France __ In order to facilitate the vaccination process for the population and increase vaccination coverage for children in France, High Authority for Health (HAS) spoke in favor of expanding the vaccination capabilities of nurses, pharmacists and midwives for children and adolescents under 16 years of age.
It should be noted that for these health professionals, the possibility of prescribing a vaccine and vaccinating varies according to the age of the child (+/- 2 years). Prescribing live vaccines to immunocompromised children also remains a competency reserved for physicians. In this opinion, HAS reaffirms the need for the training of healthcare professionals affected by the expansion of their skills.
As a reminder, HAS had already in January last year advocated expanding, with the exception of Covid-19, nurses, pharmacists and midwives’ vaccination capabilities for people aged 16 and over.
The vaccines in question
HAVE been interested in expanding the vaccination skills of nurses, pharmacists and midwives for all vaccines (compulsory or recommended) in the vaccination schedule for children and adolescents under 16 years of age: BCG, Diphtheria-Tetanus-Poliomyelitis, Haemophilus Influenzae type b (HIB), Hepatitis , Pneumococcus, Meningococcus B, Meningococcus C, Meningococcus ACYW, Measles-Mumps-Rubella, Human Papillomavirus (HPV), Varicella, Influenza.
Prescribing and administering live vaccines (eg the BCG and MMR vaccine, etc.) to immunocompromised children is excluded due to the associated risks and the complexity of their vaccination plans.
Separate recommendations depending on whether the children are +/- 2 years old
For children over 2 years of age and up to 15 years of age for whom vaccination coverage is insufficient (booster and catch-up vaccines), HAS recommends that nurses, pharmacists, and midwives be able to prescribe and administer all of the vaccines included in the vaccination plan.
For children under the age of two whose vaccination coverage is satisfactory, HAS issues different recommendations depending on the professions concerned:
no extension of the vaccination capabilities of pharmacists and nurses for this age group.
the nurses who already had the competencies can continue to administer all the vaccines included in the vaccination schedule.
authorization of midwives to prescribe and administer all the vaccines included in the vaccination schedule. To date, midwives in neonates have had the competence to prescribe and administer only BCG and hepatitis B vaccines.
Summary table by age
Training and monitoring
HAS recommends that this option for vaccination be “conditional on the completion of certification training for professionals who have not followed specific childhood vaccination modules. Midwives are therefore not affected by this certification training”.
HAS also recommends strengthening the traceability of vaccination and prescription assistance through digital tools linked to the shared medical file. In addition, it emphasizes the need to encourage doctor visits to ensure that follow-up can be maintained.
HAS also recommends that this approach be included in the framework of an overall health course for children and adolescents that mobilizes all health professionals, in addition to prescribing and administering vaccines.
It should be noted that on the occasion of this second part, HAS updated the opinion from January last year on the extension of vaccine skills in adults to include vaccines against meningococcus B and against rabies.
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