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Vaccine update: issue 312, October 2020 flu special edition

Published 13 October 2020

Applies to England

Largest flu vaccination programme ever

Autumn 2020 will see the largest flu vaccination programme ever, with an offer of flu vaccination to 30 million people in England. We know that those most at risk from flu are also vulnerable to coronavirus (COVID-19).

The expanded programme reflects the importance of protecting these people this winter, as both flu and COVID-19 will be in circulation. Nationally, a concerted effort is called for to significantly increase flu vaccine uptake. This will be supported by a new public-facing marketing campaign, ‘Just’ the flu?.

Public awareness about viruses is much higher than in previous years due to COVID-19. People are more aware about how viruses spread – even if you don’t have symptoms – and that certain groups are more at risk. This means we have already seen an increase in demand for flu vaccination.

Due to the high level of demand, some people have been asked to wait to have their vaccine until further stocks become available. However, there is enough flu vaccine for everyone who is eligible to get vaccinated before the flu season starts. A leaflet to support communications to the public on why they are being asked to wait is available to download or order.

To support the increase in demand and the expanded programme, the Department of Health and Social Care has procured additional national supply of the vaccine and have issued guidance for general practice on how this can be accessed, Accessing government-secured flu vaccines-guidance for GPs. Guidance for trusts and community pharmacy will be issued shortly.

The immediate focus of the programme is to prioritise those in at-risk groups first. All those who are household contacts of anyone on the NHS shielded patients list should also be offered flu vaccine. Under 65s who are in an at-risk group will also be prioritised. Later in the flu vaccination period, from November and December, the aim is to further extend the programme to healthy people aged 64 and under, subject to vaccine supply.

To help reduce transmission flu vaccination of children remains important. For the first time nationally, all year 7 pupils in secondary school will be offered the flu vaccine, as well as 2- and 3-year-olds and primary school-aged children.

The new year 7 cohort are children who have received the vaccine during their primary school years so both the children and their parents will be familiar with it.

All frontline health and social care workers should receive a vaccination this season to help protect them and the people they care for. Health and social care workers employed through Direct Payment (personal budgets) and/or Personal Health Budgets, such as Personal Assistants, can now access flu vaccine through the NHS funded scheme via their GP or pharmacy.

Who is eligible for the flu vaccine from 2020 to 2021?

Individuals at particular risk of severe illness from catching flu, including:

• people aged 65 and over
• pregnant women
• people in a clinical risk group

You are also advised to have the flu vaccine if you are:

• the main carer of an older or disabled person
• a household contact of someone on the NHS shielded patients list
• a child aged 2 to 11 on 31 August 2020

Later in the year, the flu vaccine will be offered to people aged 50 to 64. Providers will be given notice, so they can have services in place for any additional cohorts later in the season.

You should not delay offering a vaccine to anyone aged 50 to 64 in a clinical risk group.

Infection rates

While infection rates are low at the beginning of the season, that will change and we need to be ready. Follow the weekly surveillance reports.

Second annual flu letter: published update

The second flu letter gives additional detail on the implementation of the flu programme.

In light of the risk of flu and COVID-19 co-circulating this winter, the national flu immunisation programme will be essential in protecting vulnerable people and supporting the resilience of the health and care system. Both letters are available to download.

To prevent localised outbreaks this year, an inactivated vaccine may be offered to those children whose parents refuse the live attenuated influenza vaccine (LAIV) due to the porcine gelatine content. The alternative vaccines will be made available to school-aged vaccination providers and GPs for their 2 and 3-year-old cohorts from November.

Frontline health and social care workers

All frontline health and social care workers should receive a vaccination this season.

This should be provided by their employer, in order to meet their responsibility to protect their staff and patients and ensure the overall safe running of services. Employers should commission a service that makes access easy to the vaccine for all frontline staff, encourage staff to get vaccinated and monitor the delivery of their programmes.

NHS England and Improvement (NHSEI) will continue to support vaccination of social care and hospice workers employed by registered residential or domiciliary care providers. The eligible groups have been expanded this year to include those health and social care workers, such as Personal Assistants, employed through Direct Payment and/or Personal Health Budgets, to deliver domiciliary care to patients and service users.

Vaccination will be available through community pharmacy or an individual’s registered general practice. This scheme is intended to complement, not replace, any established occupational health schemes that employers have in place to offer flu vaccination to their workforce.

For healthcare workers, providers should use the current definition as set out in chapter 12 of the Green Book.

The following guidance is to be published soon on the annual flu pages:

• guidance for providers: flu immunisation for social care and hospice staff
• guidance for social care workers: flu vaccination
• guidance for personal care assistants: free flu vaccination

Guidance on immunisation training for the 2020 to 2021 flu season

With the ongoing global COVID-19 pandemic, it is important that this year’s annual flu vaccination programme is safely and effectively delivered to as many of those eligible as possible to protect those at risk. It is therefore crucial that those giving flu vaccine are confident, competent and have up-to-date knowledge about the vaccine(s) they are giving.

To support healthcare professionals delivering the flu vaccine programme in the 2020 to 2021 flu season, Public Health England (PHE) has published guidance on flu immunisation training. There is also a flu specific competency assessment tool for those new to giving flu vaccines this year.

The Flu Immunisation e-learning programme, written by PHE and produced by Health Education England e-Learning for Healthcare (HEE e-LfH), has been updated for the 2020 to 2021 flu season. The programme consists of 3 knowledge sessions and 3 assessment sessions.

All those undertaking this e-learning should complete the Core Knowledge session and accompanying assessment. Depending on which session(s) is relevant to your role, you can then complete one or both of the subsequent knowledge and assessment sessions, which provide more detailed information about the live and inactivated flu vaccines.

This e-learning programme is free and open access for all.

Health Matters: blog, webinar, flu videos infographics and videos

The Health Matters blog provides expert insight on PHE’s work and all aspects of public health, including a focus on the national flu immunisation programme and the delivery of the 2020 to 2021 programme.

You can also read the full edition and download the graphics and videos.

Flu publications are ready to order now

Leaflets remain an effective way of communicating the need and the benefits of having a vaccine. We know that 54% of parents still rely on them. It is important that people receive a leaflet that is accessible to them.

We have a greater range of translated resources for non-native speakers and further developed easy-read posters and leaflets. Translated resources are available to download and print locally. We also have print-ready copies if large print runs are required.

Familiarise yourself with the resources available to support the annual flu programme and order stock of the hard copies as soon as possible.

The ‘Who should have it and why’ leaflet

Available in 20 languages, this leaflet explains to patients how they can help protect themselves and their children against flu this winter. It includes information about children, eligible adults and pregnant women. It explains the importance that people at increased risk from flu, or who care for someone who is vulnerable, should have their free vaccination every year.

This leaflet can be downloaded and ordered using product code: 3079111D1.

A British Sign Language (BSL) video version is available to view and download. The leaflet has been made into 4 short videos to make them quicker to download and reduce the file size. You need to download all 4 files.

The complete BSL video is available to view:

Flu vaccination, who needs it and why leaflet BSL video.

Flu vaccination, who should have it and why – audio version (MP3 file) is available now to download and share using the product code: 2020252AA.

Flu vaccination, who should have it and why – large print version is available to download using product code: 3079111D1LP.

Guidance and resources for schools

Resources including advice for headteachers, teachers and all school support staff, are available, along with templates for the informed consent form and invitation letter.

The programme briefing for schools can be downloaded and ordered using product code 2016027C1.

The flu consent form has been updated and is available to download.

Flu vaccination – easy-read poster and leaflet

Our easy-read guides for individuals in all settings with a learning disability are available for the 2020 to 2021 flu season. These resources are aimed at people who have a learning disability or care for someone with a learning disability.

They provide advice on:

• the flu virus and why you need a vaccine every year
• signs of flu
• flu jabs and where to get one

Easy-read guides can be downloaded and ordered using product code EASYREADFLU2 and EASYREADFLU1.

The easy-read guide to having your vaccines during a pandemic is aimed at people with a learning disability and their carers. It explains the need to have the vaccine and what to expect at the appointment. It is available to download and order using product code: EASYREADFLU3

Simple text versions

Aimed at individuals with a low reading age, simple text versions of All about flu and how to stop getting it, are available to download and order using product code. Adult version (product code: 2904202) and children’s version (product code: 3248960).

Flu vaccination – protecting your child against flu 2020 to 2021

Available in 15 languages, this leaflet is for parents of 2- and 3-year-olds, primary school and year 7 secondary school-aged children. It explains which children are eligible for a flu vaccination, as well as describing the disease and the nasal flu vaccine.

These can be downloaded and ordered using product code 2902552C1.

An audio version (product code 2020251A) and braille version (product code 2902552C1BR), for blind or partially sighted people, are also available.

A BSL video version of this leaflet is available to view.

Protect your child from flu leaflet BSL video

For the download version and anyone who wants to upload this to their website or share with patients, the video has been broken down into 5 smaller chapters to make it more accessible and faster to download using product code 2020252.

‘Why do I have to wait for my vaccine?’ leaflet

This leaflet is for GP practices and pharmacies to give to patients explaining why they may be asked to wait to have their flu vaccine. There has been high demand this year so some people may have to wait until further stocks become available.

Order copies of this leaflet using product code: 2020274F.

Five reasons poster

This poster is aimed at parents and explains the vaccine and the benefits of vaccinating children against flu. Copies can be downloaded and ordered using product code: 2901251D1.

Immunising preschool children guidance

Available to download, this leaflet is about the annual flu vaccination programme for preschool children. It informs those working in the early years sector about the programme and how they can support it. It is aimed at nursery and preschool managers and staff, and childminders delivering the Early Years Foundation Stage Framework, and those who provide informal childcare, such as nannies.

‘Which flu vaccine should children have?’ poster

There are 2 types of flu vaccine available for children in 2020 to 2021:

• the ‘live’ nasal spray vaccine
• the injected inactivated flu vaccine

This chart, available for download only, indicates which vaccine children should have.

Flu vaccines: 2020 to 2021 flu season poster

Our popular poster showing the different types of flu vaccines available for the 2020 to 2021 flu season and the clinical risk groups that they apply to is available to download.

Health and social care work flu campaign resources

Protect your patients, people you care for, your family and friends and yourself from flu – it’s time to have your flu jab.

This year’s flu vaccination campaign for health and social care workers is delivered by Public Health England (PHE) and NHS England and NHS Improvement.

‘I’ve had my flu jab’ emphasises the protective benefit of the flu vaccination with a shield motif. It includes the message: ‘Protects you, your family and patients [or those you care for] from the flu. Get your free flu vaccination’ to encourage the uptake of flu vaccinations by health and social care workers.

Campaign materials, including adaptable artwork and social media tools, are available on PHE’s Campaign Resource Centre to download or print locally.

The resources include:

• A4 posters and blank belly posters, so partners can include local details about where and when vaccination is going to be held
• leaflets for staff
• sticker artwork and sheets of stickers
• social media and digital tools including digital banners and screen savers
• communications toolkit (including long and short copy)
• frequently asked questions

Public facing marketing campaign

PHE will deliver a new mass media flu vaccination marketing campaign which will run until December. It will raise awareness of the seriousness of flu while positioning the vaccine as the best protection against it. Bespoke advertising creative will call out all eligible groups for the free flu vaccine to get vaccinated.

The campaign will run on TV, video on demand, radio outdoor billboards and digital media (social and display) supported by PR, search and partnership activity.

Resources for the campaign are available to download and order from the PHE Campaign Resource Centre.

Flu immunisation – advice for running vaccination clinics this autumn

This year, practices will have to consider the use of personal protective equipment (PPE) and social distancing when planning their flu immunisation clinics.

To help support this, the South West Screening & Immunisation Team (SIT), in collaboration with partners, has made a video about how a GP practice in Bristol is planning their 2020 to 2021 flu immunisation clinics. The video outlines how this practice is using a mockup flu immunisation clinic to work out how they can deliver the service to effectively deliver flu vaccination to their patients.

Immunisation clinic video

PPE for immunisers

The current guidance on the use of PPE for immunisation is available.

Patient Group Directions

Patient Group Directions (PGDs) are now published for the 2020 to 2021 influenza season:

• inactivated Influenza PGD v08.00 (GW-1533)
• LAIV PGD v09.00 (GW-1458)
• PPV PGD v03.00 (GW-1457)

Vaccines for the 2020 to 2021 children’s flu programme supplied by PHE

Vaccine availability

The 2 vaccines in the table below are available to order by providers of the children’s flu programme in England through PHE ImmForm.

Vaccine	Manufacturer	Available to order for
Fluenz® Tetra (LAIV)	AstraZeneca	All children aged from 2 years old to those in school year 7, and children in clinical risk groups aged 2 to <18 years
Quadrivalent Influenza Vaccine (split virion, inactivated) (QIVe)	Sanofi Pasteur	All children aged 6 months to <9 years in clinical risk groups for whom LAIV is unsuitable

PHE does not supply any flu vaccines for patients aged 18 years and over. Please refer to guidance from your respective health departments for arrangements in Scotland, Wales and Northern Ireland.

Vaccine ordering information for general practices

Ordering controls will be in place for Fluenz® Tetra to enable PHE to balance incoming supply with demand. As in previous years, ordering controls for GPs are tailored to each practice and allocate an amount of vaccine based on the number of registered eligible patients.

Each GP practice has now been allocated sufficient vaccine to vaccinate at least 70% of their eligible patients (all 2- and 3-year-olds, plus children in clinical risk groups from age 4 to <18 years).

Further increases to these allocations will be made in response to demand and vaccine availability – please check ImmForm regularly for the latest information on LAIV order controls.

Requests for extra vaccine will be considered on a case by case basis throughout the season. They should be sent to the ImmForm helpdesk by emailing helpdesk@immform.org.uk or calling 020 7183 8580. Allow sufficient time before your order cut-off. Out of schedule deliveries will be by exception only.

Multi-branch practices and Fluenz® Tetra allocations

GP practices or groups that operate over multiple sites, but are part of the same organisation, will have a joint allocation (as in previous years), even where each site has a unique ImmForm account.

This means it is possible for one site to potentially order all of the available vaccine for the group, unless there is local agreement on how the allocated volume is shared across multi-branch practices.

To reduce the risk of supply interruption, PHE recommends this agreement is in place before ordering opens. The information above allows practices to estimate the amount of vaccine they have been allocated and how it should be split between all sites.

Vaccine ordering information for school-age providers

A default ordering cap of 300 packs (3,000 doses) per week, per ImmForm account, will be in place for school providers.

Where this cap is insufficient, and a provider needs a larger weekly volume of vaccine to deliver the programme (for example, where a provider covers a large area using a single account), a higher weekly cap should be requested via the PHE Vaccine Operations team by emailing vaccinesupply@phe.gov.uk.

For one-off larger orders, requests should be made via helpdesk@immform.org.uk. Allow sufficient time before the order cut-off.

Supply of inactivated flu vaccine for children who object to LAIV due to the porcine gelatine content

DHSC has secured a supply of inactivated influenza vaccine for children who object to the porcine gelatine content of Fluenz® Tetra (LAIV), which is expected to be made available to NHS providers of the children’s flu programme from November. Arrangements for this supply have not yet been finalised and further details will be communicated by DHSC as soon as they are available.

Inactivated flu vaccine ordering

PHE also supplies an egg-based Quadrivalent Influenza Vaccine (split virion, inactivated). This vaccine:

• currently has an order cap of 3 doses per week
• should be ordered for all eligible children aged less than 9 years who are contraindicated for, or too young to receive Fluenz® Tetra (LAIV) AND are in a clinical risk group

Vaccine arrangements for children in clinical risk groups aged 9 years and over for whom Fluenz® Tetra is unsuitable are as follows:

• those vaccinated in GPs should be offered locally procured QIVc where available. Where QIVc is unavailable, GPs can offer QIVe, either from locally procured stock or centrally supplied stock available via ImmForm
• school-aged providers can continue to offer centrally supplied QIVe
• full details of the vaccine (and reimbursement) arrangements for this group can be found in the flu letter published on 14 May 2020

All influenza vaccines for the 2020 to 2021 season

Information on all influenza vaccines that have been marketed in the UK for the 2020 to 2021 season is available to download.