Empowering Pharmacy in Vaccination Role

Just last month, the Pharmacy representative body, the Irish Pharmacy Union (IPU) repeated their previous call to allow pharmacists to administer flu vaccines in nursing homes and workplaces.

In welcoming the announcement by the former Minister for Health, Simon Harris TD, to make the flu vaccine available to all children aged 2-12 and all at risk groups, they said it was a ‘step in the right direction.’

The news follows a recommendation by the IPU earlier for the flu vaccine to be made freely available to everyone who wants it during the coming flu season.

Commenting, IPU Secretary General Darragh O’ Loughlin said, “While we would have liked to see the scheme extended further, making the flu vaccination available to children aged 2-12 and to all at risk groups without charge is definitely a step in the right direction. It will help increase our capacity to combat seasonal flu and prevent it from overwhelming the health system during the winter.”

Last year, over 1.1 million flu vaccines were delivered in Ireland, an increase of over 60% since pharmacies were first permitted to administer the vaccine a decade ago. Given that the convenience and availability of the vaccine has led to greater uptake, the IPU believes that pharmacists should be allowed to administer the vaccine to people in nursing homes and workplaces.

“Every year there is a spike in hospital admissions due to people suffering from flu and related complications. We can and we should do much more to prevent this by making it easier for the vaccine to be offered to wider groups of people in a community setting. Increasing the locations where this is permitted to residential services and to workplaces would significantly increase uptake and help build a herd immunity. We can’t yet stop the coronavirus, but we can stop the flu,” concluded O’ Loughlin.

The role of pharmacists in immunisation and vaccination varies across the world; in some countries pharmacists are primarily involved in ensuring the safe supply and dispensing of vaccines, as well as advocating for immunisation, while in other countries they are empowered to play a more active role, as they are legally authorised organise vaccinations activities and campaigns.

Meningococcal disease is caused by infection with Neisseria meningitidis and presents as bacterial meningitis (15 per cent of cases), septicaemia (25 per cent of cases), or a combination of the two. It is the leading infective cause of death in early childhood.

There are several strains or ‘groups’ of meningococcal bacteria (A, B, C, W, X and Y). Currently MenB accounts for the vast majority of meningococcal disease although we have recently seen an alarming rise in a particularly deadly strain of meningococcal W meningitis and septicaemia.

There are five main groups that commonly cause disease – MenA, MenB, MenC, MenW, MenY.
• Around 10% of the population carries meningococcal bacteria in the back of their throats at any given time. This is usually healthy carriage and helps develop immunity
• Occasionally the bacteria defeat the body’s defences and cause infection
• The bacteria are passed from person to person by coughing, sneezing and intimate kissing
• The bacteria break through the lining at the back of the throat and pass into the bloodstream
• They can travel in the bloodstream to infect the meninges, causing meningitis, or while in the bloodstream they can cause septicaemia

From September last year, secondary school children in first year are offered a meningococcal ACWY booster vaccination. This was rolled-out in February.

The Meningococcal ACWY vaccine will boost children’s protection against group C meningococcal disease. It will also provide additional protection against meningococcal groups A, W and Y. In addition, this vaccine also reduces the risk of carrying the disease so can help protect other people too.

MenACWY being used in Ireland is Nimenrix. This is a conjugate vaccine containing Group A, C, W and Y polysaccharides conjugated to tetanus toxoid carrier protein. The vaccine protects against N. meningitidis Groups A, C, W and Y invasive disease.

Since 2015 more cases of invasive meningococcal serogroups W and Y disease have been seen in Ireland. Prior to 2015 the annual number of both serogroups was low. Between 1999 and 2014 there was an average of two cases for both serogroups reported per year. Meningococcal disease can start very suddenly. Symptoms include fever, stiff neck, headache, joint pains and a rash.

Meningococcal disease can occur at any age, but the highest rate occurs in children under 5 years of age, especially children under 1 year old. The next high-risk group are young people aged 15-19 years.

Importantly for community pharmacists to be aware, they might have school children and/ or their parents presenting to the pharmacy with associated after effects. Some students can have an area of soreness, swelling and redness in their arm where the injection was given. This usually passes after a day or two. Some students may get a headache, feel sick in their tummy or run a slight temperature. If this happens, paracetamol or ibuprofen will help.

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