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Influenza immunisation
Every winter,
during a six to eight week period, influenza is associated with a
sharp increase in mortality and contributes to often well
publicised winter pressures on general practitioner (GP) and
hospital services. In an average year an estimated 2,000-3,000
people die in the UK from influenza related causes and GP
consultations for new episodes of influenza-like illness rise from
a baseline of less than 50/100,000 population per week to
200-250/100,000/week.
In
major epidemic years over 20,000 excess deaths have been recorded
with new GP consultations rising to well over 400/1OO,000
population/week.
Some, at least,
of this morbidity could be reduced by improving influenza
immunisation uptake rates in those most at risk of serious illness
from influenza. This means ensuring that influenza vaccine is
offered every autumn to:
those of all ages
with:
chronic
respiratory disease, including asthma;
chronic heart
disease;
chronic renal
disease;
immunosuppression
due to disease or treatment;
diabetes
mellitus;
those aged 75 years
and over; and
people in long
stay residential care.
Influenza
vaccines are effective in preventing influenza hospital admissions
and deaths, they also have a good safety record. Mild, local
injection site reactions may occur and, occasionally, systemic
symptoms lasting up to 48 hours. Rarely, the Guillain-Barre'
syndrome occurs in association with the vaccine (an estimated one
case per million vaccinees). The vaccine is contraindicated in
those with anaphylactic hypersensitivity to hens' eggs and is not
recommended in pregnant women (unless there is a clear medical
indication) or in those with a previous history of Guillain-Barre'
syndrome.
Many GP practices
have now compiled registers of those patients for whom influenza
vaccine is indicated. Patients are then invited to set
immunisation sessions or other arrangements are made for the
vaccine to be administered. Well organised immunisation
arrangements such as these are essential if uptake is to be
optimised. Vaccine may also conveniently be offered to at-risk
patients on their discharge following hospital admission if the
timing is appropriate (October/NovemberIDecember).
Routine
immunisation of health-care workers or other occupational groups
is not recommended in the UK as part of national policy. This
year, however, some health trusts may be offering influenza
vaccine to their health-care staff as part of their millennium
winter pressures planning. This would be as a contingency measure
to maintain staffing should an influenza outbreak
coincide with the
exceptional circumstances of the millennium break. Decisions on
whether to offer the vaccine to staff will be made locally.
Full details of
the UK influenza immunisation policy and available vaccines can be
found in the UK Health Departments' memorandum Immunisation
against infectious disease.
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