Highlights from the National Immunisation Conference Series 2024, which took place across four separate venues in Ireland between 21 February and 14 March

Hundreds of general practice nurses (GPNs) from all over Ireland attended the recent National Immunisation Conference Series 2024 at locations in Dublin, Athlone, Cork, and Sligo. The well received series of events was organised and co-presented by the National Immunisation Office (NIO) and Professional Development Coordinators for General Practice Nursing (PDCGPNs) to address currently relevant topics in relation to vaccination, to support professional knowledge, and enhance the skills and competency of GPNs and other healthcare professionals who are involved in the promotion and delivery of all NIO immunisation programmes.

The insightful and informative events featured a notable line-up of guest speakers and experts in the fields of immunisation and vaccine delivery. The PDCGPNs were delighted to welcome Dr Colm Henry, Chief Clinical Officer, HSE, who opened the Dublin event. Dr Áine McNamara, Area Director of Public Health, HSE West and North West, gave the opening address in Athlone and Sligo, describing the series as “a wonderful educational opportunity for those central to the delivery of our immunisation programmes”.

“It brought healthcare workers together to discuss the importance of the Primary Childhood Immunisation Programme. With the roll-out of the MMR (measles, mumps, rubella) catch-up programme next week, it was a very timely and useful event.”

Over 800 professionals attended the events, including GPNs, GPs, primary care community medical doctors, public health nurses, and staff from the NIO, Public Health Department, Community Vaccination Centres, Older Persons Services, and HSE Occupational Health Services. Topics discussed at the conferences ranged from professional practice considerations, to immunisation schedules and programmes, vaccine hesitancy, declining vaccine uptake, and medication management, among myriad other pertinent topics. Issues specific to each healthcare region were also addressed, as were the Primary Childhood Immunisation Catch-up Programme and catch-up vaccinations for refugees and applicants seeking protection. Speaking on behalf of the PDCGPNs, PDC Kathy Taaffe said the group was “delighted to have had the full support and commitment of the NIO and our Primary Care and Health and Wellbeing offices to plan and deliver this conference series”.

“We have been humbled by the huge attendance at each event, over 800 across the four venues, and the enthusiastic engagement from the many healthcare personnel who are involved daily in managing and delivering these vital immunisation programmes. This education has proven timely in light of the emerging threat of measles. It has provided the most up-to-date, evidence-based knowledge for healthcare practitioners to support them and enhance their competency and skills in clinical practice whilst working towards achieving the desired vaccine uptake rates for all the vaccine preventable diseases.”  

The PDCGPNs work closely with Nursing in General Practice (NiGP) and are passionate about building and supporting a strong network of GPNs in Ireland. They also have a personal, lived experience and understanding of the unique nature of the role compared to nursing in the public sector and the challenges this brings. At the final conference in Sligo, PDC Marie Cantwell told NiGP of her “absolute joy” at the success of the series and “to see such a fantastic turnout of GPNs at each event” – acknowledging that many of the GPNs had attended on their own time and their own expense. She noted “the commitment to professional development and patient care” this reflected and how important their role is within the entire health service.

The conference series utilised the cloud-based software Padlet to easily share information with attendees via QR codes both on and after the events. The technology hosts a real-time, collaborative platform that enables organisers to upload the presentations, agendas and other valuable information and resources from the events in virtual bulletin boards called ‘padlets’ to allow GPNs and other professionals extended access to the knowledge and data they received at the events.

This toolkit of resources and presentation slides from the series is now available for all GPNs nationally at: www.padlet.com/mariecantwell/national-immunisation-conference-series-q2plh0vkn6gpakv9.

Interim Principal Medical Officer Dr Gillian Chambers, Community Healthcare West, was just one of many attendees that acknowledged the high levels of organisation and effort that went into the series. She said: “This immunisation conference series was very well organised by the PDC team and it was timely given the measles outbreaks that were occurring in Ireland in Spring 2024. Relevant topics were well presented by subject matter and expert speakers. It provided a great opportunity to network and foster collaborative working to improve the quality and public confidence in delivery of vaccine programmes and to redouble our efforts to improve uptake rates.”

Hot topics in general practice

A wide range of topical and relevant issues in general practice were discussed at the National Immunisation Conference Series 2024. Ms Rosaleen Keaney, Advanced Nurse Practitioner Immunisations, PHN Department, Galway, provided an abundance of practical advice and guidance for GPNs in her talk, ‘Meeting Challenges on the Ground in General Practice’. The presentation addressed ways to communicate with the local immunisation department, common GPN concerns and queries, record keeping, and clinical returns, among other issues and resources.

Dr Paul Mullane, Specialist in Public Health Medicine, Public Health HSE Dublin and North East, examined low vaccine uptake among healthcare workers and the public and the effects this decline is having in his talk entitled ‘Vaccine-Preventable Diseases – New and Re-emergent Challenges’. Attendees heard that when vaccines reduce the incidence of disease very substantially, complacency often develops due to an “out of sight, out of mind” attitude among the public. Dr Mullane’s talk also included information about the latest recommendation from the Measles Incident Management Team to extend the HSE MMR (measles, mumps, rubella) catch-up programme from children aged 10 and under to those born after 1978 with designated prioritisation.

Irish College of General Practitioners Lead for Immunisations Dr Patrick Kelly talked about ‘Meeting the Challenges in General Practice’. His presentation explored the role of general practice in patient care within the overall health system and described practical ways practitioners can overcome current challenges. His take home messages included “vaccinate as many as possible, keep accurate records and make accurate timely returns, use your software functions to the max, use resources, and keep abreast of standards and guidance”.

Medication protocols

Attendees at the National Immunisation Conference Series 2024 received an overview of the core components of medication management from Ms Kathy Taaffe and Ms Mairéad Murphy, Professional Development Coordinators for General Practice Nursing (PDCGPNs). The presentation defined the legislation, regulations, and standards governing medication administration for nurses and midwives in Ireland, before looking at the national standard requirements specific to immunisation. The PDCs emphasised that nurses and midwives involved in immunisation programmes “should maintain their competency, skills, and knowledge of all aspects of the practice”.

Moving on to discuss medication protocols, the speakers described these documents as “written directions that allow for the supply and administration of a named medicinal product by a nurse or midwife in identified clinical situations”, and discussed how the protocols are applied to practice.

“Using a medication protocol involves the authorisation of the registered nurse or midwife to supply and administer a medication to groups of patients or service users in a defined situation, meeting specific criteria, and who may not be individually identified before presentation for treatment. GPNs working under medication protocols will be accountable for their own clinical practice and should be familiar with and adherent to the practices as set out in the guidelines. Medication protocols should be considered in the context of the clinical situation, safety assurance for the patients, and acceptance of accountability by the healthcare professional involved.”

Each vaccine requires a medication protocol, the conference heard. The speakers also reinforced that the Primary Childhood Immunisation Programme requires eight medication protocols, seasonal immunisations require multiple protocols, while the pre-schools booster requires two.

A suite of medicine protocols has been developed and is available on request to all GPNs to adapt for use in their practice. Email pdcgpn@hse.ie to request the protocols.

Professional Practice Matters

Marie Courtney PDCGPN Cork and Kerry set the scene at each event with a powerful presentation on ‘Professional Practice Matters’. Marie spoke of GPN professional responsibility and the need to protect registration, the importance of the professional code of conduct, the use of evidence-based practice, continuing professional development, team working, and optimising IT and modern resources in daily practice. She also highlighted all the resources that are available to support GPNs to be safe practitioners. The talk was a welcome reminder of the essentials that are a requirement for all registered healthcare practitioners that they may not dwell on in the business of everyday clinical work, as well as the value of reflecting on clinical practice.

Optimising software in general practice

PDC Marie Cantwell delivered an informative and practical talk about optimising software in general practice “to do what you need to do” at the National Immunisation Conference Series 2024, and emphasised to GPNs that even the best software “is only as good as the information we put into it”. Ms Cantwell then went on to describe recent collaboration between the PDCGPNs and the software provider Clanwilliam “to develop a new suite of videos for GPNs to use to improve and assist with optimising the ways you manage software processes”.

These videos cover various aspects related to immunisations, including administration entries, maintaining immunisation batches, recall systems, system navigation, managing immunisation reports effectively, updating/linking families in the patients’ medical records, and how to keep on top of immunisation claim statuses.

GPNs nationwide can access this suite of videos at: www.scanner.topsec.com.

Ms Cantwell then demonstrated how to access the suite of educational videos, as well as technical support from the commonly used software platforms.

“We want them [software programmes] to help with batch control, we want them to make our patient records really efficient and of optimal quality, and we want them to help with our returns and our claims,” she said about the technology. GPNs then received an update on the correct procedures for batch control and out-of-date stock, and were reminded that an assortment of support is available in the new suite of videos, before highlighting the importance of accurate record keeping.

“When I started working with the immunisation team, we looked at why our uptake figures were so low, but when we actually delved into them, they weren’t that low…. It wasn’t actually our records that were poor – our returns were poor. We didn’t have real-time figures because the returns were delayed or inaccurate…. The more information that we can send back to the return office, the more the likelihood of following a patient’s full immunisation journey into adulthood.”

Ms Cantwell then moved on to discuss the use of paper records – specifically triplicate forms – and the challenges associated with this type of record-keeping. She noted that in some areas, up to 50 per cent of practices are still using the forms. Admitting that paper records are still fully permissible and acceptable, “they don’t really make sense given the software we have in our systems,” Ms Cantwell said. “They are error-rich, they are incredibly difficult to read, and there’s an awful lot of information left out of them,” she added, and went on to demonstrate the myriad benefits of computer-generated records, as well as ways to make the process of electronic recording easier and more accurate.

Primary childhood immunisation schedule – what’s new?

Consultant in Public Health Medicine Dr Chantal Migone, National Immunisation Office (NIO), provided a comprehensive overview of the new schedule for primary childhood immunisation (PCI) in Ireland at the National Immunisation Conference Series 2024. She began with a summary of how schedule decisions are made by the Department of Health based on recommendations by the National Immunisation Advisory Committee (NIAC), and told attendees that the NIO is responsible for then coordinating the national immunisation programmes, the implementation of changes, and the introduction of new vaccines to the national programmes, which are all based on the best available evidence gathered by NIAC.

Dr Migone then presented a comparison between the current PCI schedule, that applies to babies born on or before September 30 2024, and the new schedule, that will apply to babies born on or after October 1 2024. The first change will be relevant to practice after 1 April 2025.

“There’s a number of changes happening, the first at the six months visit,” Dr Migone said, and explained that the meningitis C (MEN C) vaccination, which is usually given at this stage, has been removed. “The second change comes at 12 months, with varicella being recommended by NIAC…. Then at the 13 months visit, the Hib (Haemophilus influenzae type B)/MEN C vaccine is removed, and that’s changing to a MEN C vaccine and a six-in-one vaccine.”

Attendees then heard an overview of the data driving these changes. Dr Migone said that internationally, a significant decline in meningitis has been observed since the introduction of the MEN C vaccine in 2000, with one dose of the vaccine in the second year of life and a booster dose in adolescence showing efficacy in protecting against severe disease and establishing herd immunity. Dr Migone also said that manufacture of the Hib/MEN C vaccine will cease after 2023/24 and current supplies will expire in March 2026, which instigated a need for change and a review of the evidence to decide which Hib-containing vaccine would be superior. This led to the recommendation of the six-in-one (rather than monovalent Hib) as a suitable alternative to Hib/MEN C. “As an added bonus, it offers enhanced protection against the other five diseases in the same injection,” she added.

Dr Migone went on to say that the current schedule offers six-in-one administration at two, four, and six months, but does not offer a six-in-one booster in the second year of life, which is recommended in most countries in the EU. Introducing a six-in-one at 13 months in Ireland will align Ireland with international recommendations and also reduce the length of time between the primary series and the booster, she added.

Primary immunisation schedule: Catch-up vaccinations

During the National Immunisation Conference Series 2024, Senior Medical Officer Dr Tom Barrett, National Immunisation Office (NIO), delivered useful, practical guidance regarding common queries, particularly those about children that present late for vaccination or present from other jurisdictions having commenced a different vaccine schedule, noting that “in the last nine months we [NIO] have had over 2,000 queries about catch-up vaccinations”. He began by addressing a common, general question that arises when conflicting information exists between clinical guidelines and summaries of product characteristics of vaccines. “When this occurs, the recommendations in these guidelines, which are based on current expert advice from NIAC (National Immunisation Advisory Committee), should be followed,” Dr Barrett clarified, before moving on to talk about catch-up schedules.

Some vaccines, including pneumococcal polysaccharide vaccine (PCV) 13, MEN C, and Hib vaccine (in six-in-one vaccine), give protection to 12 months of age only, therefore, “these vaccines are not required after 12 months of age,” attendees heard. Dr Barrett then emphasised that “the optimal recommended ages and intervals provide the best immune response”, describing the minimum interval as the “shortest time between two doses of a vaccine in which an adequate response to the second dose can be expected”. He also noted that in exceptional circumstances such as imminent international travel or measles outbreak, it may be necessary to provide one or more vaccines at less than the optimal age or interval, but emphasised that this accelerated schedule should not be used routinely and that remaining doses should be given at recommended intervals to ensure the best protection.

Dr Barret then clarified that if the six months vaccines are delayed, there is no need to delay the 12 months MMR and MEN B vaccines. If the six months visit is missed and the child is aged 12 months or more, the six-in-one (third dose) from the six months visit and the 12 months MMR and MEN B only are required. If the child presents at 10 months to start their schedule, they only need two doses of MEN B vaccine, the second dose given after a two months interval (after 12 months of age). Dr Barrett also explained that the minimum interval between two doses of MEN B (given before 10 months of age) and rotavirus vaccine (given before eight months of age) is four weeks.

Elaborating on the rotavirus vaccine, Dr Barrett explained that despite the vaccine offering protection throughout childhood, it is contraindicated after eight months and 0 days of age because of the known risk of intussusception. If an infant presents up to seven months and 0 days, they can still receive the first and second doses before eight months with a four-week minimal interval between doses. “If an infant presents before eight months and 0 days, one dose can be given to provide up to 60 per cent protection,” he continued.

Dr Barrett then gave a summary of catch-up schedules depending on age for MEN C, Hib, and PCV vaccines, before proceeding to discuss the vaccines for children between 12 months and under two years who have never been vaccinated. He advised three doses of the six-in-one, two months apart, two doses of MEN B, two months apart, one dose of the MMR, MEN C, and PCV13 vaccines. The MEN C and PCV13 vaccines missed at two and six months are not recommended.

Moving on to children between two and 10 years, attendees heard three doses of the six-in-one should be given at two monthly intervals, as well as MMR and MEN C. MEN B and PCV13 are not recommended. If the child has missed the MMR and four-in-one in school, these are recommended six months after the third six-in-one vaccine, the conference heard. Dr Barrett then provided an overview of recommendations for children between 10 and 13, and those 14 and over, before summarising the seven principles of catch-up vaccination, as follows:

• MEN C vaccine given before 12 months provides protection for a child’s first year of life only.
• When a child reaches the age of 12 months, they need one dose of MEN C (given in the Hib/MEN C vaccine) only, regardless of whether or not they received MEN C vaccine in their first year of life.
• PCV13 vaccine given before 12 months gives protection for a child’s first year of life only.
• When a child reaches the age of 12 months, they need one dose of  PCV13 only, regardless of whether or
  not they have received PCV13 in their first year of life.
• If the six-month vaccines are late, eg, given at nine months, there is no need to delay the 12-month vaccines.
• If a child needs to catch up with both 12- and 13-month vaccines, they can be given at one visit.
• Once a child reaches the age of two, NIAC advises they no longer need PCV13 vaccine or MEN B vaccine, even if they have never had these vaccines. The exception is children with at-risk conditions who should be vaccinated.
• Once a child reaches the age of 10, they no longer need a Hib vaccine.
• A child over the age of one year needs a single dose of MEN C up until MEN ACWY is given in school.

“There is no funding for a catch-up programme for the MEN ACWY, tetanus, diptheria, and acellular pertussis (Tdap), and HPV9 vaccines offered in second level schools,” Dr Barrett added, and said these vaccines must be sourced privately if parents wish their children to have them. His engaging presentation finished with an overview of the most frequently asked questions regarding catch-up vaccinations in Ireland and guidance for children presenting from Ukraine.

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