Summary of influenza immunisation policy

Public Health England


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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 
* Many of this patient group will already be eligible due to complications of obesity that place them in another risk category

  • 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 

 Administration

  • 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
Influenza vaccines for the 2016/2017 influenza season
Supplier Name of product Vaccine type Age indications Ovalbumin content μg/ml (μg/dose) Contact details
AstraZeneca UK Ltd Fluenz Tetra▼ Live attenuated, nasal From 24 months to less than 18 years of age ≤1.2
(≤0.24/0.2ml dose)
Fluenz Tetra for use in the national children flu programme should be ordered through ImmForm§
Otherwise:
0845 139 0000
GSK Fluarix™ Tetra▼ Split virion inactivated virus From 3 years ≤0.1
(≤0.05/0.5ml dose)
0800 221 441
MASTA Imuvac® Surface antigen, inactivated virus From 6 months 0.2
(0.1/0.5ml dose)
0113 238 7552
Inactivated Influenza Vaccine (Split Virion) BP Split virion, inactivated virus From 6 months ≤0.1
(≤0.05/0.5ml dose)
Mylan (BGP Products) Influvac® Surface antigen, inactivated virus
From 6 months

0.2
(0.1/0.5ml dose)

0800 358 7468
Imuvac® Surface antigen, inactivated virus
From 6 months 0.2
(0.1/0.5ml dose)
Pfizer Vaccines Influenza vaccine (split virion, inactivated), pre-filled syringe Split virion, inactivated virus From 5 years
≤2
(≤1/0.5ml dose)
0800 089 4033
Enzira® Split virion Inactivated virus
From 5 years ≤2
(≤1/0.5ml dose)
Sanofi Pasteur MSD Inactivated Influenza Vaccine (Split Virion) BP Split virion inactivated virus
From 6 months
≤0.1
(≤0.05/0.5ml dose)
0800 085 5511
Intanza® 15 micrograms Split virion inactivated virus
60 years of age and over
≤0.24
(≤0.024/0.1ml dose)
Seqirus Vaccines Ltd, formerly Novartis Vaccines Agrippal® Surface antigen, inactivated virus From 6 months ≤0.4
(≤0.2/0.5ml dose)
08457 451 500
† None of the influenza vaccines for the 2016/2017 season contains thiomersal as an added preservative
‡ Note, the ovalbumin content is provided in units of μg/ml and μg/dose
§ In England, this vaccine should be ordered online via the ImmForm website: portal.immform.dh.gov.uk

Adverse reactions

  • 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

Contraindications

  • 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)

References

full guideline from…
www.gov.uk/government/collections/annual-flu-programme

Public Health England. Influenza vaccine: ovalbumin content. August 2016.
Public Health England. Influenza: the green book, chapter 19. November 2015, Guidelines summary updated October 2016.


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