Guidance

[Withdrawn] Flu in the children and young people’s secure estate

Updated 8 October 2021

This guidance was withdrawn on 4 November 2022

The information of this guidance has been superseded by information in Acute respiratory illness, including flu and COVID-19 in prisons.

Applies to England

1. Introduction

Influenza (flu) is an acute viral infection of the respiratory tract, which includes the nose, mouth, throat, bronchial tubes and lungs. It is characterised by:

• a fever
• chills
• headache
• muscle and joint pain
• fatigue

For otherwise healthy people, flu is an unpleasant but usually self-limiting disease with recovery within 2 to 7 days. Flu is easily transmitted and even people with mild or no symptoms can infect others.

The risk of serious illness from flu is higher among children under 6 months of age, older people, pregnant girls and women and people with underlying health conditions. This includes conditions such as respiratory disease, diabetes, cardiac disease or immunosuppression.

Maintaining the operational effectiveness of the children and young people secure estate is essential to preserve fully functional youth justice and welfare systems. So, minimising the impact of seasonal flu within these secure settings is important.

The children and young people secure estate (CYPSE) runs the risk of significant and potentially serious flu outbreaks, with large numbers of cases. This is because:

• of the enclosed nature of the CYPSE and the fact that children are often living close together, with social mixing during activities
• of movement of children within the estate
• access to healthcare could be limited if demand is high and has affected staffing levels
• children in the CYPSE have a higher prevalence of respiratory illness (including asthma) and other long-term conditions such as diabetes than their peers in the community

An important principle in managing seasonal flu is that children in the CYPSE should receive the same healthcare as their peers in the community. This includes access to antiviral treatment, although delivering this might be different from community models.

To reduce the impact of flu in the CYPSE, it’s very important to take a ‘whole setting’ approach to preventing, identifying and notifying illness, and to have quick access to treatment, including antivirals.

In the 2020 to 2021 flu season, there were no confirmed outbreaks of seasonal flu reported in CYPSE across England and Wales.

2. Preparing for the flu season, including vaccination

2.1 Planning for the flu season during the coronavirus (COVID-19) pandemic

In 2020 to 2021, as a result of non-pharmaceutical interventions in place for COVID-19 (such as wearing masks, physical and social distancing, and restricted international travel) flu levels were very low globally. So, there will likely be a lower level of population immunity against flu in 2021 to 2022. As social mixing and social contact return towards pre-pandemic norms, there will potentially be high levels of seasonal influenza virus (and other respiratory viruses) circulating alongside COVID-19 in winter 2021 to 2022.

Last year saw the biggest NHS flu vaccination programme ever, aiming to offer protection to as many eligible people as possible during the COVID-19 pandemic. This expanded flu vaccination programme will continue for the 2021 to 2022 flu season.

As a temporary measure, the programme will be extended this year to include 4 additional year groups in secondary school, so that all children from year 7 to year 11 will be offered vaccinations. Vaccinating children reduces flu transmission and the Joint Committee on Vaccination and Immunisation has recommended that expanding into secondary schools will be cost-effective, particularly if COVID-19 is still circulating.

Since COVID-19 is likely to be circulating together with flu, protecting children and staff at high risk of flu, who are also those most vulnerable to hospitalisation as a result of COVID-19, is vitally important.

Flu vaccine clinics may need to adjust their processes due to any COVID-19 social distancing requirements at the time of vaccination. You should consider a range of different ways for delivering the flu vaccination programme this year as advised by NHS England and NHS Improvement.

Flu immunisers should wear personal protective equipment (PPE) in keeping with the current advice on delivering the flu vaccine. Health Education England has produced a flu-specific e-learning programme, which is available free of charge. Anyone who gives or advises on flu vaccines can do this e-learning programme, which consists of a core module and separate sessions on the inactivated and live flu vaccines.

2.2 Preparing for the flu season: principles and arrangements

The public health principles guiding action within the CYPSE are the same as those in the wider community. This includes:

• appointing a flu lead to oversee preparations including the seasonal flu vaccine campaign
• vaccinating everyone in clinical risk groups (refer to the influenza chapter in the Green Book)
• vaccinating healthcare staff working in the CYPSE in line with national guidance in the Green Book
• vaccinating Youth Custody Service (YCS) custodial staff and YCS headquarters staff, who are eligible for flu vaccine via their employer through His Majesty’s Prison and Probation Service (HMPPS) business hub (this is beyond the Green Book guidance)
• vaccinating secure training centre residential staff, who are eligible for flu vaccine via their operator (this is beyond the Green Book guidance)
• vaccinating secure children’s homes residential staff through relevant occupational health services
• collecting respiratory specimens to obtain quick diagnosis, including assessing whether there is an outbreak
• making sure there is effective and appropriate care available, including access to antivirals for children who are ill or to prevent infection in those at risk of complications
• good infection prevention and control practice and resources

The CYPSE should agree clear arrangements with their UK Health Security Agency (UKHSA) health protection team (HPT) and NHS England and NHS Improvement health and justice children’s commissioners. This is to ensure the CYPSE can:

• order vaccine supplies in good time before the annual vaccination period including any extension to the vaccine programme for children in 2021 to 2022
• plan and coordinate vaccination of eligible children and staff
• record and monitor (and make available on request) local information on numbers and percentages of children and staff who have received a vaccine
• recognise possible outbreaks and report them quickly (see guidance on managing outbreaks in prisons)
• access public health advice and support, in and out of office hours
• rapidly access viral testing (and processing of swabs) to support the need for quick diagnosis and careful consideration for early treatment for clinical risk groups
• update patient group directions (PGDs) and patient specific directions (PSDs) so they are current and follow best practice
• provide antiviral medication
• ensure there is enough PPE in stock

2.3 Vaccination for children

The immunisation programme protects people who are at risk of serious illness and reduces transmission. Healthcare teams should make a register of children who are recommended to receive the flu vaccine and account for any changes or additions to the flu programme for 2021 to 2022 They can then order enough vaccine in advance and invite children to planned immunisation sessions or appointments.

The recommended flu vaccines for children are detailed in the annual flu letter.

Healthcare teams should offer vaccinations to the defined clinical risk groups outlined in the annual flu letter before flu viruses start to circulate in late September and early October.

All children aged 2 to 15 (but not 16 years or older) on 31 August 2021 should be offered the flu vaccine. There are a large number of children in secure settings who might not have been in mainstream education and so could have missed the opportunity to receive routine childhood vaccines. You can find more information on childhood vaccination programme on GOV.UK.

Children between 12 and 18 years old who are in a clinical risk group should be particularly encouraged to receive the vaccine as set out in the chapter on influenza in the Green Book.

The list of clinical risk groups in the Green Book is not exhaustive. The healthcare practitioner should apply clinical judgement to consider the risk that flu might make any underlying disease that a child may have worse, as well as the risk of serious illness from flu itself. In these cases, the child should be offered a flu vaccine, even if they are not in a clinical risk group.

2.4 Specific groups to consider for vaccination

Household contacts of immunocompromised individuals

Close contacts of an immunocompromised person should also be offered the vaccine.

In the CYPSE, any child who is sharing a room (or is in a unit similar to a household setting) with an immunocompromised child, long-term or over the winter, should be offered the flu vaccine.

Pregnant young women

Any girls in the CYPSE who are pregnant should be encouraged to have the flu vaccine. Healthcare staff should offer to vaccinate babies aged 6 months and over, who are in an eligible clinical risk group.

CYPSE staff

Different settings across the CYPSE will have different occupational health arrangements for residential, care and healthcare staff, so it’s important to include staff vaccination as part of flu preparation planning. It’s important that the CYPSE flu strategy contains clear information on vaccine coverage for all appropriate staff groups.

All healthcare staff in direct contact with children should be offered a flu vaccine by their employer, similar to healthcare staff in the community. This should form part of the secure setting’s policy for preventing flu transmission and should link directly to their occupational health policy. This will help protect patients and service users, as well as staff and wider groups.

The NHS Specialist Pharmacy Service has published guidance for healthcare providers on vaccinating their own staff. The written instruction uses a peer-to-peer approach to maximise access to the vaccine for their employees.

All staff working in the CYPSE are eligible for the flu vaccine. Non-healthcare staff working with children in the CYPSE who have close contact with children affected by flu are recommended to receive the seasonal flu vaccine.

Staff who are in clinical risk groups can access vaccines free of charge from their GP or pharmacies participating in the NHS seasonal flu vaccination programme.

Occupational health providers should provide information to CYPSE senior leaders on the number of staff in clinical risk groups and their vaccine status (without providing patient identifiable information).

2.5 Vaccination targets, coverage and recording

Planning for flu vaccination should continue as usual for this autumn and the 2021 COVID-19 vaccine programme should not disrupt or delay the flu vaccination programme.

COVID-19 and flu vaccines can be co-administered and systems should seek to give both vaccines where this will improve patient experience and the uptake of both vaccines, and will help to reduce administrative burdens.

The national flu immunisation programme for 2021 to 2022 has a number of uptake ambitions, including:

• vaccinating at least 70% of primary school-aged children
• vaccinating at least 70% of children in all clinical risk groups
• offering vaccination to 100% of healthcare workers and other non-healthcare staff providing close personal care, with at least an 85% uptake

Healthcare providers should record the offer and the uptake of the flu vaccine to children. Providers are encouraged to hold a register so that they can identify all children eligible for the flu vaccine. Updating the eligibility register throughout the flu season will help with coordinating the local flu vaccination programme.

Risk group status should also be recorded on SystmOne or equivalent clinical IT system. Providers should pay attention to including girls who could become pregnant and children who enter as part of a risk group during the flu season.

For staff groups, healthcare workers should be included in their employers’ seasonal flu vaccination programme, in line with the national flu immunisation programme. There is an uptake ambition of 85% given the additional concern about flu outbreaks in closed secure settings.

For non-healthcare staff who have close contact with children, individual employers should tell them about the need to be vaccinated and how to access vaccines through occupational health or other services.

Staff in clinical risk groups should receive a vaccine through their GP or a local pharmacy participating in the NHS seasonal flu programme, free of charge. People who are not eligible through their employer or GP should be encouraged to consider accessing vaccination privately and then claim the fee back on expenses.

2.6 Accessing vaccine supplies

Healthcare providers access flu vaccines in the same way as GP practices or school or community immunisation providers, as detailed in the chapter on influenza in the Green Book and the annual flu letter.

Vaccine supplies

Healthcare providers, or organisations that provide childhood vaccination programmes to the CYPSE, should order flu vaccine supplies directly through the ImmForm website.

Enough vaccine should be ordered based on past and planned performance and expected demographic increase to make sure that everyone at risk is offered a flu vaccine. This should also take into account any additions, temporary or permanent, to the flu programme for the season 2021 to 2022. Ordering controls are in place to reduce the amount of excess vaccine ordered by NHS providers but not used. The latest information on ordering controls and other ordering advice for vaccines is available in the vaccine update newsletter and on the ImmForm website.

In the event of an outbreak of seasonal flu, additional vaccine stock can be sourced in priority order from:

• ImmForm (providers will need to explain the basis of the increased need, as this will exceed estimates for the current season or the outbreak could happen outside the normal flu season)
• pharmacy service providers contracted to provide pharmaceutical services to the CYPSE
• vaccine manufacturers

Administrating flu vaccines

Vaccines can be administered via a prescription or a PGD. A PGD is used for vaccinating a number of people. For example, as part of nurse or pharmacist-led vaccination clinics. A PGD must be used in line with legislation and National Institute for Health and Care Excellence (NICE) guidance on PGDs.

PGDs should be in place all the time and reviewed in advance of the flu season. This is so they are ready to use for flu vaccination clinics and when the Chief Medical Officer advises the NHS that antivirals can be used for flu.

NHS England commissioners within individual regions or localities usually authorise a flu vaccine PGD that can be shared and used by GP practices and health and justice providers in that locality or region. Where providers cannot access a local NHS England authorised PGD, they can use the template PGD for the vaccine published by Public Health England (PHE) to either authorise within their organisation (for NHS trusts) or gain NHS England authorisation for its use (for non-NHS healthcare providers).

3. Diagnosis and recognising a case

3.1 Flu symptoms

It is important that all staff (residential care as well as healthcare) are aware of the symptoms of flu-like illness and of the need to quickly report possible cases to the healthcare team.

Residential care staff often have the most contact with children so are well-placed to recognise an increasing number of cases. Staff with signs and flu-like symptoms should seek advice from their GP and inform their line manager and occupational health provider.

If a child is suspected of having flu, healthcare teams should assume it is COVID-19. This means isolating them in line with the COVID-19 guidance for prisons and secure settings until laboratory testing confirms flu, or the outbreak control team (OCT) confirms an outbreak of flu. The World Health Organization defines flu as being “characterized by a sudden onset of fever, cough (usually dry), headache, muscle and joint pain, severe malaise (feeling unwell), sore throat and a runny nose”.

People with COVID-19 may have similar symptoms to flu. PHE published information on case definitions for COVID-19.

3.2 Isolating cases

CYPSE staff should isolate children with flu symptoms in single room accommodation and they should be clinically assessed as soon as possible by the healthcare team. Initially, suspected cases should be assumed to be COVID-19 cases and they should remain isolated until they have had a healthcare assessment or had test results confirmed.

If there is a suspected case, CYPSE staff should continue to keep them isolated until their symptoms resolve. This usually takes 5 days from the first sign of flu symptoms but may be longer in people with underlying medical conditions.

Different guidance applies to COVID-19, so it’s important to get the correct diagnosis and follow the appropriate guidance. COVID-19 guidance on preventing and controlling outbreaks in prisons is available.

3.3 Swabbing to confirm infection

CYPSE healthcare teams should swab people who are symptomatic as soon as possible. They should request a full respiratory screen to include COVID-19 and flu on early cases in an outbreak (typically up to 5 cases but potentially more depending on the epidemiology of the outbreak and the distribution of the cases within the facility).

Multiplex platforms that test for both flu and COVID-19 are available from pillar 1 regional laboratories. If this is not available, 2 swabs are needed for each case: one for COVID-19 testing and one for flu and other respiratory viruses. These swabs should be taken at the same time, and put into separate tubes of viral transport media, with the appropriate laboratory request forms.

While awaiting results you should follow COVID-19 infection prevention and control measures. If the test results confirm COVID-19, staff will need to take action by following COVID-19 guidance on investigation and initial clinical management of possible cases.

If flu is confirmed and the OCT agrees, all other cases meeting the clinical case definition can be regarded as suspected flu and no further testing is advised. However, the OCT may consider further testing in particular parts of the secure setting towards the end of the outbreak. This might be because the situation is complex, or to discount any possible new cases. It will also be important to consider and test for COVID-19.

4. Outbreaks

4.1 Outbreak control team

If staff suspect or confirm a seasonal flu outbreak, the UKHSA health and justice team strongly recommends that local UKHSA HPTs arrange an OCT meeting. You can find more information on managing outbreaks in the multi-agency contingency plan for disease outbreaks in prisons and secure settings guidance.

The OCT will:

• review information with partners on the extent and severity of infection (including information on children should they need to be transferred to hospital)
• collect data to guide management of effective control measures
• review and advise on infection control practice
• consider vaccine coverage among children and staff groups
• consider role of antiviral treatment or prophylaxis for cases or contacts including staff

When holding an OCT meeting for young offender institutions (YOIs) and secure training centres (STCs), you should invite:

• the national UKHSA health and justice team who can provide expert support (you can contact them by email at health-justice@phe.gov.uk)
• representatives from the UKHSA field epidemiology services team and the National Infection Service
• the HMPPS health liaison service (you can contact them by email at health@justice.gov.uk)
• NHS England health and justice commissioners
• a local authority representative

During an OCT meeting, the following questions need to be considered:

1. Has testing for seasonal flu, COVID-19 and other respiratory infections been carried out (see section on swabbing)?
2. Is there a need to offer vaccines to the children, as well as staff?
3. Is antiviral prophylaxis needed, who should receive it and how? This includes confirming that a current in-date PGD is in place.
4. What is the operational status of the secure setting? This includes any restrictions that are in place, such as a temporary stop to transfers in and out of the secure setting.
5. Should children be isolated or ‘cohorted’ (grouped together) as part of wider infection control practice?
6. Are the appropriate staff either dealing with either children who are symptomatic or children who are asymptomatic (showing no signs of being infected), but not both?
7. Is there a process for managing hospital admissions if needed?
8. Is there a process for dealing with communication and media issues?

Specific infection control considerations:

1. Re-emphasise hand and respiratory hygiene measures to help minimise the spread of the infection (for children and staff).
2. Use chlorine-based bleach products to disinfect and deep clean contaminated areas for infection control purposes (in YOIs HMPPS has approved Titan Chlor tablets).
3. If a symptomatic case needs to pass through areas where other people are waiting, then they should wear a fluid repellent surgical mask.
4. Residential healthcare staff who are assessing children with suspected flu and coming into close contact (less than one metre) to provide care should wear appropriate PPE. You can find more information on PPE recommendations in the prison COVID-19 outbreak guidance.
5. During any outbreak, residential and healthcare staff with flu-like symptoms should be excluded from work and be managed by their GP if they are in specific clinical risk groups. They may also need to seek COVID-19 testing in line with local testing pathways.
6. If staff become ill at work, they should be sent home immediately or isolated until they can be sent home.
7. Report cases among staff and children to the HPT.

Specific considerations about communications during an outbreak:

1. UKHSA may recommend that staff in clinical risk groups should be considered for post-exposure prophylaxis with antiviral medication. You can download an information leaflet for staff about using antiviral medication to treat and prevent seasonal flu.
2. Issue a letter to staff to inform them of the outbreak and provide relevant advice.

COVID-19 symptoms are like other flu-like illnesses so appropriate diagnostic testing is needed to ensure the correct diagnosis is made. You can find more information in the guidance on preventing and controlling outbreaks of COVID-19 in prisons and secure settings.

4.2 Cohorting cases

Where cases are concentrated in a particular unit or part of the secure setting, the OCT can consider ‘cohorting’ (or grouping together) all other cases in the same place, but this may not be possible. Healthcare teams should cohort cases of flu separately from suspected or confirmed cases of COVID-19.

4.3 Asymptomatic contacts

Where multiple children have had close contact and one is suspected or confirmed as having flu, the other contacts can pose an infection control risk. This is because they could be asymptomatic (show no signs of being infected). Where children stay in small groups or ‘bubbles’, the same may apply to the whole group or bubble.

These children should be isolated for 48 hours starting from their last contact with the suspected or confirmed case. However, this should be reviewed if a COVID-19 test result is known.

Practical operational considerations, such as the number of spare rooms available, will inform any decisions about whether the child stays where they are or is moved to another location away from the ill contact.

4.4 Visiting

CYPSE staff should exclude symptomatic visitors until they are no longer symptomatic. They should also discourage visitors with underlying health conditions and those at risk of more severe infection from visiting during an outbreak.

To protect patient welfare, CYPSE staff should keep visitor access to symptomatic children and young people to a minimum. They should also provide any visitors with hygiene advice. Non-urgent visits should be rescheduled until after the outbreak is over.

5. Treatment and care

Children with symptoms should be offered bed rest and oral fluids with paracetamol or ibuprofen as clinically indicated.

Healthcare staff can use antivirals for prophylaxis and treatment according to NICE guidance for preventing flu and NICE guidance for treating flu. These guidelines remain an integral part of flu control measures for closed secure settings.

You can also refer to guidance on using antivirals.

Healthcare staff should consider treating children with suspected flu that are in clinical risk groups with antivirals. This is usually oseltamivir, or more commonly known as Tamiflu. UKHSA recommends considering antiviral treatment even in vaccinated children.

5.1 Antiviral post-exposure prophylaxis of close contacts

Healthcare staff should use antivirals for post-exposure prophylaxis (AV-PEP) for contacts of cases that are in clinical risk groups. This is regardless of their seasonal flu vaccine status (although this lies outside of NICE guidance).

Where there is an extensive outbreak, the OCT should consider offering AV-PEP to all children in clinical risk groups in affected parts of, or throughout the secure setting.

5.2 Accessing supplies of flu antivirals

CYPSE flu plans should include details of the ordering process and supply of antivirals. These plans must consider the need for patients to start antivirals within 36 to 48 hours of symptoms beginning, as appropriate.

Healthcare staff should record all supplies of antivirals given to children in their clinical records. They can give Tamiflu ‘in-possession’ (where the child keeps the medication in their room). But this will be subject to a risk assessment and the secure setting’s rules, and whether the child is able to manage their medicines.

Alternative antivirals are available for patients who are unable to take Tamiflu.

There are 2 ways for children to access antivirals following a clinical assessment and diagnosis: individual prescriptions or a PSD, or a PGD.

Individual prescriptions or a patient specific direction

Healthcare staff can access antivirals by sending the prescription or PSD to the pharmacy for dispensing. This will be the pharmacy contracted to provide medicines to the CYPSE or an out-of-hours pharmacy. Healthcare staff can also use ‘over-labelled’ stock supplies that allow the prescriber or registered healthcare professional to add the patient’s name and the date to the pack. This means they can give the antivirals directly to the patient without waiting for them to come from the pharmacy. This should be completed using standard operating procedures developed and approved by the healthcare provider.

A patient group direction

Healthcare staff should only use a PGD in line with legislation and NICE guidance on PGDs. PGDs can help healthcare staff quickly access the flu vaccine and antivirals.

You can access 2 PGD templates for flu AV-PEP and treatment on GOV.UK. The templates were designed to be used in care homes only, but they can be adapted for secure settings. The PGDs cover Tamiflu for treating flu-like symptoms and for prophylaxis for people at risk of getting the flu and who meet specific criteria.

The healthcare professional who assesses the child must hand them the in- possession medication supplied under a PGD. For non-in-possession supplies, the healthcare professional who assesses the child can supply the antiviral to healthcare staff for storage so that doses can be administered under supervision in line with local arrangements.

The antiviral supplied via a PGD must be from over-labelled stock and the name of the patient and the date added to the label by the healthcare professional.

During an outbreak, UKHSA may recommend considering post-exposure prophylaxis with antiviral medication for staff in clinical risk groups. A GP would usually provide this. Some outbreaks may need a longer duration prophylaxis option for high-risk people.

A healthcare professional can give a high-risk person Tamiflu for prophylaxis for up to 42 days according to the product licence.

If a PGD is not in place when an outbreak becomes likely or begins, commissioners and providers can write prescriptions for antivirals or flu vaccines until a PGD is in place.

NHS trust healthcare providers can authorise their own PGDs and so can fast track the development and authorisation of PGDs for flu vaccine and Tamiflu.

Non-NHS providers cannot authorise their own PGDs, but they should have a mechanism to write the PGD and submit it for authorisation by the NHS England local commissioner. Health and justice commissioners need to identify who the PGD authoriser is for their local team and help the rapid PGD authorisation through this local process.

5.3 Stock access of flu vaccine and antivirals

Flu vaccine is supplied from ImmForm for people under 18 years old.

Antivirals supplied under a PGD are usually sourced already over-labelled from the provider’s usual supplier of pre-packs and over-labelled medicines. For urgent supply during an outbreak it is acceptable for the antiviral to be supplied by adding the patient name, date and site name to the manufacturer’s pack. The healthcare professional will then need to give verbal instructions to the patient about the dose, advising them to read the patient leaflet in the pack and to contact healthcare staff if they have any queries while taking it. You can find more information on PGDs on the Specialist Pharmacy Service website.

In an outbreak, commissioners should check and confirm they have access to enough antiviral stock. They may need support to access urgent stock, which UKHSA can help with.

Emergency regional stocks are a last resort. The pharmacy would need to hold the supply of antivirals and all costs for replacing them and pharmacy charges would be directly reimbursed by the commissioner.

Where stock supplies of over-labelled antivirals are used, plans should include:

• agreed minimum stock levels based on the previous year’s use with plans to amend this during an outbreak
• processes to check the antiviral stock regularly to ensure appropriate storage and expiry dates, audit the supplies made and reorder stock if this falls below minimum levels

6. Population management

6.1 Specific considerations for the CYPSE about population management during an outbreak

Where an outbreak has been declared, the governor, director or manager and the UKHSA consultant in health protection leading the OCT should complete a dynamic risk assessment form. The OCT may consider recommending restricting transfers out to other secure settings or restricting new arrivals.

Restricting transfers out to other secure settings

This is to avoid ‘seeding’ or starting an outbreak in other secure settings. Where it’s required for security reasons, notify the receiving secure setting of the outbreak. Avoid transferring symptomatic children as a priority. If a transfer is required, follow all infection control advice.

Recommendations to restrict transfers in and out of a youth justice secure setting will be considered by the YCS placement team. For children on a secure welfare placement, this will be considered by the local authority or charity that commissions the secure children’s home (SCH) or secure welfare co-ordination unit (SWCU).

Restricting new arrivals

This is to avoid ‘feeding’ or making an outbreak worse by introducing new vulnerable cases to the secure setting. If it is not possible to restrict new arrivals completely, they should be:

• assessed to determine if they are in a risk group and considered for AV-PEP and vaccine
• assessed for signs and symptoms of flu and symptomatic children who have just arrived at the secure setting should be isolated or cohorted immediately
• swabbed and considered for a treatment dose of antivirals and isolation or cohorting if they are symptomatic and in a risk group, and it’s clinically appropriate

6.2 Restricting arrivals and transfers

When a secure setting is considering limiting movement to arrivals and transfers in the CYPSE, the decision will be taken by the OCT working with the YCS, SWCU or individual SCH using the following steps.

1. The OCT should consider whether to limit arrivals or transfers out of the CYPSE only. They should work out if there is an unaffected part of the secure setting that can be used so it can continue to accept new children.
2. The OCT should consider whether full or partial movement limitation is necessary. They should obtain from the YCS head of placements an impact assessment of change in ability to receive new children or make transfers.
3. The impact assessment will consider how restrictions on accepting or transfers will affect surrounding CYPSE, and how long the restrictions are sustainable. This is done with the YCS head of placements.
4. The OCT must consider the impact assessment before they decide whether to recommend to the YCS head of placements or SWCU to change activity, limit movement or close. The YCS head of placements will work with the OCT to consider outbreak status and mitigation.
5. The YCS head of placements or SWCU would take a decision on closing a young offender institution, secure training centre or SCH to admissions and transfers. The registered SCH manager will be responsible for deciding to close to new admissions or transfers, consulting with the YCS where relevant and notifying the SWCU about any decision taken on new welfare admissions.
6. The OCT, YCS head of placements or SCH registered manager may want to limit movement, change activity or close the secure setting for a longer period than the YCS placement team, WCU, or placing authority thinks is sustainable (in some circumstances, these actions might not be deemed sustainable for any time at all). In this situation, their recommendation must be escalated to the YCS executive director for a final decision.
7. If an urgent out-of-hours decision is required, it should be made by the appropriate senior director on duty.
8. If a decision to limit movement, change activity or close is taken, a further impact assessment of continuing closure must be obtained from the YCS placement team or SCH registered manager at least every 3 days.
9. The assessment should be provided to the YCS executive director along with up-to-date information about the current status of the outbreak.
10. The YCS executive director or registered manager should then maintain or withdraw their decision to limit movement, change activity or close the establishment to receptions and transfers.
11. If the YCS placement team or SCH registered manager’s assessment says that continuing change of activity or closure is unsustainable, any decision to extend the change of activity must be escalated to the YCS executive director (or duty director in an urgent out of hours situation).

6.3 Transfers to court

In an outbreak situation, symptomatic children may not be suitable for court due to clinical needs and infection control considerations. You should tell courts that a child is ill with flu and so may not be suitable for a court appearance.

Courts should consider a video link as an alternative to a personal appearance if a symptomatic child needs to attend court.

If a personal appearance is required, appropriate infection control measures should be implemented following COVID-19 guidance on courts and tribunals planning and preparation.

6.4 New allocations from court

You should consider redirecting new children who have been allocated to an infected site. However, this may only be sustainable for a few days at most.