NI COVID-19 Booster & Flu Vaccination Programme

VACCINE SUPPLY FOR THE COVID-19 BOOSTER VACCINATION PROGRAMME
  1. Following on from HSS 69/2021 https://www.health-ni.gov.uk/sites/default/files/publications/health/doh-hss-md-69-2021_0.pdf
    This letter sets out the position regarding the availability of COVID-19 vaccines and provides advice for GPs to consider before they organise their COVID-19 booster clinics.
  2. JCVI have recommended that an mRNA vaccine is the preferred vaccine for the vast majority of people eligible to receive a booster dose. Evidence indicates that the effectiveness of the Pfizer-BioNTech or Moderna vaccines are equally high.
  3. The main rate limiting factor in the booster programme is the requirement that there has to be a minimum of 6 months from the date of receipt of the 2nd primary dose. The digital team are working with a number of GP practice managers to develop a process for automated searches to enable identification of those patients who need to be called for a booster. This will be progressed as rapidly as possible, working with the practice managers, to determine the optimal solution.
  4. Orders for the Pfizer-BioNTech vaccine can be placed with Movianto via the web based ordering system from w/c 4 October. It should be noted however that at present the Pfizer-BioNTech vaccine can only be supplied in a tray containing 1,170 doses (195 vials, each containing 6 doses of 0.3ML per vial). The vaccine is defrosted to order prior to delivery to the practice and so orders could take up to 5 working days before they will be received by a practice. All the doses must be administered within the expiry date indicated on the label attached to the pack by Movianto – typically 27 or 28 days, but a minimum of 25 days. Only practices able to use these doses should order these large packs. Other smaller practices should consider if they need to wait for the Moderna vaccine or smaller Pfizer packs when they become available later in the month, see below.
    Consumables will also need to be ordered in addition to the vaccine, practices ordering a full pack of Pfizer-BioNTech vaccine must also order
    - 12 packs of combined 23G (25mm / 1 inch) needles and 1ml syringes for administration (100 in pack)
    - 2 packs of needles for dilution (100 in pack)
     – 10 packs of 0.9% sodium chloride 5ml ampoules for dilution (20 in pack)
     – 1 pack of Patient Information Leaflets (1,200 leaflets per box)
    Practices should be advised that existing supplies of 38mm (1.5inch) combined needles and syringes ordered and held by practices for administration of the AstraZeneca vaccine to morbidly obese individuals can also be used for administration of the Pfizer/BioNTech vaccine to morbidly obese individuals.
    Revised vaccination cards are being produced by the Public Health Agency and practices will be advised when these are available to order from Movianto. In the interim, practices are advised to continue use the current vaccination cards and write booster against the 1st dose entry.
  5. The Moderna vaccine will be available to order from w/c 11 October however due to limited supplies GPs are encouraged to use a full tray of the Pfizer vaccine, where possible. The Moderna vaccine comes in packs of 100 doses, which will allow for approximately 170 half doses (10 vials, each containing 17 half doses of 0.25ML per vial) to be administered. The vaccine is defrosted to order prior to delivery to the practice and so orders could take up to 5 working days before they will be received by a practice. All the doses must be administered within the expiry date indicated on the label attached to the pack by Movianto – typically 26 or 27 days, but a minimum of 24 days.
    Initial orders of the Moderna vaccine in October will be capped at 2 packs per practice, with a minimum of two weeks interval before further deliveries will be available to the practice. Consumables will also need to be ordered in addition to the vaccine, and practices ordering a full pack of Moderna vaccine must also order:
    - 1 pack of combined 23G (25mm / 1 inch) needles and 1ml syringes for administration (200 in pack)
    – 2 packs of Patient Information Leaflets (100 leaflets per box)
    Practices should be advised that existing supplies of 38mm (1.5inch) combined needles and syringes ordered and held by practices for administration of the AstraZeneca vaccine to morbidly obese individuals can also be used for administration of the Moderna vaccine to morbidly obese individuals.
  6. Revised vaccination cards are being produced by the Public Health Agency and practices will be advised when these are available to order from Movianto. In the interim, practices are advised to continue use the current vaccination cards and write booster against the 1st dose entry.
  7. It is intended that by late October smaller pack sizes of the Pfizer vaccine will be available which will enable packs of 30 vials (180 doses) to be issued. Unlike the flu vaccine it will not be possible to order on a daily basis and therefore a minimum of two packs per practice would have to be ordered, with a minimum of two weeks interval before further deliveries will be available to the practice. It is expected that all GP practices will use some of the Pfizer vaccine at some stage during the booster programme.
  8. Practices are therefore asked to consider their requirements based on the number of eligible patients they will have throughout October and into November reaching the 6 month mark since receipt of their 2nd COVID-19 vaccine before placing an order via the Movianto NI online ordering page.
Vaccine Management System

HSCB VMS page

Login : https://vms.healthandcareni.net/gp

An updated version of VMS allowing recording of COVID-19 booster dose, as well as 3rd primary dose for immunosuppressed patients and influenza vaccinations will be available on 6th October.
VMS Users may need to refresh their browser once they log in to ensure they are logging on to the new version. This will only need to be done if you have bookmarked the VMS URL.

All previous URLs lead to the new app. GPs can use this URL https://vms.healthandcareni.net/gp/ and be taken to the new app.

Please be advised that the “save for later” function should not be used at this time.

Vaccine Management System

HSCB VMS page

Login : https://vms.healthandcareni.net/gp

An updated version of VMS allowing recording of COVID-19 booster dose, as well as 3rd primary dose for immunosuppressed patients and influenza vaccinations will be available on 6th October.
VMS Users may need to refresh their browser once they log in to ensure they are logging on to the new version. This will only need to be done if you have bookmarked the VMS URL.

All previous URLs lead to the new app. GPs can use this URL https://vms.healthandcareni.net/gp/ and be taken to the new app.

Please be advised that the “save for later” function should not be used at this time.

A single primary dose for young people aged 12-17 October 2021

Following recent JCVI advice and Departmental circulars HSS(MD)54/2021, and HSS(MD) 70/2021 a single primary dose of COVID-19 vaccination should be offered to young people aged 12-15. Only Pfizer is currently suitable for this age group.

Children aged 12- 15 will be offered COVID-19 vaccination in school, but a small number may miss the opportunity to be vaccinated in school due to absence, illness etc.

In line with HSS(MD)56/2021 young people aged 16 & 17 are currently being encouraged to attend Trust run clinics, but these are expected to close in coming weeks. Pfizer is the recommended vaccine for this age group

Community pharmacies will continue to provide 1st and 2nd doses of COVID-19 vaccination for adults, but they are using Aztra Zeneca and Moderna vaccies.

GPs will have Pfizer available to them for the booster programme.

GPs are therefore asked to facilitate requests from children/young people for COVID-19 vaccination if the practice has Pfizer vaccine available. Practices are not required to actively call young people, but the claim form will be amended to allow practices to claim for vaccinating them

COVID-19 & Influenza vaccination in nursing homes

Care homes residents and staff are vulnerable to both COVID-19 and influenza, and were amongst the first to be offered COVID-19 vaccination using Trust teams. Trust teams have been re-established to offer COVID-19 booster vaccination to care home residents and staff.

Trusts have indicated that while the mobile teams providing COVID-19 boosters will be co-administering influenza vaccine to residents in residential homes, they will not be providing influenza vaccination in nursing homes. Practices should ensure they retain sufficient vaccine for their patients in nursing homes, and arrange for their vaccination using their own staff, nursing home staff or district nurses, in line with previous years.

COVID-19 vaccination and rare side effects

Guidance relating to blood clotting, myocarditis and Guillain-Barre Syndrome (GBS) after COVID-19 vaccination.

Information and guidance for health professionals on very rare conditions reported after COVID-19 vaccination.

Blood clotting

If you have any clinical concerns, patients should be urgently referred to hospital and to appropriate specialist services for further assessment, particularly if the symptoms are unexplained and present in combination with thrombocytopaenia.

The recommended management of this rare presenting condition is available from the British Society of Haematologists (BSH) here with specific guidance produced from the Royal College of Emergency Medicine (RCEM) here  Emergency Departments and Acute Medical Units

A brief guidance document on the primary care management of suspected thromboembolism with thrombocytopenia after COVID-19 vaccination has been produced by the Royal College of General Practitioners (RCGP).

Myocarditis and Guillain-Barre Syndrome (GBS)

If you have any clinical concerns, patients should be urgently referred to appropriate specialist services for further assessment. Further information and guidance will be added as it becomes available.

Guidance, training and resources relating to the COVID-19 vaccination programme are available.

Guidance on blood clotting

 

Leaflets on blood clotting

 

Guidance on myocarditis and pericarditis

 

Guidance on Guillain-Barre Syndrome

 
HSCB & PHA Public FAQs

HSCB is maintaining a FAQ for the public regarding the GP COVID-19 vaccine rollout and you may find this helpful where patients have questions. The link is http://www.hscboard.hscni.net/coronavirus/covid-19-vaccination-programme/.

The PHA also have some helpful FAQs for the public at https://www.publichealth.hscni.net/covid-19-coronavirus/northern-ireland-covid-19-vaccination-programme/covid-19-vaccination-programme

A 3rd primary dose for immunosuppressed patients

Following recent JCVI advice and Departmental circular HSS(MD) 66/2021 a 3rd primary dose of COVID-19 vaccination should be offered to immunosuppressed patients.

The majority of these patients will be under secondary care and Trusts have been asked to identify these patients and make arrangements for them to have the 3rd dose vaccination. If these patients approach the practice they should be directed to their consultant for advice.

It is possible that some patients who are not under ongoing secondary care management will have been prescribed high dose steroids by their GP. The JCVI have said this is individuals who had received high-dose steroids (equivalent to >40mg prednisolone per day for more than a week) for any reason in the month before vaccination. Individuals who had received brief immunosuppression (≤40mg prednisolone per day) for an acute episode (for example, asthma / COPD / COVID-19) and individuals on replacement corticosteroids for adrenal insufficiency are not considered severely immunosuppressed sufficient to have prevented response to the primary vaccination

The extended LES will fund:

  1. Practices completing a search of their clinical systems to identify patients aged 12 or older where the GP has prescribed high-dose steroids (equivalent to >40mg prednisolone per day for more than a week) for any reason in the month before vaccination.
  2. If any of the identified patients are adults (18 years or older) are not currently receiving treatment via secondary care, they should be issued with a letter recommending that they receive a 3rd primary dose via a local community pharmacy using the Moderna vaccine. Draft letters are attached at Annex B and C of HSS(MD) 66/2021which GPs may wish to adapt and use.
  3. If any of the identified patients are under 18 years and are not currently receiving treatment via secondary care, they should be referred to their local Trust via the CCG route to be considered for vaccination.
GOV.UK - COVID-19 vaccination programme Resources

https://www.gov.uk/government/collections/covid-19-vaccination-programme

**This relates to PHE guidance but some information / resources may be transferrable**

 

GOVERNANCE, HANDLING & PREPARATION REQUIREMENTS

DEPLOYMENT OF THE PFIZER AND MODERNA COVID-19 VACCINES IN GENERAL PRACTICE - HSS(MD)68/2021

DEPLOYMENT OF THE PFIZER AND MODERNA COVID-19 VACCINES IN GENERAL PRACTICE – GOVERNANCE, HANDLING AND PREPARATION REQUIREMENTS

Both vaccines are inherently “fragile” in nature and so must be handled carefully. The key component is messenger Ribonucleic Acid (mRNA) which is a delicate substance. The mRNA is encased in microscopic lipid nanoparticles both to protect it and to help it get into cells. Once inside the cell, the mRNA instructs the cell to produce particular coronavirus proteins, and it is this that leads to the immune response that protects us. These nanoparticles are delicate and so this is why the vaccine is distributed in the frozen state so that the nanoparticles do not degrade, including when being transported. Similarly, if the thawed vial is shaken rather than gently inverted during preparation, the lipid nanoparticles may again degrade, or release the mRNA which is destroyed and therefore deactivated.

Pfizer / BioNTech have been granted a Conditional Marketing Authorisation (CMA) for their vaccine by the European Medicines Agency (EMA), branded as Comirnaty®. The Summary of Product Characteristics (SmPC) for Comirnaty® is available on the EMA website.

The COVID-19 Vaccine Moderna (Spikevax®) vaccine is also authorised for use in Northern Ireland in line with a Conditional Marketing Authorisation issued by the EMA. The SmPC for the Spikevax® product is available on the EMA website.

Both vaccines have specific requirements for their preparation, including the need for aseptic non-touch technique (ANTT) when preparing doses for administration, as well as defined time limitations for onward transport once thawed and for administration once the vial is first punctured. These requirements are likely to be updated as more information becomes available, and so practices should always refer to the relevant SmPC which contains the most up to date information about the characteristics of each vaccine to inform local planning.

Technical Standard Operating Procedures (SOP)

To mitigate the risks of inadvertently inactivating the vaccines, a suite of technical SOPs and other resources has been developed by the NHS Specialist Pharmacy Service (SPS) which general practice pharmacy teams may find useful.
Both the Comirnaty® and Spikevax® vaccines are sensitive to light and movement and so have specific transport requirements including temperature and time constraints which may impact on the ability to deploy the vaccine in off-site locations. Practices considering the use of mRNA vaccines in off-site locations should refer to the NHS SPS resources developed to support the appropriate use of COVID-19 vaccines in temporary vaccination sites. Due to the characteristics of the Pfizer (Comirnaty®) and Moderna (Spikevax®) vaccines, which require dedicated areas for preparation of the vaccine and observation following administration, the use of “drive-through” temporary vaccination site models is not appropriate.

Training resources

The Public Health Agency (PHA) has developed a range of professional guidance and information resources on the COVID-19 vaccination programme, including a detailed training resource with vaccine specific information for each of the approved COVID-19 vaccines in use in Northern Ireland.


In addition, Pfizer has produced an online educational resource containing bespoke information for healthcare professionals in Northern Ireland, including a video demonstrating the handling and preparation of the Comirnaty® vaccine.

Handling multiple vaccines

As more COVID-19 vaccines become available, it is important to ensure procedures are in place to make certain that each person gets the right dose of the right vaccine at the right time and that the vaccine has been stored and handled as specified in the product’s authorisation documentation.

The different COVID-19 vaccines have different storage, handling and preparation requirements, different dosages and different observation periods following vaccination. There may also be differences in the contraindications for each vaccine and in the advice that should be given about possible anticipated side effects.

The NHS Specialist Pharmacy Service has put together guidance on safe practice for handling multiple vaccines from receipt through to administration. Vaccinators are encouraged to read through this guidance in order to minimise the risk of errors where multiple vaccines are available.

Support from HSC Trust Medicines Information service

Senior pharmacy leaders and their teams within HSC Trusts have considerable experience and working knowledge of both the Pfizer / BioNTech and Moderna vaccines. General practice teams may contact the Regional Medicines and Poisons Information Centre in the Belfast HSC Trust on 028 9504 0558 (Monday to Friday9.00am to 5.00pm) or by email at [email protected] for advice and support with any specific queries. Please note, the resources highlighted above must be referred to before contacting the Regional MI service.

Ordering and distribution - Comirnaty® & Spikevax®

As with the AstraZeneca vaccine used in the primary vaccination programme, arrangements are being put in place for practices to order supplies of the Comirnaty® and Spikevax® vaccines via the Movianto web based ordering system. The Health and Social Care Board will work with the Public Health Agency and with practices to agree quantities that will be available for practices to order, and further details will be provided in the coming days.

Vaccines, consumables and associated equipment will be delivered to base sites. Due to the fragile nature of mRNA vaccines, onward transport should be minimised where possible. Where transport to an off-site location is required, practices should ensure that processes are in place to support the appropriate transport of the vaccine to the end-user location in line with the requirements outlined in the relevant SmPC. Cold-chain requirements and the advice provided in the NHS SPS resources highlighted above must be adhered to in order to preserve the nature of the vaccines. Care should be taken to pack vaccines securely to minimise movement during transit. It is recommended that only the quantities of vaccine required for a particular off-site clinic are transported to the end location.

Comirnaty®

At this time the Comirnaty® vaccine is currently supplied to practices in packs of 195 vials, with 6 doses available from each vial. This is a total of 1170 doses per pack. Practices will also need to order the required consumables from Movianto along with the required quantities of vaccine – combined needles and syringes for dilution, combined needles and syringes for administration, sodium chloride 0.9% injection for dilution and the relevant Patient Information Leaflet (PIL). Comirnaty® is currently distributed in packs measuring approximately 229mm x 229mm x 40mm, and practices should ensure that there is sufficient refrigerated storage available to accommodate this.

As outlined above, any supply of stock from one practice to another would constitute wholesale supply and necessitate the supplying practice to hold a WDA. We recognise that the need to apply for and hold a WDA is not likely to be feasible for most general practices and so the Department is actively working to put a solution in place to provide smaller packs for use by general practices. At this time it is envisaged that smaller pack sizes will be made available to support practices from the end of October 2021. Further information will be made available in due course.

The vaccine will be delivered to practices designated to receive Comirnaty® at a temperature of 2-8°C following defrosting by Movianto. The process of defrosting and distribution may take 3 to 5 days. The vaccine has a 1 month expiry date following defrosting when stored at 2-8°C. Therefore, it is important to note that on receipt by the practice, the actual expiry date will be less than 1 month due to the time required for the defrosting and distribution process. This will be clearly indicated on a label added by Movianto and will typically be 27 to 28 days (but with a minimum of 25 days) available to practices on delivery.
Following defrosting, within the 1 month expiry date at 2-8°C, the Comirnaty® vaccine can be transported for up to 12 hours. This will include the transport time to deliver the vaccine to practices from Movianto. Practices should plan any further transport to off-site locations on the basis that there is a maximum of 2 hours available for onward transport following initial delivery from Movianto.

Spikevax®

The Spikevax® vaccine is supplied in packs of 10 vials, each containing 10 full doses of 0.5mL. Each pack measures approximately 60mm x 51mm x 126mm. JCVI have recommended administration of a half dose of 0.25mL as part of the COVID-19 booster programme. Actions are progressing to support administration of a half dose of the Moderna vaccine, including updating the regional Vaccine Management System (VMS), training and PIL. We will issue further advice on this as soon as possible. NOTE Practices should not administer a half dose Moderna booster to patients until instructed to do so.

The vaccine will be delivered to practices designated to receive Spikevax® at a temperature of 2-8°C following defrosting by Movianto. The vaccine has a 30 day expiry date following defrosting when stored at 2-8°C. However the actual expiry date will be less than this due to the time required for the defrosting and distribution process and this will be indicated on a label added by Movianto. The process of defrosting and distribution may take 3 to 5 days and so the actual expiry date will typically be 26 to 27 days from delivery, with a minimum of 24 days available to practices on delivery.

Following defrosting, the Spikevax® vaccine can be transported for up to 12 hours at 2-8°C, within the 30 day expiry date. This will include the transport time to deliver the vaccine to practices from Movianto. Practices should plan any further transport to off-site locations on the basis that there is a maximum of 2 hours available for onward transport following initial delivery from Movianto.

While every effort is being made to ensure timely delivery of orders that are placed with Movianto, practices should not schedule vaccination clinics before deliveries of vaccine have been confirmed.

Monitoring and reporting

Healthcare professionals are reminded that all suspected adverse reactions to medicines or devices related to the management of COVID-19 should be reported to the MHRA via the Yellow Card Scheme https://coronavirus-yellowcard.mhra.gov.uk/

Conclusion

We would like to offer our sincere thanks to general practice teams across Northern Ireland for their efforts in delivering the primary COVID-19 vaccination programme. Your efforts have been instrumental in the delivery of a programme that has been successful in protecting people from serious illness and has ultimately saved many, many lives.

Introducing a booster programme this autumn will help to prolong protection from COVID-19 in those most at risk from this virus and will help to reduce hospitalisations as we head into colder weather and what will be a challenging period for our health service.

Yours sincerely

PROF SIR MICHAEL McBRIDE / Chief Medical Officer

MRS CATHY HARRISON /Chief Pharmaceutical Officer

Pfizer / Comirnaty

Information for practices using Pfizer / Comirnaty

Iinformation for practices using PFIZER / COMIRNATY

COMIRNATY Northern Ireland Handling, Preparation & Administration Poster

Both vaccines have specific requirements for their preparation, including the need for aseptic non-touch technique (ANTT) when preparing doses for administration, as well as defined time limitations for onward transport once thawed and for administration once the vial is first punctured. These requirements are likely to be updated as more information becomes available, and so practices should always refer to the relevant SmPC which contains the most up to date information about the characteristics of each vaccine to inform local planning.

Training for Vaccinators - PFIZER / COMIRNATY

All vaccinators must be registered health care professionals.  Health care assistants may support vaccinators including post vaccination observation but may not administer the vaccine as part of this service.

All vaccinators should complete the COVID-19 vaccinator competency assessment tool  Any training needs identified by the COVID-19 vaccinator competency assessment tool should be addressed.  Copies of the assessments should be held in the practice.  Additional training and information is available on the PHA website.

All vaccinators should complete the e-learning for health module on COVID-19. 

In addition they shoould complete the eLearning  Pfizer-BioNTech COVID-19 vaccine (Comirnaty)

This e-learning course provides specific information about the Pfizer-BioNTech COVID-19 vaccine (Comirnaty). It is designed to provide healthcare workers involved in delivering the vaccine with the knowledge they need to safely and effectively deliver this vaccine.

Preparing doses of vaccines using aseptic non-touch technique (ANTT)

https://www.sps.nhs.uk/articles/preparing-doses-of-vaccines-using-aseptic-non-touch-technique-antt/

This page should be read in conjunction with other material on vaccine preparation, in particular their  Standard Operating Procedures.

Anaphylaxis 

HSS-MD-85-2020-ADRENALINE-FOR-ANAPHYLAXIS-KITS-A-REMINDER-TO-HEALTH-CARE-PROFESSIONALS

RCUK’s expert anaphylaxis group is currently updating the anaphylaxis guidelines for 2021. In light of the current mass vaccination programme they have provided updated information for use in any vaccination setting to give clear guidance to healthcare professionals involved. We have also produced a poster of the algorithm for the management of anaphylaxis in the vaccination setting.

e-LFT Recognising and Managing Anaphylaxis Training 

Basic Life Support

eLFH – Basic Life Support

RCGP : Community CPR in the COVID-19 world

Additional Resources

EMC NI SmPC / PIL

Supply & Ordering - PFIZER / COMIRNATY

The Pfizer-BioNTech vaccine can only be supplied in a tray containing 1,170 doses (195 vials, each containing 6 doses of 0.3ML per vial). The vaccine is defrosted to order prior to delivery to the practice and so orders could take up to 5 working days before they will be received by a practice.

All the doses must be administered within the expiry date indicated on the label attached to the pack by Movianto – typically 27 or 28 days, but a minimum of 25 days.

Only practices able to use these doses should order these large packs. Other smaller practices should consider if they need to wait for the Moderna vaccine or smaller Pfizer packs when they become available later in the month, see below.

Consumables will also need to be ordered in addition to the vaccine, practices ordering a full pack of Pfizer-BioNTech vaccine must also order
– 12 packs of combined 23G (25mm / 1 inch) needles and 1ml syringes for administration (100 in pack)
– 2 packs of needles for dilution (100 in pack)
– 10 packs of 0.9% sodium chloride 5ml ampoules for dilution (20 in pack)
– 1 pack of Patient Information Leaflets (1,200 leaflets per box)

Practices should be advised that existing supplies of 38mm (1.5inch) combined needles and syringes ordered and held by practices for administration of the AstraZeneca vaccine to morbidly obese individuals can also be used for administration of the Pfizer/BioNTech vaccine to morbidly obese individuals.

Revised vaccination cards are being produced by the Public Health Agency and practices will be advised when these are available to order from Movianto. In the interim, practices are advised to continue use the current vaccination cards and write booster against the 1st dose entry.

Storage - PFIZER / COMIRNATY

The vaccine will be delivered to practices designated to receive Comirnaty® at a temperature of 2-8°C following defrosting by Movianto. The process of defrosting and distribution may take 3 to 5 days. The vaccine has a 1 month expiry date following defrosting when stored at 2-8°C. Therefore, it is important to note that on receipt by the practice, the actual expiry date will be less than 1 month due to the time required for the defrosting and distribution process. This will be clearly indicated on a label added by Movianto and will typically be 27 to 28 days (but with a minimum of 25 days) available to practices on delivery.

Following defrosting, within the 1 month expiry date at 2-8°C, the Comirnaty® vaccine can be transported for up to 12 hours. This will include the transport time to deliver the vaccine to practices from Movianto. Practices should plan any further transport to off-site locations on the basis that there is a maximum of 2 hours available for onward transport following initial delivery from Movianto.

Moderna / SpikeVax

Information for practices using Moderna / SpikeVax

Both vaccines have specific requirements for their preparation, including the need for aseptic non-touch technique (ANTT) when preparing doses for administration, as well as defined time limitations for onward transport once thawed and for administration once the vial is first punctured. These requirements are likely to be updated as more information becomes available, and so practices should always refer to the relevant SmPC which contains the most up to date information about the characteristics of each vaccine to inform local planning.

Training for Vaccinators - MODERNA / SPIKEVAX

All vaccinators must be registered health care professionals.  Health care assistants may support vaccinators including post vaccination observation but may not administer the vaccine as part of this service.

All vaccinators should complete the COVID-19 vaccinator competency assessment tool  Any training needs identified by the COVID-19 vaccinator competency assessment tool should be addressed.  Copies of the assessments should be held in the practice.  Additional training and information is available on the PHA website.

All vaccinators should complete the e-learning for health module on COVID-19. 

In addition they shoould complete the eLearning  Moderna COVID-19 vaccine (SpikeVax)

This e-learning course provides specific information about the ModernaCOVID-19 vaccine (SpikeVax). It is designed to provide healthcare workers involved in delivering the vaccine with the knowledge they need to safely and effectively deliver this vaccine.

Preparing doses of vaccines using aseptic non-touch technique (ANTT)

https://www.sps.nhs.uk/articles/preparing-doses-of-vaccines-using-aseptic-non-touch-technique-antt/

This page should be read in conjunction with other material on vaccine preparation, in particular their  Standard Operating Procedures.

Anaphylaxis 

HSS-MD-85-2020-ADRENALINE-FOR-ANAPHYLAXIS-KITS-A-REMINDER-TO-HEALTH-CARE-PROFESSIONALS

RCUK’s expert anaphylaxis group is currently updating the anaphylaxis guidelines for 2021. In light of the current mass vaccination programme they have provided updated information for use in any vaccination setting to give clear guidance to healthcare professionals involved. We have also produced a poster of the algorithm for the management of anaphylaxis in the vaccination setting.

e-LFT Recognising and Managing Anaphylaxis Training 

Basic Life Support

eLFH – Basic Life Support

RCGP : Community CPR in the COVID-19 world

Additional Resources

EMC NI SmPC / PIL

Supply & Ordering - MODERNA / SPIKEVAX

The Moderna vaccine will be available to order from w/c 11 October however due to limited supplies GPs are encouraged to use a full tray of the Pfizer vaccine, where possible.

The Moderna vaccine comes in packs of 100 doses, which will allow for approximately 170 half doses (10 vials, each containing 17 half doses of 0.25ML per vial) to be administered.

The vaccine is defrosted to order prior to delivery to the practice and so orders could take up to 5 working days before they will be received by a practice. All the doses must be administered within the expiry date indicated on the label attached to the pack by Movianto – typically 26 or 27 days, but a minimum of 24 days.

Initial orders of the Moderna vaccine in October will be capped at 2 packs per practice, with a minimum of two weeks interval before further deliveries will be available to the practice. Consumables will also need to be ordered in addition to the vaccine, and practices ordering a full pack of Moderna vaccine must also order:
– 1 pack of combined 23G (25mm / 1 inch) needles and 1ml syringes for administration (200 in pack)
– 2 packs of Patient Information Leaflets (100 leaflets per box)
Practices should be advised that existing supplies of 38mm (1.5inch) combined needles and syringes ordered and held by practices for administration of the AstraZeneca vaccine to morbidly obese individuals can also be used for administration of the Moderna vaccine to morbidly obese individuals.

Storage - MODERNA / SPIKEVAX

temperature of 2-8°C following defrosting by Movianto. The vaccine has a 30 day expiry date following defrosting when stored at 2-8°C. However the actual expiry date will be less than this due to the time required for the defrosting and distribution process and this will be indicated on a label added by Movianto. The process of defrosting and distribution may take 3 to 5 days and so the actual expiry date will typically be 26 to 27 days from delivery, with a minimum of 24 days available to practices on delivery.

Following defrosting, the Spikevax® vaccine can be transported for up to 12 hours at 2-8°C, within the 30 day expiry date. This will include the transport time to deliver the vaccine to practices from Movianto. Practices should plan any further transport to off-site locations on the basis that there is a maximum of 2 hours available for onward transport following initial delivery from Movianto.

While every effort is being made to ensure timely delivery of orders that are placed with Movianto, practices should not schedule vaccination clinics before deliveries of vaccine have been confirmed.

SPS PREPARING DOSES OF VACCINES USING ASEPTIC NON-TOUCH TECHNIQUE (ANTT)

SPS Preparing doses of vaccines using aseptic non-touch technique (ANTT)

https://www.sps.nhs.uk/articles/preparing-doses-of-vaccines-using-aseptic-non-touch-technique-antt/

This page should be read in conjunction with other material on vaccine preparation, in particular their  Standard Operating Procedures. enc below

Implementing aseptic non-touch technique

Aseptic non-touch technique (ANTT) minimises the risk of contamination transfer to critical surfaces during manipulations. It is achieved by disinfecting sites and ensuring equipment is removed from protective packaging immediately before use.

In all cases operators should sanitise their hands prior to commencing vaccine preparation and follow local guidance around use of gloves.

Using trays for assembly of consumables

If a tray is used as the preparation work area it should be disinfected on all sides with alcohol wipes before starting preparation.

If trays are only being used to hold the vials and equipment before preparation there is no need to disinfect the tray surface. In this case, the bench area should be disinfected.

Disinfecting vial bungs and ampoule necks with alcohol wipes

Vial bungs and ampoule necks should be disinfected and allowed to dry before the bung is punctured or the ampoule opened.

Handling syringes and needles

The outer packaging does not require disinfection if preparation is in a clinical area.  The packaging should be opened immediately before the connection between needle and syringe is made.

  1. Open the needle packaging by peeling the packaging apart to only expose the needle connection. Do not remove the needle from the packaging and place on the surface as this risks contaminating the hub.
  2. Open the syringe packaging by peeling apart and removing the syringe. Avoid touching the syringe tip.
  3. Connect the syringe and needle immediately before placing in the work area.
  4. Only remove needle sheath immediately before use for vaccine reconstitution/dose withdrawal.
Information and guidance specific to COVID-19 Vaccine Pfizer-BioNTech

 

Resources covering pharmaceutical aspects of the vaccination programme specific to COVID-19 Vaccine Pfizer-BioNTech

SPS Standard Operating Procedures.

Information and guidance specific to COVID-19 Vaccine AstraZeneca

Resources covering pharmaceutical aspects of the vaccination programme specific to COVID-19 Vaccine AstraZeneca

Information and guidance specific to COVID-19 Vaccine Pfizer-BioNTech

Resources covering pharmaceutical aspects of the vaccination programme specific to COVID-19 Vaccine Pfizer-BioNTech

Information and guidance specific to COVID-19 Vaccine Moderna

Resources covering pharmaceutical aspects of the vaccination programme specific to COVID-19 Vaccine Moderna

COVID-19 Vaccine Pfizer-BioNTech Handling and Preparation Video

A video produced by Pfizer showing the correct handling and preparation of the COVID-19 Vaccine Pfizer-BioNTech

Running a vaccination clinic

Larger or offsite clinics

Our colleagues in regional emergency planning want to ensure that the emergency services, DfI Roads and councils are aware of the locations of larger or off-site COVID-19 vaccination clinics in case there are steps that can be taken to aid the clinics or if you need emergency assistance, for example:

o   If you need to seek help from NIAS e.g. anaphylaxis

o   If you need to seek help from PSNI re traffic issues or other problems

o   So DfI Roads can consider their winter gritting programme in these areas

HSCB would be grateful if you would let your PSM know as soon as possible please about any large or off-site clinics being planned

Clinical ResourcesCOVID-19 VaccinationHSC Updates

Extending the GP cohorts for COVID-19 vaccination

"I wrote to you on 26th January about extending the GP cohorts for COVID-19 vaccination. Practices were asked to start actively calling and vaccinating patients in the 75-79 and 70-74 age groups and those who are Clinically Extremely Vulnerable (CEV) as their vaccine supply allows. This is a further update to that letter. The Department of Health has asked that, in line with the current policy, GPs priority order should be as follows: 1. Patients over 80 (DoB on or before 31 March 1941) AND...

Clinical ResourcesCOVID-19 VaccinationHSC Updates

COVID-19 vaccination deliveries

Practices have really risen to the challenge of this vaccination programme. By 4th February you had collectively vaccinated over 115,000 patients including around 90% of patients aged 80 or over. I would like to thank you for all the hard work and enthusiasm.  I know that for many practices vaccine supply remains a limiting factor. Please be advised and assured that Movianto have been working extremely hard to get vaccines out to all practices as soon as possible, sometimes within hours of...

Clinical ResourcesCOVID-19 VaccinationGPNI WebinarsHSC UpdatesWebinars

GPNI Webinar – COVID-19 Vaccination Update January 2021

Following on from the successful December 2020 Vaccination Programme Update we are delighted to be joined again by representatives including Alan Stout - NIGPC, Laurence Dorman - RCGP & Margaret O'Brien - HSCB to update us on where we are presently with rollout of the NI COVID-19 Vaccination Programme.  You can find further vaccination resources (including webinars and links to the HSCB Primary care resource page) at the GPNI NI Vaccination Programme Page Northern Ireland COVID-19...

Clinical ResourcesCOVID-19 VaccinationHSC Updates

Protected: UPDATE FROM ALAN STOUT NIGPC CHAIR 19/1/21

Dear all, a further brief update from todays meeting: 154,500 vaccines given, 34,553 over 80's through practices, 3190 practice staff vaccinated, 04% wastage (total of 168 from start of program. Seeing a significant pattern of reduction of outbreaks in care homes already Guidance from PHA coming in next 24 hours around transport of vaccine and allowing us to move it if needed or desired. Main housebound and new admissions to care homes will be done through District Nursing teams. We are...