Bite-sized Learning: Flu update

Next week (1 October) sees the start of the annual seasonal flu vaccination campaign starts in earnest, and general practice nurses are being urged to encourage vaccine uptake in everyone who is eligible for the national programme

INTRODUCTION

The flu vaccination programme is an important priority for reducing morbidity, mortality and hospitalisation associated with flu during the winter period, when the NHS and social care are under pressure. The children’s programme also reduces transmission of the virus across the community.

Eligibility for this autumn’s vaccination programme has not changed since last year. Those in clinical risk groups, older adults, and pregnant women are eligible alongside the offer as part of the children’s programme to 2 and 3 year olds, all primary school aged children, and secondary school aged children up to Year 11.

WHAT’S THE PROBLEM

Last season (2024 to 2025) saw higher flu levels than the previous season. In England, influenza-attributable excess mortality was estimated at 7,757 deaths, and there were 53 paediatric deaths, both exceeding figures for the previous year (2023 to 2024). The vaccines last season were relatively well matched to the predominant circulating strain, reducing the chances of at-risk adults being hospitalised by almost half, and children by two thirds. Recent UKHSA modelling shows flu vaccination prevented around 100,000 hospitalisations in England last year. Vaccination also reduces the volume of GP consultations, and helps to ease pressure on A&E.

As last season, the flu vaccination programme for adults is planned to start later than in previous seasons, with most adults to be offered a vaccine from 1 October. This aligns with COVID-19 vaccinations to enable co-administration of both vaccines wherever possible.

The Green Book Influenza Chapter at https://www.gov.uk/government/publications/influenza-the-green-book-chapter-19 has recently been updated to include the Joint Committee on Vaccination and Immunisation (JCVI) advice on flu vaccines and timing of the programme, the Patient Group Directions (PGDs), and training materials for healthcare professionals.

A winter vaccinations communications campaign, which began in September, will gradually be ramped up throughout September, with national paid for marketing activity starting to target pregnant women and children and expanding to include at risk groups in October, to encourage the uptake of flu vaccines.

Frontline healthcare workers are also being urged to have their flu jabs this season to start returning towards the uptake seen before the COVID-19 pandemic. 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.

TIMING

Flu vaccine’s effectiveness can wane over time in adults, and therefore it is preferable to vaccinate most adults closer to the time when the flu virus is likely to peak, typically in December or January. The majority of the vaccinations should be completed by the end of November.

Protection from the vaccine lasts much longer in children, therefore the priority is to start vaccinating all children (including those in clinical risk groups) from 1 September, or as soon as vaccine becomes available, both to provide early protection to children and reduce transmission to the wider population. For school-aged cohorts, vaccination should be completed by the Friday 12 December 2025.

Pregnant women are an exception to the later start date. Women should be vaccinated before they give birth to protect the newborn baby and were therefore eligible from 1 September.

UPTAKE LAST SEASON

Last flu season was the first time that the delayed start to the programme was implemented. Despite 4 weeks less time to vaccinate most adults, vaccination for those aged 65 years and over was just shy of the WHO target of 75% by the end of the season, with unprecedented levels of vaccination activity seen during October. For those aged 65 years and over there was an astounding 16% point rise in the first week of the programme and a further exceptional 21% point increase in the second week, with momentum continuing throughout October. However, vaccination activity levels slowed at the start of November, and this year practices are being urged to maintain momentum November, will ensure as many people as possible are protected.

However, uptake among children aged 2 and 3 years, primary school-aged children and some of those in clinical risk groups were concerning. Low initial uptake among pregnant women is attributed to the focus on establishing the maternal RSV programme that was introduced last September.

The UKHSA says: ‘We are aware that a huge amount of planning activity has been completed by providers ahead of this season to increase uptake across many of these groups. A huge thank you for everyone’s efforts ahead of this upcoming season.’

ELIGIBILITY 2025 to 2026

From 1 September 2025:

• Pregnant women
• All children aged 2 or 3 years old (on 31 August 2025)
• All primary school aged children (from Reception class to Year 6)
• Secondary school-aged children from Years 7 to 11
• All children in clinical risk groups aged from 6 months to less than 18 years

From 1 October 2025:

• Those aged 18 to under 65 years in clinical risk groups such as those with:
• 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
• Frontline staff employed by the following types of social care providers without employer led occupational health schemes
• Those living in long-stay residential care homes or nursing homes other long-stay health or social care facilities or a house bound patient

Examples of those in 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)

WHICH FLU VACCINES?

For vaccination of those aged 65 years and over

• Adjuvanted inactivated influenza vaccine (AIIV)
• High-dose inactivated influenza vaccine (IIV-HD)
• Recombinant inactivated influenza vaccine (IIVr)

The inactivated influenza cell-culture vaccine (IIVc) can also be considered for use in this age group if all other options are unavailable, but the inactivated influenza egg-culture vaccine (IIVe) is not advised for use in this age group.

NB Professional facing resources such as the JCVI statement, the Green Book chapter, PGDs and healthcare professional training documents have begun using a naming system that is independent of the number of virus strains contained in the vaccines. For example, inactivated influenza vaccines are now abbreviated as IIVx rather than QIVx or TIVx (quadrivalent (Q) trivalent (T)).

For vaccination of adults 18 to 64 years of age in an at-risk group

• Inactivated influenza cell-culture vaccine (IIVc)
• Inactivated recombinant influenza vaccine (IIVr)

The adjuvanted inactivated influenza vaccine is now licensed from the age of 50 years, therefore aIIV can also be considered for use in those aged 50 to 64 years alongside the above.

The high dose influenza vaccine is licensed from the age of 60 years, therefore, IIV-HD can also be considered for use in those aged 60 to 64 years alongside the above.

The inactivated influenza egg-culture vaccine (IIVe) can also be considered for use in this age group if all other options are unavailable.

Children aged 2 to less than 18 years of age

(In order of preference)

1. Live attenuated influenza vaccine (LAIV).
2. Inactivated influenza cell-culture vaccine (IIVc) (where LAIV is medically contraindicated or otherwise unsuitable).

The inactivated influenza cell-culture vaccine (IIVc) is egg-free. Egg-allergic individuals can be safely vaccinated in any setting with this vaccine, including those who have required admission to intensive care for a previous severe anaphylaxis to egg.

The inactivated influenza egg-culture vaccine (IIVe) can also be considered for use in this age group if all other options are unavailable.

Children less than 2 years of age in an at-risk group

• Inactivated influenza cell-culture vaccine (IIVc).

The inactivated influenza egg-culture vaccine (IIVe) can also be considered for use in this age group, if all other options are unavailable.

Source

UKHSA. Vaccine update. 2025;362: flu special. 1 September 2025. https://www.gov.uk/government/publications/vaccine-update-issue-362-august-2025-flu-special