REMEDY : BNSSG referral pathways

Influenza

Checked: 08-10-2018 by Rob.Adams Next Review: 08-10-2019

Flu vaccination

Please see the PHE Annual Flu Vaccination page for up to date information on the current years vaccination advice and schedule.

FAQ's 2018/19

The following has been taken from the GP bulletin dated 4.10.18:

Following a considerable number of enquiries about what to do when the ‘wrong’ flu vaccine has been given inadvertently and further discussion within the national team about this, Public Health England has revised the guidance on what to do when this occurs. The following advice has been republished in the Inactivated influenza vaccine: information for healthcare practitioners available on the PHE flu immunisation webpage. This can be found on pages 19 and 20 of the attached document.

 

Individuals who have inadvertently been given a flu vaccine that is not the one recommended for their age group

If an individual has inadvertently received a flu vaccine different to the one recommended for their age group, they should be informed of the error and the potential implications of this error. Although both the QIV (Quadrivalent Influenza Vaccine) and aTIV (adjuvanted Trivalent Influenza Vaccine) should provide some protection against flu in all age groups, individuals aged 65 years and over (particularly those more than 75 years of age) may not respond as well to the QIV as they would to the aTIV, and individuals aged under 65 years will not benefit from the opportunity to make protection against an additional flu strain if they have been given aTIV. 

If the individual wishes to receive the vaccine that they should have been given, this can be offered following a discussion of the benefits and risks. The clear benefit is the additional protection that may be offered by the correct vaccine but they should be alerted to the potential increased risk of a local or systemic reaction. Although there is no data available on the safety and effectiveness of administering a second flu vaccine shortly after the first in adults, this advice is based on general principles of vaccination, experience of flu revaccination following cold chain and administration incidents and information about the high dose flu vaccine used in the United States (which contains four times the amount of antigen that is in a single dose of QIV or aTIV).  

If a decision is made to offer the vaccine the individual should have received, it is recommended that this is done as soon as possible after the first dose was given and ideally within a week. This will enable protection to be made as soon as possible. It can still be given if more than a week has elapsed however. 

This advice also applies to those who have been given unadjuvanted TIV.

 

The advice about vaccination for 65+ and under 18 HCWs has also been incorporated into the updated document, along with changes to the latex section and other minor additions/clarifications in response to some of the many flu queries PHE are receiving.  If you are getting queries that are not currently covered in this document that you think would be of use to others, please let us know (england.swscreeningandimms@nhs.net ) and we can pass on to the PHE immunisation team. We have also attached the childhood flu programme information for healthcare professionals, for further reference.

Other Frequently asked questions

The Screening & Immunisation Team is also receiving queries around the aTIV and egg or latex allergies and so the guidance from the programme documents on GOV.uk have been highlighted below:

Latex

Fluad (aTIV) will be supplied to the UK market predominantly as a pre-filled syringe with a syringe tip cap. The manufacturer’s SPC states that no natural rubber latex is detected in the syringe tip cap. The unattached needles supplied along with the pre-filled syringes do not contain latex: the needle hub and needle sheath are both polypropylene.

Egg (ovalbumin) content

There is no ovalbumin-free vaccine available for the 2018/19 flu season.

Inactivated influenza vaccines may contain traces of egg such as ovalbumin. A table stating the ovalbumin content of the flu vaccines for the 2018/19 season is available on the PHE Annual flu programme webpage.

With the exception of those individuals with a severe anaphylaxis to egg which has previously required intensive care, patients with less severe egg allergy can be immunised in any setting using an inactivated influenza vaccine with an ovalbumin content less than 0.12 micrograms/ml (equivalent to 0.06 micrograms in a 0.5 ml dose).

The aTIV vaccine, Fluad, contains more than the recommended ovalbumin content for patients with egg allergy (each 0.5ml dose contains less than or equal to 0.2μg ovalbumin). Patients aged 65 years and over with an egg allergy should therefore be given a quadrivalent vaccine with an ovalbumin content less than 0.12 micrograms/ml (0.06 micrograms in a 0.5 ml dose).

Patients with a previous anaphylactic reaction to egg

Patients with severe anaphylaxis to egg who have previously required intensive care should be referred to specialists for immunisation in hospital. If there is any uncertainty about the cause of an anaphylactic reaction, the patient should be advised to consult with an immunologist.

 

All of these responses and other FAQs can be found here: https://www.gov.uk/government/publications/inactivated-influenza-vaccine-information-for-healthcare-practitioners

If you have any additional questions, please email: england.swscreeningandimms@nhs.net