FAQs

In 2019/20, 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=7,621,505)

72.4 66.2 -75.5

Clinical risk groups aged 6 months to under 65 years

(n=3,204,299)

44.9 41.8-48.6

Pregnant women

(n=282,092)

43.7 39.2-50.2

2 and 3 years old

(n=590,041)

43.8 32.4-54.0

Frontline healthcare workers2*

(n=791,112)

74.3 66.2-83.1

Source: Public Health England (PHE)1,2

Cumulative influenza vaccinations administered in primary care patients from 1 September 2019 to 29 February 2020. Frontline healthcare workers: cumulative vaccinations administered up to and including February 2020.
* By staff group: Highest uptake seen in support to clinical staff, lowest uptake seen in support staff to GPs.

PHE targets for uptake in children 2020/21

NHS England is aiming to increase vaccine uptake rates, to a target of at least 75% in eligible pre-school children, and at least 75% in eligible school-aged children.3

Targets may vary in Northern Ireland, Scotland and Wales.

References

  1. Public Health England. Seasonal influenza vaccine uptake in GP patients: winter season 2019 to 2020. Final data for 1 September 2019 to 29 February 2020. June 2020. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/912099/Annual-Report_SeasonalFlu-Vaccine_GPs_2019-20_FINAL_amended.pdf.
  2. Seasonal influenza vaccine uptake in healthcare workers (HCWs) in England: winter season 2019 to 2020. Final data for 1 September 2019 to 29 February 2020. June 2020. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/894751/Seasonal_influenza_vaccine_uptake_in_healthcare_workers__HCWs__in_Englan....pdf.
  3. Whitty C, Doyle Y & Powis S. The national flu immunisation programme 2020 to 2021- update. 05 August 2020. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907149/Letter_annualflu_2020_to_2021_update.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.1,2

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.3

Vaccine effectiveness in recent seasons 
The 2018/19 season (the most recent for which data are currently available) was the sixth season of the NHS childhood immunisation programme:4

  • Mid-season data suggest vaccine effectiveness of 87% in children aged 2 to 17 years against the main circulating strain, influenza A(H1N1)pmd09. Effectiveness data against influenza B strains are unavailable

Vaccine effectiveness in earlier seasons:5-7

  • In 2017/18, 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)5
  • 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.  Available at: 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. Recommended composition of influenza virus vaccines for use in the 2020-2021 northern hemisphere influenza season. 28 February 2020. Available at: https://www.who.int/influenza/vaccines/virus/recommendations/2020-21_north/en/.

3. Whitty C, Doyle Y & Powis S. The national flu immunisation programme 2020 to 2021- update. 05 August 2020. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907149/Letter_annualflu_2020_to_2021_update.pdf.

4. Gov.uk. Children's vaccine 87% effective against circulating flu strain. 22 February 2019. Available at: https://www.gov.uk/government/news/childrens-vaccine-87-effective-against-circulating-flu-strain.

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.  Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/779474/Influenza_vaccine_effectiveness_in_primary_care_2017_2018.pdf. (Accessed July 2020).

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.  Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/779475/Influenza_vaccine_effectiveness_in_primary_care_2016_2017.pdf. (Accessed July 2020).

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.  Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/779476/Influenza_vaccine_effectiveness_in_primary_care_2015_2016.pdf. (Accessed July 2020).

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
  • Decreased appetite
  • Malaise

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

  • Pyrexia
  • Myalgia
  • Headache

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 Summary of Product Characteristics. Available at: 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 Consideration for social distancing
    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 egg-based, quadrivalent vaccines for use in the 2020-2021 northern hemisphere influenza season contain the following:2

  • A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus
  • A/Hong Kong/2671/2019 (H3N2)-like virus
  • B/Washington/02/2019 (B/Victoria lineage)-like virus
  • B/Phuket/3073/2013 (B/Yamagata lineage)-like virus

*The H1N1 strain in this year’s vaccine is: A/Hawaii/66/2019 MEDI 326775 (confirmed as an A/Guangdong-Maonan/SWL1536/2019 pdm09-like virus)1 which complies with the WHO recommendation (Northern Hemisphere) and EU decision for 2020/21 season2,3

References

  1. Fluenz Tetra Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/3296/smpc.
  2. World Health Organization. Influenza. Recommended composition of influenza virus vaccines for use in the 2020-2021 northern hemisphere influenza season. 28 Februrary 2020. Available at: https://www.who.int/influenza/vaccines/virus/recommendations/2020-21_north/en/.
  3. European Medicines Agency. Biologics Working Party Ad hoc Influenza Working Group. EMA/CHMP/BWP/134670/2020. 08 May 2020. Available at: https://www.ema.europa.eu/en/documents/regulatory-procedural-guideline/biologics-working-party-bwp-ad-hoc-influenza-working-group-amended-european-union-recommendations/2021_en.pdf.

The cohorts for the 2020/21 flu season are as follows:

The NHS Seasonal Flu Immunisation Programme offers a free nasal spray flu vaccine to all eligible children in England aged 2 and 3 years old, school children in Reception to Year 7, and those clinically at risk aged 2-17 years.*1

There may be some variance across the UK within the other devolved nations: please check the respective communications for Wales, Northern Ireland and Scotland.
If a child is not eligible for the nasal spray flu vaccine, they may be offered an alternative injectable vaccine.1

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

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 immunisation teams, 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 vaccination2
  • 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.2 Flu antivirals may also affect the response to the vaccine if taken in the two weeks following vaccination2  
  • 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 studies2
  • 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.2 For the same reason, salicylates must not be given for 4 weeks following vaccination unless medically indicated2
  • Gelatine: This nasal spray flu vaccine contains a highly processed form of gelatine (porcine, derived from pigs),2 which is used globally in many essential medicines.3 Some faith groups accept the use of porcine gelatin in medical products3 – 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-feeding2

References

  1. Whitty C, Doyle Y & Powis S. The national flu immunisation programme 2020 to 2021- update. 05 August 2020. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907149/Letter_annualflu_2020_to_2021_update.pdf.
  2. Fluenz Tetra Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/3296/smpc.
  3. Public Health England, NHS. Vaccines and porcine gelatine. October 2018. Available at:
    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 2020/21:1

  • 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)
  • High-dose egg-grown trivalent influenza vaccine (TIV-HD)

References

  1. Whitty C, Doyle Y & Powis S. The national flu immunisation programme 2020 to 2021- update. 05 August 2020. Available at:
    https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907149/Letter_annualflu_2020_to_2021_update.pdf.
  2. Department of Health. Immunisation Against Infectious Disease. (The Green Book.) Chapter 19: Influenza. London: The Stationery Office. April 2019. Available at: 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

*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. 
  • 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
  • At 12 hours, Fluenz Tetra should be used immediately or discarded1

Reference

  1. Fluenz Tetra Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/3296/smpc.

Co-administration of trivalent Fluenz 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

Reference

  1. Fluenz Tetra Summary of Product Characteristics. Available at: 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.

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 or inactivated influenza vaccine.    

Reference

  1. Fluenz Tetra Summary of Product Characteristics. Available at: 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 4 years. Further details of those controls are available in Vaccine Update and on ImmForm to enable informed local planning.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 2020/21.2

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 for the correct ordering procedure.

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.

References

  1. Whitty C, Doyle Y & Powis S. The national flu immunisation programme 2020 to 2021- update. 05 August 2020. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907149/Letter_annualflu_2020_to_2021_update.pdf.
  2. Whitty C, Doyle Y & Powis S. The national flu immunisation programme 2020/21. 14 May 2020. Available at: https://www.england.nhs.uk/wp-content/uploads/2020/05/national-flu-immunisation-programme-2020-2021.pdf.

Influenza immunisation training:

Training and information about the influenza immunisation programme for the 2020/21 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 (for HCPs and waiting rooms), for parents, and also for schools immunisation teams.

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

  • Protecting your child against flu leaflet 
  • 5 reasons to vaccinate your child poster

These are available from https://www.gov.uk/government/publications/flu-vaccination-leaflets-and-posters

Alternatively, you can order from:
Health publications orderline
Immunisation Publications Department
Immunisation and Countermeasures
Public Health England
National Infection Service
61 Colindale Avenue
Colindale
London NW9 5EQ
Telephone: 0300 123 1002

External Resources

Flu plan 2020/ 2021


Seasonal influenza vaccine uptake in GP practices


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 30 December 2019. Available at: https://www.cdc.gov/flu/symptoms/coldflu.htm.

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

3. Public Health England, NHS. Protecting your child against flu. Information for parents and carers. July 2020. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907433/Protecting_Child_Against_Flu_DL_leaflet_2020.pdf.

4. NHS Website. Vaccinations. Children’s flu vaccine. Last reviewed July 2019. Available at: 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

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

*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 June 2019. Available at: https://www.who.int/biologicals/vaccines/influenza/en/

2. Centers for Disease Control and Prevention.Children & influenza. Last reviewed October 2019. Available at: 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. 

The NHS Seasonal Flu Immunisation Programme offers a free nasal spray flu vaccine to all eligible children in England aged 2 and 3 years old, school children in Reception to Year 7, and those clinically at risk aged 2-17 years.*1

There may be some variance across the UK within the other devolved nations; please check with your GP, nurse or pharmacist.2-5

If a child is not eligible for the nasal spray flu vaccine, they may be offered an alternative injectable vaccine.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. Whitty C, Doyle Y & Powis S. The national flu immunisation programme 2020 to 2021- update. 05 August 2020. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907149/Letter_annualflu_2020_to_2021_update.pdf.

2. Smith G, McQueen F & Parr RM. Scottish childhood flu vaccination programme 2020-21. 26 June 2020. Available at: https://www.sehd.scot.nhs.uk/cmo/CMO(2020)17.pdf.

3. NHS inform. Flu vaccine. Last reviewed 09 September 2020. Available at: https://www.nhsinform.scot/healthy-living/immunisation/vaccines/flu-vaccine.

4. Atherton F. Welsh Health Circular. WHC (2020) 013. The national influenza immunisation programme 2020-21 (2). Available at: https://gov.wales/sites/default/files/publications/2020-08/national-influenza-immunisation-programme-2020-21.pdf.

5. Northern Ireland Department of Health. Flu vaccination programme to be expanded. 18 August 2020. Available at: https://www.health-ni.gov.uk/news/flu-vaccination-programme-be-expanded.

 

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. Available at: 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 2020-2021 northern hemisphere influenza season. 28 February 2020. Available at:
https://www.who.int/influenza/vaccines/virus/recommendations/2020-21_north/en/.

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. Available at: 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? 3 January 2020. Available at: https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm.
  3. WHO. Influenza. Recommended composition of influenza virus vaccines for use in the 2020-2021 northern hemisphere influenza season. 28 February 2020. Available at: https://www.who.int/influenza/vaccines/virus/recommendations/2020-21_north/en/.
  4. Whitty C, Doyle Y & Powis S. The national flu immunisation programme 2020 to 2021- update. 05 August 2020. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907149/Letter_annualflu_2020_to_2021_update.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

Reference

1. Centre for Clinical Vaccinology and Tropical Medicine, Oxford Vaccine Group. Vaccine Knowledge Project. Vaccine ingredients. Last reviewed 30 August 2019. Available at: http://vk.ovg.ox.ac.uk/vaccine-ingredients#thiomersal.

External Resources

Flu plan 2020/ 2021


Seasonal influenza vaccine uptake in GP practices


Influenza: The Green Book,
chapter 19


Information on the supply of
Fluenz Tetra


Weekly national flu reports

Published by Public Health England.

GB-22675 - October 2020