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Vaccine update: issue 342, September 2023, flu special edition

Published 9 October 2023

Applies to England

© Crown copyright 2023

This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk.

Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

This publication is available at https://www.gov.uk/government/publications/vaccine-update-issue-342-september-2023-flu-special-edition/vaccine-update-issue-342-september-2023-flu-special-edition

Flu vaccination programme

Flu vaccination is now underway. It is a critically important public health intervention and a key priority for 2023 to 2024 to reduce morbidity, mortality and hospitalisation associated with flu at a time when the NHS and social care will be managing winter pressures whilst continuing to recover from the impact of the COVID-19 pandemic.

Last season saw a year of high flu activity, with excess deaths associated with flu the highest for 5 years (14,500 compared to an average figure of 13,500). This is the highest figure since the 2017 to 2018 season, when there were 22,500 excess deaths associated with flu.

Last season the vaccines were well matched to the predominant circulating strain, indicating that flu vaccination again last season had an important role preventing serious illness and keeping people out of hospital. The best protection against getting seriously ill and needing hospitalisation is to get the flu vaccine ahead of winter. Recent UKHSA modelling shows flu vaccination prevented over 25,000 hospitalisations in England last year, so we have clear evidence that the protection from last season’s vaccine programme helped prevent a much worse winter.

This Vaccine Update flu special sets out the details of those who are eligible this year, which includes an expansion of the programme to secondary school aged children in years 7 to 11. We also provide links to our flu publications including leaflets, letter templates, consent forms and posters, with leaflets translated into over 30 languages and provided in braille, British Sign Language, large print, simple text for those with low literacy, and easy read for those with a learning disability.

In light of risks presented by the new BA.2.86 variant of COVID-19, COVID-19 vaccination for adults has been brought forward. Flu and COVID-19 vaccines can be administered at the same time where it is operationally expedient to do so. See communication of 30 August 2023 from NHS England.

A winter vaccinations marketing campaign will launch early November running through to mid-December, encouraging the uptake of influenza and COVID-19 vaccines. The campaign supports both vaccination programmes and focuses on pregnant women, at risk groups and for flu, also pre-school aged children.

Who is eligible

The following are eligible for an NHS vaccine in 2023 to 2024:

  • all children aged 2 or 3 years old (on 31 August 2023)

  • primary school aged children (from reception class to year 6)

  • secondary school-aged children from years 7 to 11

  • those aged 6 months to under 65 years in clinical risk groups such as those defined below

  • pregnant women

  • those aged 65 years and over

  • those in long-stay residential care homes

  • carers in receipt of carer’s allowance, or those who are the main carer of an elderly or disabled person

  • close contacts of immunocompromised individuals

  • locum GPs[footnote 1]

  • frontline staff employed by the following types of social care providers without employer led occupational health schemes:

  • registered domiciliary care provider

  • direct payment (personal budgets) and or personal health budgets, such as personal assistants

  • a registered residential care/ nursing home[footnote 1]

  • a voluntary managed hospice provider[footnote 1]

  • those living in:

  • long-stay residential care homes or nursing homes [footnote 1]

  • other long-stay health or social care facilities[footnote 1]

  • a house-bound patient (defined in the ES specification)

Examples of clinical risk groups

  • chronic (long-term) respiratory disease, such as asthma (requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission), chronic obstructive pulmonary disease (COPD) or bronchitis

  • chronic heart disease, such as heart failure

  • chronic kidney disease at stage 3, 4 or 5

  • chronic liver disease

  • chronic neurological disease, such as Parkinson’s disease or motor neurone disease

  • learning disability

  • diabetes and adrenal insufficiency

  • splenic dysfunction or asplenia

  • a weakened immune system due to disease (such as HIV/AIDS) or treatment (such as cancer treatment)

  • morbidly obese (defined as BMI of 40 and above)

For further information see the tripartite annual flu letter published on 25 May 2023 and the amendment to the letter published on 3 July 2023. Additional information the GP Seasonal Influenza Vaccination Enhanced Service Specification and the Community Pharmacy Seasonal Influenza Vaccine Service.

Frontline health and social care workers

All frontline health care workers, including both clinical and non-clinical staff who have contact with patients, should be offered a flu vaccine for the prevention of the transmission of flu to help protect both staff and those that they care for. Vaccination of frontline healthcare workers for flu continues to be an employer responsibility without an activity-based payment.

Social care workers directly working with people clinically vulnerable to flu should also have the flu vaccine provided by their employer. There are circumstances where frontline staff, employed by specific social care providers without access to employer led occupational health schemes (see eligibility criteria above ), can access the vaccine through the NHS free of charge.

Trusts are eligible for a CQUIN payment for flu vaccinations where they achieve a minimum of 75% uptake amongst ‘frontline HCWs on ESR’. Please note flu vaccinations delivered to non-frontline staff will not be counted towards the CQUIN indicator.

There is a recognised data collection to accompany the NHS Standard Contract (see Frontline healthcare worker COVID-19 and flu vaccination uptake collection). This is the source for NHSE publication of frontline healthcare worker vaccinations and the basis for associated payments, such as the flu CQUIN indicator. For details on the government’s official statistics (published by UKHSA) on vaccine uptake in frontline healthcare workers please see the disease surveillance and vaccine uptake data.

Additional information on flu immunisation is available to download and order online for social care staff using product code F23SCSEN2, personal assistants using product code F23SCPAEN3 and Social Care and Hospice Providers using product code F23SCPEN1.

A health and social care workers winter vaccinations communications toolkit to support the uptake of vaccinations is available to download.

Immunisation against infectious disease: Chapter 19 – influenza

The influenza chapter in Immunisation against infectious disease (the Green Book) gives detailed descriptions about clinical risk groups advised to receive influenza vaccination and guidance for healthcare workers on administering the influenza vaccine

Which flu vaccine should be offered

Every year the Joint Committee on Vaccination and Immunisation (JCVI) reviews the latest evidence on influenza vaccines and recommends the type of vaccine to be offered to individuals.  The JCVI recommendations for the 2023 to 2024 season can be read in the November 2022 statement. NHS England confirmed which vaccines will be reimbursed on the NHS as part of the tripartite annual flu letter for the 2023 to 2024 season.

A list of all influenza vaccines marketed in the UK (including details of ovalbumin content) is available on GOV.UK

A poster for practices summarising this information is available to download.

For more information on children’s flu vaccines see vaccines and availability.

Guidance on immunisation training for 2023 to 2024 influenza season

All healthcare professionals involved in administering the influenza vaccine must have the necessary knowledge, skills, training and mechanisms in place to supply and safely administer influenza vaccines.

The updated flu immunisation training recommendations were published in August 2023. These include recommended training requirements by workforce group for influenza vaccination Appendix A, suggested content that should be covered in theoretical and/or work based training Appendix B at and a competency assessment tool for new influenza vaccinators Appendix C.

If training is not available locally, all those who advise on or administer influenza vaccines are recommended to complete the flu specific e-learning programmewhich is updated annually and is available free of charge with open access for all on the e-Learning for Healthcare (eLfH) website. This e-learning programme consists of a core knowledge module, separate modules on the inactivated and live influenza vaccines and accompanying knowledge assessments for each module.

The national flu immunisation programme for 2023 to 2024 slide set is available to download and a flu vaccination programme 2023 to 2024: information for healthcare practitioners document, containing information about the current influenza programme, the vaccines available and commonly raised issues for influenza vaccination has also been published.

Patient group directions

Patient group directions (PGDs) for the 2023 to 2024 influenza season are available. These include a PGD for live attenuated influenza vaccine, the LAIV PGD, and a separate inactivated influenza vaccine PGD. Practitioners must not use these PGDs until they have been authorised in Section 2. This is a legal requirement in accordance with the Human Medicines Regulations 2012. Practitioners should follow local policy/procedures to access authorised PGD documents.

There is a separate PGD for the community pharmacy seasonal influenza vaccine service which is authorised nationally by NHSE and published on the associated NHS webpage for the community pharmacy seasonal influenza vaccine service.

National protocol for inactivated influenza vaccine

For the 2023 to 2024 influenza season, there is a national protocol for the administration of inactivated influenza vaccine to individuals eligible for vaccination as part of the nationally commissioned influenza vaccination programme. The national protocol allows for a mixed workforce model for vaccination similar to that used for COVID-19 vaccination. In accordance with the national protocol for inactivated influenza vaccine administration of inactivated influenza vaccine may be by appropriately trained persons, following assessment of the individual by a specified registered professional as detailed in the national protocol.

Public facing marketing campaign

This year the national marketing campaign which supports uptake of this winter’s essential vaccinations – influenza and COVID-19 – will launch early November, running through to mid-December. The integrated campaign supports both vaccination programmes, targeting cohorts where uptake is traditionally lower; pregnant women, parents of 2 to 3 year olds and those with underlying health conditions.

The campaign narrative sets out that both influenza and COVID-19 spread more easily in winter and can be life-threatening, but that those eligible can protect themselves by having the flu and COVID-19 vaccinations, helping to reduce the serious illness these diseases can cause, should they catch one of them. The call to action is: Get Vaccinated. Get Winter Strong.

The campaign will launch with broadcast radio and video on demand, digital and multicultural marketing advertising supported by search, PR and partnership activity.

Printed materials will be available to order from the Campaign Resource Centre.

Public facing communication resources

A public facing communications toolkit (Autumn- Winter 2023 Communications Toolkit), posters/display materials and a pack of social media materials are now available on Future NHS. Because assets are being updated regularly, please bookmark this link and refer to the latest version rather than working out of a saved local version.

Communications resources to support winter flu and COVID-19 vaccinations for health and social care professionals

To support flu and COVID-19 vaccination uptake amongst eligible frontline health and social care workers, the staff-facing communications toolkit is now available on the Campaign Resource Centre. The pack includes more than 80 designed assets (posters including customisable versions, social cards, leaflets, sticker templates).

Flu publications available to order

Leaflets remain an effective way of communicating the need and the benefits of having a vaccine and inform the consent process. It is important that people receive a leaflet in a format that meets their needs. Accessible versions are an important resource to improve uptake in underserved communities. We also want everyone to have a positive vaccination experience and having accessible information is part of that experience.

Our leaflets and resources are all available to download and many can also be ordered. We have a wide range of leaflets in translated versions, simple text, easy read, large print, braille, video British Sign Language versions, and easy read and video for those who have a learning disability.

There are also HTML versions which are text only. This helps search engines on the web that look for content, people who use screen readers and assisted technology. HTML versions can also be signposted to in e-consent forms which need to include leaflets when asking for consent. If using e-consent it is important to recognise that not all parents and carers have access to digital resources, so it is important to provide the leaflets as paper copies as well.

Schools and the school aged immunisation service can identify which accessible versions would be helpful for their cohorts. For example, if there are students who are deaf or use British Sign Language (BSL), they can make the videos available on screens or share the link with parents and children. It is important to recognise that many BSL users rely on BSL resources as written literacy in this group can be lower.

Stay up to date with all of the publications to support the annual flu programme.

Available publications

Disease surveillance and vaccine uptake data

Influenza and COVID-19 disease surveillance reporting is combined into one report to create the ‘Weekly national Influenza and COVID-19 Surveillance Report’ which is published weekly on Thursdays at 2pm. For the 2023 to 2024 season the data will be available on GOV.UK

The report summarises information from the surveillance systems which are used to monitor influenza, SARS-CoV-2 (the virus that causes COVID-19), and other seasonal respiratory viruses in England. As with previous seasons, from week 41 (12 October 2023) onwards, ‘top lines’ on vaccine uptake by cohorts will be included in the weekly surveillance report.

The government’s official statistics on vaccine coverage for eligible GP registered patients, school-aged children and frontline healthcare workers are managed through the ImmForm website. This data is used to formally evaluate the programme year on year. For the 2023 to 2024 season monthly vaccine uptake will be published as official statistics at 2pm on the following dates:

School Age Manual survey collection Pre-release date 2pm Publication date 2pm
October Wednesday 22 November 2023 Thursday 23 November 2023
November Wednesday 20 December 2023 Thursday 21 December 2023
December Wednesday 24 January 2024 Thursday 25 January 2024
January Wednesday 21 February 2024 Thursday 22 February 2024
Frontline HCWs Survey
(Flu and COVID-19)		 Pre-release date 2pm Publication date 2pm
October Wednesday 22 November 2023 Thursday 23 November 2023
November Wednesday 20 December 2023 Thursday 21 December 2023
December Wednesday 24 January 2024 Thursday 25 January 2024
January Wednesday 21 February 2024 Thursday 22 February 2024
February Wednesday 20 March 2024 Thursday 21 March 2024
GP Survey Month Pre-release date 2pm Publication date 2pm
October Wednesday 22 November 2023 Thursday 23 November 2023
November Wednesday 20 December 2023 Thursday 21 December 2023
December Wednesday 24 January 2024 Thursday 25 January 2024
January Wednesday 21 February 2024 Thursday 22 February 2024
February Wednesday 20 March 2024 Thursday 21 March 2024

Further communication on data collection tools, collection timelines, and user guides will be shared with stakeholders separately. For any queries related to the data collections or official statistics, please contact the relevant mailbox as follows:

Links to the monthly data for the 2023 to 2024 season will be published on GOV.UK

Note that as for previous seasons there will be specific webpages for each collection, but the webpage addresses are not available in advance of the pages being published. However, the collections will be named as follows:

  • Seasonal influenza vaccine uptake in school age children: winter season 2023 to 2024

  • Seasonal influenza vaccine uptake in frontline healthcare workers in England: winter season 2023 to 2024

  • Seasonal influenza vaccine uptake in GP patients in England: winter season 2023 to 2024

Routine vaccine supply

Vaccines for the 2023 to 2024 children’s flu programme supplied by UKHSA

All flu vaccines for the 2023 to 2024 children’s flu programme are available to order by NHS providers in England via UKHSA’s ImmForm website.

UKHSA 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.

Vaccines and availability

The 2 vaccines available and the groups these vaccines should be ordered for are shown in the table below. The latest and most accurate information on availability of centrally supplied vaccines for the children’s flu programme is available on the ImmForm news page at all times. It is strongly advised that all parties involved in the provision of influenza vaccines to children ensure they remain up to date with this.

Vaccine Manufacturer Available to order for
Fluenz® Tetra (LAIV) AstraZeneca All children from 2 years of age to school year 11; and Children in clinical risk groups aged 2 to <18 years[footnote 2]
Cell Based Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (QIVc) Seqirus Children in clinical risk groups aged 6 months to <2 years All other eligible[footnote 3] children aged 2 to <18 years for whom LAIV is unsuitable

LAIV ordering information for general practice

Ordering controls will be in place for general practices, to enable UKHSA to balance supply with demand. These controls work by allocating an amount of LAIV based on the number of registered eligible patients and are tailored to each practice.

UKHSA expects to be able to accommodate the following, however at this time, this information remains subject to change:

  • each GP practice will initially be allocated sufficient LAIV to vaccinate at least 50% of their eligible patients (all children aged 2 and 3 years, plus children in clinical risk groups from age 4 to <18 years) when ordering commences
  • increases to these allocations may be made in response to demand and vaccine availability
  • requests for extra vaccine will be considered on a case-by-case basis throughout the ordering period. Requests for additional vaccine should be sent to the helpdesk (helpdesk@immform.org.uk) and should be sent in good time before your order cut-off; out of schedule deliveries will be by exception only

You can view how many packs of LAIV your practice has available to order through the allocation report (you will be asked to log in with your ImmForm credentials). You will then need to select:

  • Stock management reports; followed by
  • Products available to order (Allocation managed) report

Please note that this report is not updated in real-time and so may not account for any orders or allocation amendments made within the last 30-45 minutes

Multi-branch practices and LAIV allocations

Please note that 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 that 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

LAIV ordering information for school-age providers

School providers are able to place 2 orders and receive 2 deliveries of LAIV per week, to assist in the management of vaccine volumes required across limited storage space at delivery points. This operates on a 48-hour delivery schedule requiring the order to be placed before the 11.55am cut off 2 working days before the required delivery day. The table below illustrates the respective delivery days versus ordering day.

Order day (before 11.55am cut off) Delivery day
Monday Wednesday
Tuesday Thursday
Wednesday Friday
Thursday Monday
Friday Tuesday

Customers must ensure that the point of delivery will be open and staffed between 9am and 5pm on the delivery day when placing orders for LAIV.

Please note that this does not affect the routine ordering and delivery schedule of any other vaccines (including inactivated flu vaccines) ordered from ImmForm and is applicable to Fluenz® Tetra (LAIV) only.

A default weekly ordering cap of 450 packs (4,500 doses) per week is in place for school provider accounts.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 UKHSA Flu Vaccine Operations team by emailing childfluvaccine@ukhsa.gov.uk

Please ensure requests are sent at least 2 working days before an order is needed to be placed against the higher cap, to allow time for your account to be set up correctly. For one-off larger orders during the ordering period, requests should be made via helpdesk@immform.org.uk

Inactivated flu vaccine ordering

The cell-based Quadrivalent Influenza Vaccine (surface antigen, inactivated) (QIVc) is available to order, in a single dose pack, for:

  • children in clinical risk groups aged from 6 months to less than 2 years old;
  • children aged from 2 to <18 years old in clinical risk groups for whom LAIV is clinically contraindicated or otherwise unsuitable; and
  • healthy children from 2 years old to those in school year 11, for whom LAIV is unsuitable (for example, due to objection to LAIV on the grounds of its porcine gelatine content)

Order controls are also in place for this vaccine as follows:

  • for GPs, there is an initial cap of 10 doses/packs per week
  • for school-age providers, there is a cap of 450 doses/packs per week

For one-off larger orders of inactivated vaccines, requests should be made via helpdesk@immform.org.uk in good time before your order cut-off.

Non-routine vaccine supply

Hepatitis A vaccine

Adult:

  • GSK: supply of Havrix Adult PFS singles and packs of 10 are currently available
  • Sanofi Pasteur: Avaxim PFS singles and packs of 10 are currently available
  • MSD: VAQTA Adult is available

Paediatric:

  • GSK: supply of Havrix Paediatric singles and packs of 10 are currently available
  • MSD: VAQTA Paediatric is available
  • Sanofi Pasteur: Avaxim Junior singles are currently available

Hepatitis B vaccine

Adult:

  • GSK: Engerix B PFS singles and packs of 10 are currently available
  • GSK: supply of Fendrix is currently available
  • MSD: HBVAXPRO 10 micrograms is available
  • MSD: HBVAXPRO 40 micrograms is available
  • Valneva: PreHevbri is available

Paediatric:

  • GSK: supply of Engerix B Paediatric singles is currently available
  • MSD: HBVAXPRO 5 micrograms is available

Combined hepatitis A and B vaccine

  • GSK: Twinrix Adult singles and packs of 10 are available
  • GSK: Twinrix Paediatric is currently available
  • GSK: Ambirix is available

Combined hepatitis A and Typhoid vaccine

Sanofi Pasteur: Viatim is now a discontinued product and no longer available for sale.

Typhoid vaccine

  • Sanofi Pasteur: Typhim singles and packs of 10 are available
  • Patientric: Vivotif is available

Rabies vaccine

  • Valneva: Rabipur is available. Due to high demand, orders are capped to maximum of 6 doses per order, per week (restrictions are anticipated to remain in place until 3rd week of August)
  • Sanofi Pasteur: Rabies BP is now a discontinued product and no longer available for sale

Pneumococcal polysaccharide vaccine (PPV)

MSD: supply of Pneumovax 23 (PPV23) PFS is available.

Pneumococcal polysaccharide conjugate vaccine (PCV)

Pfizer: Prevenar 13 is currently available.

Varicella zoster vaccine

  • GSK: VARILRIX is currently available
  • MSD: VARIVAX is available
  • MSD: ZOSTAVAX is now a discontinued product

Diphtheria, tetanus, poliomyelitis (inactivated) vaccine

Sanofi Pasteur: Revaxis is available.

Diphtheria, tetanus, pertussis (acellular) and (inactivated) vaccine

  • GSK: supply of Boostrix-IPV is currently available
  • Sanofi Pasteur: Repevax is currently available

MMR

  • MSD: MMR Vaxpro is currently available
  • GSK: Priorix is currently available

Meningitis ACWY vaccine

  • GSK: Menveo is currently out of stock – expected recovery in October
  • Pfizer: Nimenrix is currently available
  • Sanofi Pasteur: MenQuadfi is available

Yellow fever

Sanofi Pasteur: Stamaril is available.

Human papillomavirus (HPV) vaccine

  • MSD: GARDASIL has been discontinued (Please refer to ImmForm for NIP supply status)
  • MSD: Gardasil 9 is currently available
  • GSK: Cervarix has been discontinued

Cholera vaccine

  • Valneva: Dukoral is available
  • Patientric: Vaxchora is available

Japanese encephalitis vaccine

Valneva: Ixiaro is available.

Meningococcal group b vaccine

GSK: Bexsero is currently available

Diphtheria, tetanus, pertussis, hib vaccine and poliomyelitis

GSK: Infanrix IPV+Hib is currently available

Hib + meningococcal group c combined vaccine

GSK: Menitorix is currently available

Live attenuated rotavirus vaccine

GSK: Rotarix is currently available

Herpes zoster vaccine

GSK: Shingrix is currently available

  1. Of the eligible cohorts those marked 1 may be vaccinated by any general practice, regardless of whether they are registered with that general practice. ↩ ↩2 ↩3 ↩4 ↩5

  2. Unless LAIV clinically contraindicated or otherwise unsuitable.  ↩

  3. Children from 2 years of age to school year 11, and children in clinical risk groups aged 2 to <18 years. ↩

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