Immunisation Clinical Advice & Response Service (ICARS)

The aim of the South West Immunisation Clinical Advice Response Service (ICARS) is to provide public health guidance to clinicians administering all vaccines commissioned under Section 7a or Covid-19 programmes, and to respond to clinical incidents as they arise in these programmes. ICARS operates Monday-Friday, 9am-5pm (excepting bank holidays) and endeavour to respond to your enquiry within 2 working days.

Please contact ICARS by email at

Incident reporting

In the event of a clinical incident relating to Covid-19 or Section 7a vaccination programmes in the South West, please complete an ICARS Incident Reporting Form and return it to  Step-by-step guidance on how to fill in the form and return it to ICARS can be found here.

The table below has some examples of what is in scope for the ICARS service, and what is not:

In Scope Out of scope
·        ​Vaccine eligibility queries for Section 7A vaccines

·        Scheduling (When is this patient eligible for a vaccine and which vaccines can they receive?) ​

·        Safety (e.g. presence of underlying health conditions or medications) ​

·        Vaccine contraindication queries

·        Receiving a duplicate vaccine (double dosing)

·        Receiving a vaccine early or late​

·        Expired vaccine administered

·        Incomplete dose of vaccine given

·        Incorrect vaccine administered

·        Incorrect/missing recording of a vaccination event

·        Vaccine given to the wrong patient

·        Incorrect vaccine reconstitution

·        Cold chain queries and incidents

·        Vaccine delivery or supply issues impacting section 7a vaccination programmes.

·        Signposting of where to order S7A vaccines.

·        Needlestick injuries that affect patients

·        Vaccinations outside Section 7a (i.e. travel vaccines, tetanus following injury or animal bite)

·        Vaccine ordering on behalf of settings

·        Other logistics queries, e.g. provision of PPE​

·        Staffing queries or staffing shortages

·        Infection control advice

·        Clinical waste issues​

    • Call and recall issues​

·        Data reporting issues​

·        Needlestick injuries that affect staff (refer to occupational health – provider may wish to contact health protection)

·        Reported side effects / adverse events (refer to vaccine SPC data and report as a yellow card incident to MHRA)

·        Translation of immunisation histories

·        Provision of individuals immunisation histories (refer to CHIS to obtain if the patient is under 19 years old)

·        Vaccine administration (IoS) payment issues (e-mail

·        Immunisation training queries or provision of immunisation training


For advice on cold chain incidents and general immunisation incidents: Vaccine incident guidance: responding to vaccine errors – GOV.UK (

We kindly ask that all correspondence sent to us does not include patient identifiable details (PID).  We only require a patient’s date of birth to be able to answer immunisation scheduling queries.  We do not have access to clinical records.

Learning from incidents and queries

ICARS continuously reviews recent queries and incidents to identify learning that may be of benefit to others.  This learning is shared internally, via bulletins to clinicians and on this site.  Please see previous shared learning updates below.

  • ICARS learning February 2024:
    • Oral polio vaccination (OPV) since April 2016 guidance
    • Pneumococcal vaccination eligibility for those with Coeliac Disease
    • Reminder: COVID-19 vaccine expiry dates
    • Vaccine ordering from manufacturers and claiming costs back from the ICB
    • Patient flags for vaccination


  • ICARS learning September 2023:
    • Private vaccines
    • Hepatitis B positive fathers
    • Advice from national about disregarding fractional IPV doses
    • Advice for children under 10 who require additional doses of IPV to bring them up to date with the UK schedule
    • Cold chain audit response
    • Postponing vaccination due to fever and presence of a neurological condition
    • Business continuity plan to support maintain a stable cold chain
    • Guidance on data logger usage


If you have contacted ICARS for advice and support, we would be very grateful for your feedback to help us improve the service.  The short feedback form has 5 questions and can be accessed here.

Immunisation guidance:


Healthcare worker guidance for specific immunisation programmes:

For more guidance, please visit our NHSE SW immunisation page: NHS England — South West » Immunisations

Supportive tools:

Vaccines are sensitive biological substances that when too hot or too cold can quickly lose their efficacy. If vaccines are stored outside of the recommended temperature range, the vaccine may fail to create the desired immune response and result in sub-optimal protection against vaccine preventable diseases.

The purpose of the vaccine cold chain is to maintain vaccine product quality from the time of manufacturer until the point of administration. This is fulfilled by ensuring that vaccines are handled, stored and transported within the appropriate temperature range according to the manufacturer’s summary of product characteristics.

ICARS would like to request sites storing vaccines to complete our annual audit tool is available here. This audit tool was adapted from the Oxford Vaccine Group (Vaccine storage audit) and should be used in conjunction with:

Please direct any queries to the South West Immunisation Clinical Advice and Response Service (ICARS) at