 18-19 17-18 Variation 18-19 17-18 Variation West pathways Berkshire 74 74.5 -0.5 48.8 50.2 -1.4 48.5 49.0 -0.5 52.1 48.6 3.5 56.1 49.4 6.7 East Berkshire 69.5 71.6 -2.1 47.1 50.2 -3.1 42.3 45.6 -3.3 43.7 38.0 5.7 46.7 39.6 7.1 Data source: https://www.gov.uk/government/statistics/seasonal-flu-vaccine-uptake-in-gp-patients-monthly-data-2018-to-2019 13
Two Year Comparison of Seasonal Influenza Vaccination Uptake Rates 2017/18 CCG Under 65 (at- All Pregnant All Aged 3 65 and over All Aged 2 years risk only) Women years 53.6 55.8 BRACKNELL AND ASCOT 73.5 46.7 51.5 48.5 49.8 WINDSOR, ASCOT AND MAIDENHEAD 70.9 43.5 43.4 48.5 35.9 SLOUGH 69.9 26.1 27.9 NEWBURY AND DISTRICT 77.5 55.0 52.1 58.0 55.6 49.9 48.1 NORTH & WEST READING 75.0 47.5 49.3 SOUTH READING 70.4 48.3 43.9 36.9 40.1 48.2 52.6 WOKINGHAM 73.8 53.7 52.8 2018/19 Local Authority Under 65 (at- All Pregnant All Aged 2 All Aged 3 65 and over risk only Women years years BRACKNELL AND ASCOT 72.4 52.8 48.6 55.6 58.7 53.3 WINDSOR, ASCOT AND MAIDENHEAD 71.4 47.4 44.6 51.7 37.9 SLOUGH 68 46.9 38.2 34.5 READING 71.8 47.3 46.5 44.4 48.7 WEST BERKSHIRE 76.9 56 51.7 61.2 65.3 WOKINGHAM 75.1 47.9 50.7 59 62.2 Data source: https://www.gov.uk/government/statistics/seasonal-flu-vaccine-uptake-in-gp-patients-monthly-data-2018-to-2019 14
2018/19 Uptake of seasonal flu vaccination for individuals aged under 65 years in clinical risk groups showing range of uptake within the LA`s 15 Data source: https://w ww.gov.uk/government/statistics/seasonal-flu-vaccine-uptake-in-gp-patients-monthly-data-2018-to-2019
Uptake in clinical risk groups 2018-19 by locality superimposed by influenza related mortality ratios (Age adjusted relative risk Sept 2010-May 2011 ) 70.0 60.0 60.0 50.0 % vaccination uptake 50.0 40.0 Relative Risk 40.0 30.0 30.0 20.0 20.0 10.0 10.0 0.0 0.0 Axis Title NHS OXFORDSHIRE CCG NHS BUCKINGHAMSHIRE CCG NHS BERKSHIRE WEST CCG NHS EAST BERKSHIRE CCG Relative risk Data source: https://w ww.gov.uk/government/statistics/seasonal-flu-vaccine-uptake-in-gp-patients-monthly-data-2018-to-2019 16
Additional Services in Thames Valley Kidney dialysis units delivered 317 Flu vaccinations across Thames Email, letter or Fax Valley Email Wexham East Berkshire or letter/fax maternity gave Pharmacies gave 5958 and 155 and RBH Berkshire West gave 297 flu pharmacies gave vaccinations 8370 flu vaccinations INPUT DATA
The 2018-19 flu vaccines composition Quadrivalent vaccines contained the following four viruses: ➢ an A/Michigan/45/2015 (H1N1)pdm09-like virus ➢ an A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus ➢ a B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage) ➢ a B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage). Trivalent vaccines contained three of the above strains but did not contain: ➢ B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage ). 18
GP consultations consultation rate -in-hours syndromic surveillance system 19
Evaluation findings of the promotional flu vaccination letter sent to parents of 2-3 in Berkshire ➢ NHS England South West and Thames Valley jointly composed a letter promoting the programme and informing parents/carers that their 2 or 3 year old was eligible for a flu vaccination ➢ CHIS were commissioned to send the letter to parents/carers of all 2 and 3 year olds in Berkshire. ➢ Berkshire was prioritised due to lower overall vaccine uptake rates and higher levels of deprivation compared to the rest of Thames Valley. ➢ The letter was sent in the week commencing 15 th October 2018 20
Change in flu vaccine uptake 2017/18 to 2018/19 2 year olds 3 year olds 2017/18 2018/19 Change 2017/18 2018/19 Change Oxfordshire CCG -3.6 -0.5 53.5 49.9 55.6 55.1 Buckinghamshire 46.6 43.9 -2.7 49.6 48.6 -1.0 CCG Berkshire West CCG 48.6 52.1 3.5 49.4 56.1 6.7 East Berkshire CCG 38.0 43.7 5.7 39.6 46.7 7.1 21
Trend in the uptake of flu vaccine among 2 year olds 100 90 80 Percentage uptake 70 60 2016/17 50 40 2017/18 30 2018/19 20 10 0 NHS OXFORDSHIRE NHS NHS BERKSHIRE NHS EAST CCG BUCKINGHAMSHIRE WEST CCG BERKSHIRE CCG CCG 22
Trend in the uptake of flu vaccine among 3 year olds 100 90 80 Percentage uptake 70 60 2016/17 50 40 2017/18 30 2018/19 20 10 0 NHS OXFORDSHIRE NHS NHS BERKSHIRE NHS EAST CCG BUCKINGHAMSHIRE WEST CCG BERKSHIRE CCG CCG 23
Reflection and next steps ….. ➢ Flu vaccination uptake among 2 and 3 year olds increased in Berkshire West and East Berkshire in 2018/19 ➢ Vaccine uptake among 2 and 3 year olds reduced in both Buckinghamshire and Oxfordshire during the same time period ➢ The letter commissioned by CHIS to send to parents of 2 and 3 year olds is likely to have contributed to this increase in Berkshire ➢ A similar impact was seen parts of the South West who also commissioned the same letter ➢ No other clear explanation in how the 2 and 3 year old programme was run across Thames Valley in 2018/19 to account for this difference in uptake rates, apart from work undertaken by CHIS to improve vaccine uptake in Berkshire 24
2018-19 School aged flu vaccination performance Flu delivery in Thames Valley: The story in numbers Berks = 74 476 children Bucks = 41 766 children Oxon = 48,573 children Berks = 400 schools (8 special schools) Bucks = 200 schools ( 9 special schools ) Oxon = 270 schools (8 special schools) Data source: https://www.gov.uk/government/statistics/seasonal-flu-vaccine-uptake-in-children-of-primary-school-age-monthly-data-2018-to-2019 25
2018-19 School age flu vaccine Performance Data source: https://www.gov.uk/government/statistics/seasonal-flu-vaccine-uptake-in-children-of-primary-school-age-monthly-data-2018-to-2019 26
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