With pharmacist influenza vaccination here to stay, pharmacy’s role in battling flu is only going to grow.
In April 2016, pharmacist vaccinations became available in Queensland permanently, and less than a month later, Victoria became the final Australian state to gain government approval for the service.
With pharmacists around the country now offering flu vaccination, in some cases on the spot, it’s more important than ever that pharmacists are able to advise on a variety of issues around the flu, including preventive strategies, the difference between colds and flu, and how to treat influenza when it arises – including whether or not antibiotics are appropriate.
The profile of flu in the mind of the consumer has risen since the 2009 advent of Influenza-A (H1N1), or “swine flu,” says the Immunisation Coalition’s Alan Hampson.
Dr Hampson told the AJP that this virus has already been around this year – and that the strain is exhibiting some unusual behaviour.
“Swine flu has become a seasonal influenza, from the moment it left pigs and started in humans,” Dr Hampson told the AJP.
“A totally new influenza virus only happens once in a blue moon. The last time was 1968: the Hong Kong flu. Before that, in 1957, the Asian flu, and in 1918, the Spanish flu. We know there’s a reservoir of influenza viruses out there in the animal population, mainly in aquatic birds, and somewhere they’ve managed to get into the human population.
“The 2009 virus caught the population’s imagination, and it’s stayed with us in essentially the same form as in 2009, which is rather unusual. It keeps coming back, and it’s been responsible for most of the early cases in Australia this year.
“It’s been doing this around the world – it’s a little unusual, to say the least, in that it really hasn’t changed, and we don’t understand why a virus that hasn’t changed is able to come back into the population on multiple occasions.”
Dr Ian Barr, Acting Director of the World Health Organization (WHO) Collaborating Centre for Reference and Research on Influenza, at the Doherty Institute told health reporters recently that while predicting the course of a flu season can be difficult, stakeholders can look to the Northern Hemisphere’s latest season for some guidance.
The Northern Hemisphere’s peak season tends to run from December through to February/March.
“What we saw was a bit of a mixture, depending what part of the globe you were in,” he says. “In the United States they had mainly pandemic viruses and a relatively moderate season, and in Europe they had mainly pandemic early on but this switched to influenza B viruses later in the season which dominated overall.
“In 2015 in Australia we had a very big B season, and we don’t have those very often, so looking towards what might happen going forward, it’s probably more likely that we’ll have a H1N1 pandemic virus circulating in the majority of Australia this winter.
“The ones which we have seen early in the season are very similar to the viruses which circulated in lowish numbers last year, and we would think that the current vaccine… should cover that strain fairly well.
“So we’re hoping for a quieter season this year compared to 2014-15.”
Greater uptake of flu vaccination would certainly help towards a quieter flu season in 2016 – and it’s possible that the advent of pharmacist vaccination can help with just that.
Professor Lisa Nissen from the School of Clinical Sciences, Queensland University of Technology, who led the QPIP implementation team, told the AJP that across the Queensland Pharmacist Immunisation Pilot studies, including phase one and two, 15% of customers vaccinated in pharmacy had never been vaccinated before.
Pharmacies need a careful approach to telling the public about their flu vaccination service, however. Earlier this year, the TGA issued a reminder note to all immunisation providers, which included pharmacists and pharmacies, to help them use the correct wording in their vaccination advertising, given vaccines are generally S4.
“The Pharmacy Guild has also provided information for owners around general marketing material – a lot of that has been tailored to broad messages about vaccination and preventive health care,” says Prof Nissen.
“So they’re things like, ‘Ask your pharmacist about flu,’ or ‘Ask your pharmacist about immunisation,’ or ‘Are your vaccinations up to date?’
“They’re more prompts than direct marketing for particular vaccines.”
Earlier this year, the Wanniassa Capital Chemist in the ACT – where regulations changed to permit pharmacist vaccination only in March this year – told the AJP that customers responded with enthusiasm to their approach to vaccination, which included donning high-visibility vests mentioning vaccination and approaching people on the shop floor (pictured).
“Around influenza season and around the dispensary counter, when people are handing out prescriptions, they can ask whether customers have had their flu vaccination for the year,” says Prof Nissen.
“If people say no, you can offer to do it today or to make a booking for them. It’s prompting, or at least opening, the conversation with them.”
Some customers were identified in the QPIP studies as being eligible for free vaccination under the National Immunisation Program; a number of these people were, however, happy to pay for the vaccine in pharmacy, some citing convenience as a factor.
Prof Nissen says that when pharmacists talk to NIP-eligible customers – such as people with asthma, pregnant women and people aged over 65 – they should remind these customers that they can receive vaccination through their GP.
“Some of these people may need other vaccines, like the pneumococcal vaccine, so it’s also good to remind certain patient groups of this. Pharmacy has a real opportunity now to open these conversations with people.”
People who have been vaccinated should remain in the pharmacy for around 15 minutes after the process to ensure that they do not have an adverse reaction. This also provides an opening for pharmacists.
“Pharmacist vaccination is also a fantastic opportunity to ask people how they’re going: do they have any other questions about their medicines, any other health conditions, or general concerns?” said Prof Nissen.
“When we looked at the outcomes from the QPIP study we had 70%-plus say that the pharmacist talked to them about another health condition, and they thought that was great. They enjoyed the opportunity to have more of a one-on-one interaction with the pharmacist. With an OTC consultation you don’t always get that opportunity.”
If adverse events do occur, pharmacists must know how to deal with them, she says.
“The worst case scenario is an anaphylactic reaction – for the influenza vaccine this would be incredibly rare, we’re talking probably one in a million people,” Prof Nissen told the AJP.
“However you need to know how to respond. In the studies we did see vasovagal reactions: people who feel faint or woozy from having a vaccine. A lot of people will tell you, ‘I’m not good with needled’.
“A lot of those events were telegraphed and explained, and pharmacists were able to prepare, lay the patient down and allow them to recover. This is why it’s important that there’s an area you can lie somebody down if you need to, where they can be comfortable and recover.”
State and territory requirements differ slightly around certain aspects of training – pharmacists should get in touch with their state PSA or Guild branch to find out the specifics of their locale, says Prof Nissen – but one common factor is that to provide flu vaccinations, pharmacists need current first aid with CPR accreditation.
“I think long term, that will be something that needs to be kept current as an ongoing requirement possibly for all registrants, as so many pharmacists will be offering vaccination services,” says Prof Nissen.