FAQs

In 2018/19, the latest available flu vaccine uptake data shows the following uptake rates were achieved (including range in vaccine uptake levels by area team):1,2

Eligible group Overall uptake (%) Range in uptake by area team (%)

65 years or older

(n=7,260,596)

72.0 65.4 - 75.1

Clinical risk groups aged 6 months to under 65 years

(n=3,276,592)

48.0 44.4 - 51.6

Pregnant women

(n=293,359)

45.2 41.0 - 51.7

2 and 3 years old

(n=593,706)

44.9 32.4 - 56.5

Frontline healthcare workers2*

(n=739,187)

70.3 63.1 - 72.8

Source: Public Health England (PHE)1,2

Cumulative influenza vaccinations administered in primary care patients from 1 September 2018 to 28 February 2019. Frontline healthcare workers: cumulative vaccinations administered up to and including February 2019.
* By staff group: Highest uptake seen in GP practice nurses and support to clinical staff, lowest uptake seen in support staff to GPs.

PHE targets for uptake in children 2019/20

The NHS childhood flu immunisation programme in England is aiming for 100% offer of immunisation to eligible children – pre-school children aged 2 and 3 years old and all primary school-aged children.3

The uptake ambition for the 2019/20 flu season has been increased, with different figures for pre-school and school-aged children:3

  • Pre-school children aged 2 and 3 years old: At least 50% with most practices aiming to achieve higher3
  • Primary school-aged children: An average of at least 65% to be attained by every provider across all primary school years3

Targets may vary in Northern Ireland and Scotland.4,5 In Wales, specific uptake targets for the 2019/20 flu season have not been set.6

References

  1. Public Health England. Seasonal influenza vaccine uptake in GP patients: winter season 2018 to 2019. Final data for 1 September 2018 to 28 February 2019. May 2019. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/804889/Seasonal_influenza_vaccine_uptake_in_GP_patients_1819.pdf.
  2.  Public Health England. Seasonal influenza vaccine uptake in healthcare workers (HCWs) in England: winter season 2018 to 2019. Final data for 1 September 2018 to 28 February 2019. May 2019. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/804885/Seasonal_influenza_vaccine_uptake-HCWs-2018_Final.pdf.
  3. Van-Tam J, Deputy Chief Medical Officer et al. The national flu immunisation programme 2019/20. 22 March 2019. https://www.england.nhs.uk/wp-content/uploads/2019/03/annual-national-flu-programme-2019-to-2020-1.pdf.
  4. McBride M, Chief Medical Officer et al. Seasonal influenza vaccination programme 2018/19 (Northern Ireland). 14 June 2018. http://www.hscbusiness.hscni.net/pdf/Seasonal%20Influenza%20Vaccination%20Programme%202018-19.pdf.
  5. Calderwood C, Chief Medical Officer et al. Scottish childhood flu vaccination programme 2018-19. 9 August 2018. https://www.sehd.scot.nhs.uk/cmo/CMO(2018)06.pdf.
  6. Atherton F, Chief Medical Officer, Medical Director NHS Wales. Welsh Health Circular WHC (2019) 015. The national influenza immunisation programme 2019-2020. 16 April 2019. http://www.gpone.wales.nhs.uk/sitesplus/documents/1000/WHC2019-015%20-%20The%20National%20Influenza%20Immunisation%20Programme%202019-20_English_WORD.pdf.

Due to the changing nature of influenza viruses, the World Heath Organization (WHO) monitors their epidemiology worldwide and makes recommendations on the strains to be included for the forthcoming winter (for both the northern and southern hemispheres).1,2 Influenza vaccines are then manufactured using virus strains which are in line with these recommendations.1,3

The effectiveness of flu vaccines varies from year to year, depending on variables such as the closeness of the match between the composition of a vaccine and the circulating strains, the type of vaccine and the age of the individual being vaccinated.1

Detailed information on the vaccine effectiveness of Fluenz Tetra can be found here: https://www.gov.uk/government/publications/influenza-vaccine-effectiveness-seasonal-estimates.

Since the programme started in 2013, Public Health England (PHE) has continued to recommend the nasal spray flu vaccine as part of the childhood influenza vaccination programme.4

Vaccine effectiveness in recent seasons 
The 2017/18 (the most recent for which data are currently available) was the fifth season of the NHS childhood immunisation programme:5

  • Provisional end-of-season estimates of vaccine effectiveness showed an adjusted* all-age vaccine effectiveness rate of 15% (95% CI: -6.3, 32.0): against primary care consultations for laboratory-confirmed cases of influenza infection
  • Adjusted vaccine effectiveness* for 2-17-year-olds receiving quadrivalent live attenuated influenza vaccine (Fluenz Tetra) was 26.9% (95% CI: -32.6, 59.7): 90.3% (95% CI: -16.4, 98.9) against A(H1N1)pdm09 and 60.8% (95% CI: 8.2, 83.3) against influenza B. There was no significant effectiveness against A(H3N2)

Vaccine effectiveness in earlier seasons:6,7

  • In 2016/17, the adjusted* vaccine effectiveness rate in 2-17-year-olds was 65.8% (95% CI: 30.3, 83.2): 57.0% (95% CI: 7.7, 80.0) against A(H3N2), and 78.6% (95% CI: -86.0, 97.5) against influenza B6
  • In 2015/16, the adjusted** vaccine effectiveness rate of the quadrivalent live attenuated influenza vaccine (Fluenz Tetra) in 2-17-year-olds was 57.6% (95% CI: 25.1, 76)7

*Adjusted for age, gender, month, pilot area and surveillance scheme
**Adjusted for age, gender, month and surveillance scheme

References
1. Department of Health. Immunisation Against Infectious Disease. (The Green Book.) Chapter 19: Influenza. London: The Stationery Office. April 2019.  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/796886/GreenBook_Chapter_19_Influenza_April_2019.pdf.

2. World Health Organization. Influenza. 2019. https://www.who.int/influenza/en/. (Accessed July 2019).

3. World Health Organization. Influenza. Recommended composition of influenza virus vaccines for use in the 2019-2020 northern hemisphere influenza season. 21 March 2019. https://www.who.int/influenza/vaccines/virus/recommendations/2019_20_north/en/.

4. Van-Tam J, Deputy Chief Medical Officer et al. The national flu immunisation programme 2019/20. 22 March 2019. https://www.england.nhs.uk/wp-content/uploads/2019/03/annual-national-flu-programme-2019-to-2020-1.pdf.

5. Public Health England. Influenza vaccine effectiveness (VE) in adults and children in primary care in the United Kingdom (UK): provisional end-of-season results 2017-18.  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/779474/Influenza_vaccine_effectiveness_in_primary_care_2017_2018.pdf. (Accessed 26 July 2019).

6. Public Health England. Influenza vaccine effectiveness (VE) in adults and children in primary care in the United Kingdom (UK): provisional end-of-season results 2016-17.  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/779475/Influenza_vaccine_effectiveness_in_primary_care_2016_2017.pdf. (Accessed 26 July 2019).

7. Public Health England. Influenza vaccine effectiveness (VE) in adults and children in primary care in the United Kingdom (UK): provisional end-of-season results 2015-16.  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/779476/Influenza_vaccine_effectiveness_in_primary_care_2015_2016.pdf. (Accessed 26 July 2019).

Link to previous years:
https://www.gov.uk/government/publications/influenza-vaccine-effectiveness-seasonal-estimates

The most common adverse events, occurring in at least 1 in 10 recipients, are:1

  • Nasal congestion/rhinorrhoea
  • Headache
  • Decreased appetite
  • Malaise

Other common adverse events, which occur in between 1 in 10 and 1 in 100 recipients, are:1

  • Pyrexia
  • Myalgia

Uncommon adverse events, which occur in between 1 in 100 and 1 in 1000 recipients, are:1

  • Epistaxis
  • Rash and hypersensitivity reactions

Occurrences of Guillain-Barré syndrome and worsening of Leigh syndrome (mitochondrial encephalomyopathy) have been reported very rarely with Fluenz Tetra (both occur in fewer than ;1 in 10,000 recipients).1

References

  1. Fluenz Tetra nasal spray suspension Influenza vaccine (live attenuated, nasal) Summary of Product Characteristics. August 2019. https://www.medicines.org.uk/emc/product/3296/smpc.  

Setting up a flu clinic in your surgery or school can help to increase vaccine uptake among eligible children. To help your clinic run smoothly, here are a few helpful tips:

Prepare in advance – at least three weeks before the clinic

1. Publicise the clinic – making sure parents/guardians as well as children are aware:
    o When and where the clinic will take place
    o How to book appointments
    o Who is eligible
Posters and other materials for you to put on display can be found here: 
www.fluenztetra.co.uk

2. Encourage parents and children to spread the word to their friends:
    o Potential seriousness of flu
    o How flu is spread
Further information for parents and patients can be found here: 
www.sharegoodtimesnotflu.co.uk

3. Send out and collect consent forms well in advance, where needed

On the day – reduce waiting times and increase efficiency 
Ensure you have an adequate supply of:
    o Vaccine
    o Trained staff to administer the flu vaccine
    o Administration staff to manage appointments
    o Space for people to wait
    o Activities to occupy waiting recipients and siblings
    o Refreshments

Fluenz Tetra is a quadrivalent vaccine which contains four live attenuated influenza virus strains (two A strains and two B strains).1

The WHO recommends that the quadrivalent vaccines for use in the 2019/20 northern hemisphere influenza season contain the following:2

  • A/Brisbane/02/2018 (H1N1)pdm09-like virus*
  • A/Kansas14/2017 (H3N2)-like virus
  • B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage)
  • B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage)

*The H1N1 strain in this year’s vaccine is: A/Switzerland/3330/2017 (confirmed as an A/Brisbane/02/2018 pdm09-like virus)1 which complies with the WHO recommendation (northern hemisphere) and EU decision for 2019/2020 season2,3

References

  1. Fluenz Tetra nasal spray suspension Influenza vaccine (live attenuated, nasal) Summary of Product Characteristics. August 2019. https://www.medicines.org.uk/emc/product/3296/smpc.
  2. World Health Organization. Influenza. Recommended composition of influenza virus vaccines for use in the 2019-2020 northern hemisphere influenza season. 21 March 2019. https://www.who.int/influenza/vaccines/virus/recommendations/2019_20_north/en/.
  3. European Medicines Agency. Biologics Working Party Ad hoc Influenza Working Group. Amended EU recommendations for the seasonal influenza vaccine composition for the season 2019/2020. EMA/CHMP/BWP/266098/2019. 15 May 2019. https://www.ema.europa.eu/en/documents/regulatory-procedural-guideline/biologics-working-party-bwp-ad-hoc-influenza-working-group-amended-european-union-recommendations/2020_en.pdf.

The cohorts for the 2019/20 flu season are as follows:

The NHS Seasonal Flu Immunisation Programme offers a free nasal spray flu vaccine to all eligible children aged 2 to 3 (on 31st August 2019) and clinically at-risk* 2-17 year olds in GP surgeries, and all eligible primary school children.1-4

(There may be some variance in Scotland.3
If a child is not eligible for the nasal spray flu vaccine, they may be offered an alternative injectable vaccine.1-4

*Clinically at-risk includes chronic long-term illness such as heart disease, kidney disease, liver disease, neurological disease, asthma and diabetes.1-4

Who is not suitable for a free nasal spray flu vaccine? 
Contraindications for Fluenz Tetra are as follows:

  • Hypersensitivity to the active substances, to any of the excipients listed in section 6.1 of the Summary of Product Characteristics (e.g. gelatine), or to gentamicin (a possible trace residue) 
  • Severe allergic reaction (e.g. anaphylaxis) to eggs or to egg proteins (e.g. ovalbumin)
  • Children and adolescents with clinical immunodeficiency due to conditions or immunosuppressive therapy such as: acute and chronic leukaemias; lymphoma; symptomatic HIV infection; cellular immune deficiencies; and high-dose corticosteroids
  • Children and adolescents younger than 18 years of age receiving salicylate therapy because of the association of Reye’s syndrome with salicylates and wild-type influenza infection

Fluenz Tetra is not contraindicated for use in individuals with asymptomatic HIV infection; or individuals who are receiving topical/inhaled corticosteroids or low-dose systemic corticosteroids or those receiving corticosteroids as replacement therapy, e.g. for adrenal insufficiency. 
For further details, please also see the “Pre-administration checklist for FluenzTM Tetra” for healthcare professionals, downloadable from www.fluenztetra.co.uk/materials.

Other warnings and precautions for the use of Fluenz Tetra:

  • Close association with severely immunocompromised individuals (e.g. bone marrow transplant recipients requiring isolation) should be avoided for vaccine recipients as far as possible for 1–2 weeks following vaccination5
  • Flu antivirals may potentially affect the efficacy of the vaccine. Therefore, the vaccine should not be administered until at least 48 hours after flu antivirals are stopped.5 Flu antivirals may also affect the response to the vaccine if taken in the two weeks following vaccination5  
  • Severe asthma and active wheezing: Fluenz Tetra should not be administered to children and adolescents with severe asthma or active wheezing because these individuals have not been adequately studied in clinical studies5
  • Salicylate therapy: Children or adolescents receiving salicylate therapy must not be given Fluenz Tetra as there is an association between the use of salicylates and Reye’s syndrome during influenza infection.5 For the same reason, salicylates must not be given for 4 weeks following vaccination unless medically indicated5
  • Gelatine: This nasal spray flu vaccine contains a highly processed form of gelatine (porcine, derived from pigs),5 which is used globally in many essential medicines.6 Some faith groups accept the use of porcine gelatin in medical products6 – the decision is, of course, up to the parents or guardians of your patient. For further information about porcine gelatine and the nasal influenza vaccine, seeVaccines and porcine gelatine:
    https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/751199/Vaccines_porcine_gelatine.pdf.
  • Pregnancy and breast-feeding: Fluenz Tetra is not recommended during pregnancy and should not be used during breast-feeding5

References

  1. Van-Tam J, Deputy Chief Medical Officer et al. The national flu immunisation programme 2019/20. 22 March 2019. 
    https://www.england.nhs.uk/wp-content/uploads/2019/03/annual-national-flu-programme-2019-to-2020-1.pdf.
  2. McBride M, Chief Medical Officer et al. Seasonal influenza vaccination programme 2018/19 (Northern Ireland). 14 June 2018.
    http://www.hscbusiness.hscni.net/pdf/Seasonal%20Influenza%20Vaccination%20Programme%202018-19.pdf.
  3. Calderwood C, Chief Medical Officer et al. Scottish childhood flu vaccination programme 2018-19. 9 August 2018.
    https://www.sehd.scot.nhs.uk/cmo/CMO(2018)06.pdf.
  4. Atherton F, Chief Medical Officer, Medical Director NHS Wales. Welsh Health Circular WHC (2019) 015. The national influenza immunisation programme 2019-2020. 16 April 2019.
    http://www.gpone.wales.nhs.uk/sitesplus/documents/1000/WHC2019-015%20-%20The%20National%20Influenza%20Immunisation%20Programme%202019-20_English_WORD.pdf.
  5. Fluenz Tetra nasal spray suspension Influenza vaccine (live attenuated, nasal) Summary of Product Characteristics. August 2019.
    https://www.medicines.org.uk/emc/product/3296/smpc.
  6. Public Health England, NHS. Vaccines and porcine gelatine. October 2018.
    https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/751199/Vaccines_porcine_gelatine.pdf.

Several different flu vaccines are available for use in the UK.1,2 Some are trivalent, containing two subtypes of influenza A and one B virus. Quadrivalent vaccines contain an additional B virus and are now routinely available.2 The use of any vaccine should be based on official recommendations. 

Types of flu vaccines included in the national flu immunisation programme 2019/20:1

  • Egg-grown quadrivalent live attenuated influenza vaccine (LAIV) (Fluenz Tetra)
  • Standard egg-grown quadrivalent influenza vaccine (QIVe)
  • Cell-grown quadrivalent influenza vaccine (QIVc)
  • Adjuvanted trivalent influenza vaccine (aTIV)

References

  1. Van-Tam J, Deputy Chief Medical Officer et al. The national flu immunisation programme 2019/20. 22 March 2019.
    https://www.england.nhs.uk/wp-content/uploads/2019/03/annual-national-flu-programme-2019-to-2020-1.pdf.
  2. Department of Health. Immunisation Against Infectious Disease. (The Green Book.) Chapter 19: Influenza. London: The Stationery Office. April 2019. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/796886/GreenBook_Chapter_19_Influenza_April_2019.pdf.
  • Children, particularly those of school age, contribute considerably to the spread of flu to their nursery and school friends, families and communities1-3
  • Influenza causes absenteeism and lost productivity, with children missing school or day care and their parents or guardians missing work3
  • A study across 14 flu seasons from 1995 to 2009 used Clinical Practice Research Datalink (CPRD) and Public Health England data to show the burden of flu in primary care4
  • Seasonal mean estimates of flu-attributable GP consultations in the UK were 857,996 for respiratory disease* (broadly defined), of which around 75% were for Influenza A.4 The highest rates of GP consultations for Influenza A were seen in children <5 years old4
  • Mathematical modelling in a study showed that that vaccinating as few as 50% of 2 to <18 year olds  with live attenuated influenza vaccine (LAIV) could result in a substantial reduction (up to 84%) in the annual number of GP consultations resulting from influenza A and B infections5
  • A dynamic transmission model showed that paediatric vaccination of 2 to <18 year olds appears to be a highly cost-effective intervention that directly protects those targeted for vaccination, with indirect protection extending to both the very young and the elderly6
  • Public Health England states that vaccinating children each year not only helps to protect children themselves but there will be reduced transmission across all age groups, lessening levels of flu overall and reducing the burden of flu across the population7

*GP consultations were logged using READ codes combined into respiratory diagnoses consistent with recognised ICD-10 groupings. Flu-attributable consultations included all disorders in the ICD-10 respiratory disease chapter, otitis media, and selected presenting symptom codes that were used in some GP surgeries in lieu of specifying a clinical diagnosis.4

References

  1. Principi N et al. Pediatr Infect Dis J. 2003;22(10):S207–10. doi: 10.1097/01.inf.0000092188.48726.e4. 
  2. Neuzil KM et al. Arch Pediatr Adolesc Med. 2002;156(10):986-991. 
  3. Ambrose CS, Antonova EN. Eur J Clin Microbiol Infect Dis. 2014;33(4):569-575 doi: 10.1007/s10096-013-1986-6. 
  4. Fleming DM et al. Epidemiol Infect. 2016;144:537-547 doi: 10.1017/S0950268815001119. 
  5. Pitman RJ et al. Vaccine. 2012;30(6):1208-1224 doi: 10.1016/j.vaccine.2011.11.106. 
  6. Pitman RJ et al. Vaccine. 2013;31(6):927-942 doi: 10.1016/j.vaccine.2012.12.010. 
  7. Van-Tam J, Deputy Chief Medical Officer et al. The national flu immunisation programme 2019/20. 22 March 2019. https://www.england.nhs.uk/wp-content/uploads/2019/03/annual-national-flu-programme-2019-to-2020-1.pdf.
  • Fluenz Tetra should be kept in a refrigerator (2-8⁰C). Do not freeze1
  • The nasal applicator should be kept in the carton to protect it from light1
  • Before use, the vaccine may be taken out of the refrigerator for a maximum period of 12 hours at a temperature not above 25⁰C. It should not be returned to the refrigerator1
  • After 12 hours, Fluenz Tetra should be used immediately or discarded1

Reference

  1. Fluenz Tetra nasal spray suspension Influenza vaccine (live attenuated, nasal) Summary of Product Characteristics. August 2019. https://www.medicines.org.uk/emc/product/3296/smpc

Co-administration of Fluenz Tetra with the live attenuated vaccines for measles, mumps, rubella, varicella and orally administered poliovirus has been studied. Only the immune response to the rubella vaccine was significantly altered.1 However, this alteration may not be of clinical relevance with the two-dose immunisation schedule of the rubella vaccine.1

Co-administration of Fluenz Tetra with inactivated vaccines has not been studied.1

Based on the potential for influenza antiviral agents to reduce the effectiveness of Fluenz Tetra, administration of Fluenz Tetra is not recommended until 48 hours after the cessation of influenza antiviral therapy. If Fluenz Tetra is administered at the same time as influenza antiviral agents, revaccination should be considered.1

References

  1. Fluenz Tetra nasal spray suspension Influenza vaccine (live attenuated, nasal) Summary of Product Characteristics. August 2019. https://www.medicines.org.uk/emc/product/3296/smpc.

Fluenz Tetra should not be used once it has gone past its expiry date. Fluenz Tetra has a maximum shelf life of 18 weeks. Check the expiry date (day, month, year) on individual sprayers before administration.1  Discard any unused vaccine at the end of the vaccination season to prevent use of expired vaccine.

If expired Fluenz Tetra is administered, this should be reported as an adverse event.

Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to AstraZeneca by visiting https://aereporting.astrazeneca.com or by calling 0800 783 0033.

The primary concern with administering expired Fluenz Tetra vaccine is that the vaccine strains may lose their effective potency.

There is no scientific evidence suggesting that administration of an expired dose of Fluenz Tetra would increase the risk of reactogenicity or other adverse safety outcomes, other than potential lack of influenza protection.

A clinical decision will need to be made as to whether to re-administer another unexpired vaccine in order to ensure the patient has adequate protection.

If a clinical decision is made to re-administer a vaccine dose, it should be with a properly stored, unexpired dose of Fluenz Tetra (if available) or inactivated influenza vaccine.    

Reference

  1. Fluenz Tetra nasal spray suspension Influenza vaccine (live attenuated, nasal) Summary of Product Characteristics. August 2019. https://www.medicines.org.uk/emc/product/3296/smpc.

GP surgeries

GPs in England will be subject to similar ordering controls to those that have been in place for the past 3 years. Further details of those controls will be made available in Vaccine Update and on ImmForm news over the summer, to enable informed local planning. Public Health England (PHE) will also be working with NHS England to better understand the requirements and ordering practices of school providers with a view towards minimising wastage in this part of the programme.1
As in previous years, PHE has centrally procured flu vaccine for children included in this year’s flu programme, including those aged from six months to less than 18 years old in clinical risk groups. Supplies are available to providers of the children’s flu programme in England via ImmForm.1

It remains the responsibility of GPs and other providers to order sufficient flu vaccine directly from manufacturers for older eligible patients of the flu programme in 2019/20.1

Information on vaccine availability is provided and published by your respective health departments in Scotland, Wales and Northern Ireland. 

If you wish to purchase stock for anyone outside the groups covered by the national programme but within licence, please contact 0845 139 0000 to purchase Fluenz Tetra.

For private purchases, Fluenz Tetra is supplied under AstraZeneca’s standard terms and conditions of supply, subject to the following additional provisions:

  • Fluenz Tetra requires cold chain storage and it is your responsibility to ensure that it is kept in the proper conditions at all times
  • Fluenz Tetra is not provided on a ‘sale or return’ basis: if you do not sell or use the stocks of Fluenz Tetra that you purchase from AstraZeneca then you will have no right to return it to AstraZeneca and/or claim a refund

There are no private ‘pre-orders’ for Fluenz Tetra, sufficient stock will be available to order privately at the start of the flu season.

Pharmacy

Some pharmacies may be taking part in the national childhood influenza vaccination programme. If so, please contact your local coordinator to ensure correct ordering channel.

If you wish to purchase privately, please call 0845 139 0000. For private purchases, Fluenz Tetra is supplied under AstraZeneca’s standard terms and conditions of supply, subject to the following additional provisions:

  • Fluenz Tetra requires cold chain storage and it is your responsibility to ensure that it is kept in the proper conditions at all times
  • Fluenz Tetra is not provided on a ‘sale or return’ basis: if you do not sell or use the stocks of Fluenz Tetra that you purchase from AstraZeneca then you will have no right to return it to AstraZeneca and/or claim a refund

Pack information
Pack Description: Fluenz Tetra Nasal Spray 10 x 0.2ml
All codes will be available from AstraZeneca.

Reference

  1. Van-Tam J, Deputy Chief Medical Officer et al. The national flu immunisation programme 2019/20. 22 March 2019. https://www.england.nhs.uk/wp-content/uploads/2019/03/annual-national-flu-programme-2019-to-2020-1.pdf.

Influenza immunisation training:

Training and information about the influenza immunisation programme for the 2019/20 season is available from Public Health England:
https://publichealthengland-immunisati.app.box.com/s/48xi8ezl0lmifo09qiebpsmzsqc0sib6

Nasal spray e-learning module:
Royal College of Nursing-accredited e-module

  • Refresh your knowledge if you've taken the module in previous years
  • Includes access to a step-by-step Fluenz Tetra administration guide
  • A certificate will be emailed to you on completion of the module

Materials for GP surgeries, schools and parents:
See elsewhere on www.fluenztetra.co.uk and also www.sharegoodtimesnotflu.co.uk for a wide range of support materials to download or order. This includes materials for GP surgeries (or HCPs and waiting rooms), for parents, and also for schools immunisation teams.

Public Health England provides the following information for parents/guardians:

Alternatively, you can order from:
Health and Social Care Publications orderline 
Health and Social Care Publications 
PO Box 777 
London SE1 6XH 
Telephone: 0300 123 1002 

External Resources

Flu plan 2019/ 2020


Seasonal influenza vaccine uptake and effectiveness since launch


Influenza: The Green Book,
chapter 19


Information on the supply of
Fluenz Tetra


Weekly national flu reports

Published by Public Health England.

Questions your patients may ask

The main symptoms of flu and the common cold can be similar, so it can be difficult to tell them apart based on symptoms alone.1 They are actually caused by different viruses, and in general flu is worse than the common cold with more intense symptoms, while colds are usually milder.1 Children with flu will not have the energy to play and will want to stay in bed more than normal.2 Someone with a cold is more likely to have a runny or stuffy nose.1
Colds do not generally cause serious health problems.1 With flu, however, beyond the symptoms in the table below, serious complications can occur in some children, including painful ear infection, acute bronchitis and pneumonia.3,4

SIGNS & SYMPTOMS

FLU

COLD

Symptom onset

Abrupt

Gradual

Fever

Usual

Rare

Aches

Usual

Slight

Chills

Fairly common

Uncommon

Fatigue/weakness

Usual

Sometimes

Sneezing/stuffy nose

Sometimes

Common

Sore throat

Sometimes

Common

Chest discomfort, cough

Common

Mild to moderate

Headache

Common

Rare

Adapted from: Centers for Disease Control and Prevention, Is it a cold or flu?1

References:

1. Centers for Disease Control and Prevention. Influenza (flu). Cold versus flu. Last reviewed 8 February 2019. https://www.cdc.gov/flu/symptoms/coldflu.htm

2. Canadian Paediatric Society. Caring for Kids. Influenza in children. Last updated August 2015. https://www.caringforkids.cps.ca/handouts/influenza_in_children

3. Public Health England, NHS. Protecting your child against flu. Information for parents. Flu immunisation in England. May 2019. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/806857/PHE_Protecting_Child_Against_Flu_leaflet.pdf.

4. NHS. Vaccinations. Children’s flu vaccine. Last reviewed July 2019. https://www.nhs.uk/conditions/vaccinations/child-flu-vaccine/.

Seasonal flu has an annual incidence rate estimated at 5%-10% in adults and 20%-30% in children, globally.1

Flu can cause serious illness and even death.2 Young children are at greatest risk of catching flu and bear a substantial, yet under-recognised burden, due to frequent complications and hospitalisations.2,3

As well as those with existing health problems, healthy children are also susceptible to flu and its associated complications, such as pneumonia and middle ear infections (otitis media).2,4,5

Children, particularly those of school age, contribute considerably to the spread of flu to their nursery and school friends, families and communities.4,6,7

Influenza causes absenteeism and lost productivity, with children missing school or day care and their parents or guardians missing work.7

A study across 14 flu seasons from 1995-2009 used Clinical Practice Research Datalink (CPRD) and Public Health England data to show the burden of flu in primary care.8 Seasonal mean estimates of flu-attributable GP consultations in the UK were 857,996 for respiratory disease* (broadly defined), of which around 75% were for Influenza A.8

The highest rates of GP consultations for Influenza A were seen in children <5 years old.8

Mathematical modelling in a study showed that vaccinating as few as 50% of 2 to <18 year olds with live attenuated influenza virus (LAIV) could result in a substantial reduction (up to 84%) in the annual number of GP consultations resulting from influenza A and B infections.9

A dynamic transmission model showed that paediatric vaccination of 2 to <18 year olds appears to be a highly cost-effective intervention that directly protects those targeted for vaccination, with indirect protection extending to both the very young and the elderly.10

Public Health England states that vaccinating children each year not only helps to protect children themselves but also reduces transmission across all age groups, lessening levels of flu overall and reducing the burden of flu across the population.11

*GP consultations were logged using READ codes combined into respiratory diagnoses consistent with recognised ICD-10 groupings. Flu-attributable consultations included all disorders in the ICD-10 respiratory disease chapter, otitis media, and selected presenting symptom codes that were used in some GP surgeries in lieu of specifying a clinical diagnosis.8

References:

1. World Health Organization. Biologicals. Influenza. Last reviewed November 2018. https://www.who.int/biologicals/vaccines/influenza/en/

2. Centers for Disease Control and Prevention.Children & influenza. Last reviewed April 2019. https://www.cdc.gov/flu/highrisk/children.htm

3. Usonis V et al. BMC Infect Dis. 2010;10:168. doi: 10.1186/1471-2334-10-168.

4. Principi N et al. Pediatr Infect Dis J. 2003;22(10):S207–10. doi: 10.1097/01.inf.0000092188.48726.e4.

5. Heikkinen T et al. Eur J Pediatr. 2006;165(4):223-228 doi: 10.1007/s00431-005-0040-9. 

6. Neuzil KM et al. Arch Pediatr Adolesc Med. 2002;156(10):986-991. 

7. Ambrose CS, Antonova EN. Eur J Clin Microbiol Infect Dis. 2014;33(4):569-575 doi: 10.1007/s10096-013-1986-6. 

8. Fleming DM et al. Epidemiol Infect. 2016;144:537-547 doi: 10.1017/S0950268815001119. 

9. Pitman RJ et al. Vaccine. 2012;30(6):1208-1224 doi: 10.1016/j.vaccine.2011.11.106. 

10. Pitman RJ et al. Vaccine. 2013;31(6):927-942 doi: 10.1016/j.vaccine.2012.12.010. 

11. Van-Tam J, Deputy Chief Medical Officer et al. The national flu immunisation programme 2019/20. 22 March 2019. https://www.england.nhs.uk/wp-content/uploads/2019/03/annual-national-flu-programme-2019-to-2020-1.pdf

The NHS Seasonal Flu Immunisation Programme offers a free nasal spray flu vaccine to all eligible children aged 2 to 3 (on 31st August 2019) and clinically at-risk* 2-17 year olds in GP surgeries, and all eligible primary school children.1-4 (There may be some variance in Scotland.3)

If a child is not eligible for the nasal spray flu vaccine, they may be offered an alternative injectable vaccine.1-4

*Clinically at-risk includes chronic long-term illness such as heart disease, kidney disease, liver disease, neurological disease, asthma and diabetes.1-4

References

1. Van-Tam J, Deputy Chief Medical Officer et al. The national flu immunisation programme 2019/20. 22 March 2019. https://www.england.nhs.uk/wp-content/uploads/2019/03/annual-national-flu-programme-2019-to-2020-1.pdf

2. McBride M, Chief Medical Officer et al. Seasonal influenza vaccination programme 2018/19 (Northern Ireland). 14 June 2018. http://www.hscbusiness.hscni.net/pdf/Seasonal%20Influenza%20Vaccination%20Programme%202018-19.pdf

3. Calderwood C, Chief Medical Officer et al. Scottish childhood flu vaccination programme 2018-19. 9 August 2018. https://www.sehd.scot.nhs.uk/cmo/CMO(2018)06.pdf.

4. Atherton F, Chief Medical Officer, Medical Director NHS Wales. Welsh Health Circular WHC (2019) 015. The national influenza immunisation programme 2019-2020. 16 April 2019. http://www.gpone.wales.nhs.uk/sitesplus/documents/1000/WHC2019-015%20-%20The%20National%20Influenza%20Immunisation%20Programme%202019-20_English_WORD.pdf.

The virus that causes flu is constantly changing so it is very important to have the vaccine each year to protect against the latest form of the virus.1,2

Every year, the World Health Organization (WHO) recommends which virus strains should be used in flu vaccines for the next flu season − since vaccines have to be prepared well in advance of the season.1,2

Fluenz Tetra vaccine helps the child’s immune system recognise the flu virus so they can build an immune response to help prevent the child getting ill from flu.

References 

1. Department of Health. Immunisation Against Infectious Disease. (The Green Book.) Chapter 19: Influenza. London: The Stationery Office. April 2019. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/796886/GreenBook_Chapter_19_Influenza_April_2019.pdf.

2. WHO. Influenza. Recommended composition of influenza virus vaccines for use in the 2019-2020 northern hemisphere influenza season. 21 March 2019.
https://www.who.int/influenza/vaccines/virus/recommendations/2019_20_north/en/.

In England, children of primary school age (date of birth on or after 1 September 2008 and on or before 31 August 2015) will be offered the vaccine at school if their school is taking part in the UK national flu vaccination programme.1 

In some areas, the UK national flu vaccination programme may be delivered by an alternative provider such as a GP surgery.

If your 4-year-old child is clinically at risk*, and Fluenz Tetra is not available at their school, they can receive it at a GP surgery.1

*Clinically at risk includes chronic long-term illness such as heart disease, kidney disease, liver disease, neurological disease, asthma and diabetes.1

References:

  1. Van-Tam J, Deputy Chief Medical Officer et al. The national flu immunisation programme 2019/20. 22 March 2019. https://www.england.nhs.uk/wp-content/uploads/2019/03/annual-national-flu-programme-2019-to-2020-1.pdf.

The effectiveness of flu vaccines varies from year to year, depending on the match between the flu viruses circulating and what is in flu vaccines.1

Flu viruses are clever and change constantly, and every year the World Health Organization (WHO) recommends which virus strains should be used in vaccines for the next flu season − since vaccines have to be prepared well in advance.2,3

Other factors that can affect the effectiveness of vaccines include the type of vaccine and the age of the person being vaccinated.1

Since the programme started in 2013, Public Health England (PHE) has continued to recommend the nasal spray flu vaccine as part of the childhood influenza vaccination programme.4

Detailed information on the vaccine effectiveness of Fluenz Tetra can be found here: https://www.gov.uk/government/publications/influenza-vaccine-effectiveness-seasonal-estimates.

References

  1. Department of Health. Immunisation Against Infectious Disease. (The Green Book.) Chapter 19: Influenza. London: The Stationery Office. April 2019. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/796886/GreenBook_Chapter_19_Influenza_April_2019.pdf.
  2. Centers for Disease Control and Prevention. Influenza (Flu). Vaccine effectiveness: how well do the flu vaccines work? 12 October 2018. https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm.
  3. WHO. Influenza. Recommended composition of influenza virus vaccines for use in the 2019-2020 northern hemisphere influenza season. 21 March 2019. https://www.who.int/influenza/vaccines/virus/ recommendations/2019_20_north/en/.
  4. Van-Tam J, Deputy Chief Medical Officer et al. The national flu immunisation programme 2019/20. 22 March 2019. https://www.england.nhs.uk/wp-content/uploads/2019/03/annual-national-flu-programme-2019-to-2020-1.pdf.
  • Fluenz Tetra is thiomersal-free1
  • There is no latex in the raw materials of this vaccine or in any components of the sprayer. However, it is possible this vaccine or sprayer could have been exposed to latex during the packaging process1

References

1. Centre for Clinical Vaccinology and Tropical Medicine, Oxford Vaccine Group. Vaccine Knowledge Project. Vaccine ingredients. Last reviewed 4 July 2019. http://vk.ovg.ox.ac.uk/vaccine-ingredients#thiomersal.

External Resources

Flu plan 2019/ 2020


Seasonal influenza vaccine uptake and effectiveness since launch


Influenza: The Green Book,
chapter 19


Information on the supply of
Fluenz Tetra


Weekly national flu reports

Published by Public Health England.

GB-17971 - September 2019