Summary of influenza immunisation policy
Recommendations for the use of the vaccines
- The aim of the influenza immunisation programme are to protect those who are most at risk of serious illness or death should they develop influenza and to reduce transmission of the infection, thereby contributing to the protection of vulnerable patients who may have a suboptimal response to their own immunisations
- Immunisations should be offered to:
- all those aged 65 years or older
- all those aged six months or older in the clinical risk groups shown in the table below
- children not in clinical risk groups that are eligible for vaccination as part of the ongoing phased roll out of the extension of the programme to all children aged two to less than seventeen years old
Clinical risk groups who should receive the influenza immunisation
- Influenza vaccine should be offered to people in the clinical risk categories set out below
|Clinical risk category||Examples (this list is not exhaustive and decisions should be based on clinical judgement)|
|Chronic respiratory disease||Asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission.
Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD).
Children who have previously been admitted to hospital for lower respiratory tract disease.
See full guideline precautions section on live attenuated influenza vaccine
|Chronic heart disease||Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease.|
|Chronic kidney disease||Chronic kidney disease at stage 3, 4 or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation.|
|Chronic liver disease||Cirrhosis, biliary atresia and chronic hepatitis.|
|Chronic neurological disease (included in the DES directions for Wales)||Stroke, transient ischaemic attack (TIA). Conditions in which respiratory function may be compromised due to neurological disease (e.g. polio syndrome sufferers). Clinicians should offer immunisation, based on individual assessment, to clinically vulnerable individuals including those with cerebral palsy, learning disabilities, multiple sclerosis and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability|
|Diabetes||Type 1 diabetes, type 2 diabetes requiring insulin or oral hypoglycaemic drugs, diet controlled diabetes.|
|Immunosuppression (see full guideline contraindications and precautions section on live attenuated influenza vaccine)||Immunosuppression due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression, bone marrow transplant, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement disorder).
Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day (any age), or for children under 20kg, a dose of 1mg or more per kg per day
It is difficult to define at what level of immunosuppression a patient could be considered to be at a greater risk of the serious consequences of influenza and should be offered influenza vaccination. This decision is best made on an individual basis and left to the patient’s clinician.
Some immunocompromised patients may have a suboptimal immunological response to the vaccine.
|Asplenia or dysfunction of the spleen||This also includes conditions such as homozygous sickle cell disease and coeliac syndrome that may lead to splenic dysfunction.|
|Pregnant women||Pregnant women at any stage of pregnancy (first, second, or third trimesters).
See full guideline precautions section on live attenuated influenza vaccine
(class III obesity)*
|Adults with a body mass index ≥40 kg/m2|
- GPs should take into account the risk of influenza infection exacerbating any underlying disease that the patient may have, as well as the risk of serious illness from influenza itself
- In addition to the above, immunisation should be provided to healthcare and social care workers in direct contact with patients/clients to protect them and to reduce the transmission of influenza within health and social care premises, to contribute to the protection of individuals who may have a suboptimal response to their own immunisations, and to avoid disruption to services that provide their care. This would include:
- health and social care staff directly involved in the care of their patients or clients
- those living in long-stay residential care homes or other long-stay care facilities where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality (this does not include prisons, young offender institutions, university halls of residence etc.)
- those who are in receipt of a carer’s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill. Vaccination should be given on an individual basis at the GP’s discretion in the context of other clinical risk groups in their practice
- others involved directly in delivering health and social care such that they and vulnerable patients/clients are at increased risk of exposure to influenza
- The inactivated influenza vaccines given by intramuscular injection should be given preferably into the upper arm (or anterolateral thigh in infants). However, individuals with a bleeding disorder should be given vaccine by deep subcutaneous injection to reduce the risk of bleeding
- The live attenuated influenza vaccine is administered by the intranasal route and is supplied in an applicator that allows a divided dose to be administered in each nostril (total dose of 0.2ml, 0.1ml in each nostril):
- administration of either dose does not need to be repeated if the patient sneezes or blows their nose following administration
- heavy nasal congestion might impede delivery of the vaccine to the nasopharyngeal mucosa—defer administration until nasal congestion resolves, or consider intramuscular administration
- Inactivated influenza vaccines can be given at the same time as other vaccines. The live attenuated vaccine can also be given at the same time as other live or inactivated vaccines
- Intramuscular and intradermal vaccines should be given at separate sites, preferably in a different limb. If given in the same limb, they should be given at least 2.5cm apart
- Antibody levels may take up to 14 days to rise
- Influenza activity is not usually significant before the middle of November and therefore the ideal time for immunisation is September to early November. However, this does not preclude vaccination in later months
|Supplier||Name of product||Vaccine type||Age indications||Ovalbumin content μg/ml (μg/dose)‡||Contact details|
|AstraZeneca UK Ltd||Fluenz Tetra▼||Live attenuated, nasal (quadrivalent)||From 24 months to less than 18 years of age||≤1.2
0845 139 0000
|GSK||Fluarix™ Tetra▼||Split virion inactivated virus (quadrivalent)||From 3 years||≤0.1
|0800 221 441|
|MASTA||Imuvac®||Surface antigen, inactivated virus||From 6 months||0.2
|0113 238 7552|
|Inactivated influenza vaccine (split virion) BP||Split virion, inactivated virus||From 6 months||≤0.1
|Quadrivalent influenza vaccine (split virion, inactivated)▼||Split virion, inactivated virus||From 3 years||≤0.1
|Mylan (BGP Products)||
|Surface antigen, inactivated virus||From 6 months||
|0800 358 7468|
|Imuvac®||Surface antigen, inactivated virus||From 6 months||0.2
|Influenza vaccine, suspension for injection (influenza vaccine, surface antigen, inactivated)||Surface antigen, inactivated virus||From 6 months||0.2
Influenza vaccine (split virion, inactivated), prefilled syringe
|Split virion, inactivated virus||From 5 years||≤2
|0800 089 4033|
|Enzira®||Split virion Inactivated virus||From 5 years||≤2
|Sanofi Pasteur MSD||
Quadrivalent influenza vaccine (split virion, inactivated)▼
|Split virion inactivated virus||From 3 years||≤0.1
|0800 854 430|
Inactivated influenza vaccine (split virion) BP
|Split virion inactivated virus||
From 6 months
|Seqirus Vaccines Ltd, formerly Novartis Vaccines||Agrippal®||Surface antigen, inactivated virus||From 6 months||≤0.4
|08457 451 500|
‡ Note, the ovalbumin content is provided in units of μg/ml and μg/dose
- Pain, swelling or redness at the injection site, low grade fever, malaise, shivering, fatigue, headache, myalgia and arthralgia are among the commonly reported symptoms after intramuscular or intradermal vaccination
- A small painless nodule (induration) may also form at the injection site. These symptoms usually disappear within one to two days without treatment. Nasal congestion/rhinorrhoea, reduced appetite, weakness and headache are common adverse reaction following administration of the live attenuated intranasal vaccine
- Immediate reactions such as urticaria, angio-oedema, bronchospasm and anaphylaxis can occur
- Refer to the summary of product characteristics for individual products when deciding which vaccine to give. There are very few individuals who cannot receive any influenza vaccine. When there is doubt, appropriate advice should be sought promptly from the screening and immunisation team in the NHS England area team, a consultant in communicable disease control or a consultant paediatrician, so that the period the individual is left unvaccinated is minimised
- None of the influenza vaccines should be given to those who have had:
- a confirmed anaphylactic reaction to a previous dose of the vaccine, or
- a confirmed anaphylactic reaction to any component of the vaccine (other than ovalbumin—see full guideline precautions section)
full guideline from…
Public Health England. Influenza vaccine: ovalbumin content. August 2017.
Public Health England. Influenza: the green book, chapter 19. November 2015, Guidelines summary updated October 2017.
First included: October 2011, updated October 2017.