Guidance

National flu immunisation programme 2024 to 2025 letter

Updated 18 June 2024

Please refer to the Statement of amendment to the annual flu letter for 2024 to 2025 published on 12 June 2024 for changes to the NHS influenza immunisation programme 2024 to 2025.

12 March 2024

Dear colleagues,

Flu vaccination remains a critically important public health intervention to reduce morbidity and mortality in those most at risk including older people, pregnant women and those in clinical risk groups. It helps the health and social care system manage winter pressures by helping to reduce demand for GP consultations and likelihood of hospitalisation. Vaccinating health and care workers also plays an important role in helping to prevent transmission of flu, protecting themselves and those they care for.

This letter sets out guidance for the 2024 to 2025 season and includes the next steps for regions and providers to take, including which flu vaccines to order. The letter confirms that there are no changes to the eligible cohorts for the coming year, although providers should read the section on the timing of the programme carefully.

Eligibility

Eligibility for flu vaccination is based on the advice and recommendations of the Joint Committee on Vaccination and Immunisation (JCVI). This includes a vaccination programme for children based on JCVI’s 2012 recommendation, using live attenuated influenza vaccine (LAIV) which provides individual protection to the child and reduces transmission in the wider population.

The following groups are to be offered flu vaccination in line with the announced and authorised cohorts (see timings section):

From 1 September 2024:

• pregnant women
• all children aged 2 or 3 years on 31 August 2024
• primary school aged children (from Reception to Year 6)
• secondary school aged children (from Year 7 to Year 11)
• all children in clinical risk groups aged from 6 months to less than 18 years

From October 2024, exact start date to be confirmed by NHS England in due course:

• those aged 65 years and over
• those aged 18 years to under 65 years in clinical risk groups (as defined by the Green Book, Influenza Chapter 19)
• 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
• frontline workers in a social care setting without an employer led occupational health scheme including those working for a registered residential care or nursing home, registered domiciliary care providers, voluntary managed hospice providers and those that are employed by those who receive direct payments (personal budgets) or Personal Health budgets, such as Personal Assistants

All frontline health care workers, including both clinical and non-clinical staff who have contact with patients, should be offered flu vaccine from October (exact start date to be confirmed in due course) as a vital part of the organisations’ policy for the prevention of the transmission of flu. 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 cohort eligibility above), can access the vaccine through the NHS free of charge. For NHS Standard Contract holders, further information about the 2024 to 2025 Commissioning for Quality and Innovation (CQUIN) scheme will be available shortly.

Providers are expected to deliver a 100% offer to eligible groups. They should ensure they make firm plans to equal or improve uptake rates in 2024 to 2025, particularly in those cohorts where uptake has traditionally been lower (clinical risk groups, children aged 2 and 3 years, and pregnant women). Providers should also ensure they have robust plans in place for tackling health inequalities for all underserved groups.

Timing

Based on the evidence that flu vaccine’s effectiveness can wane over time in adults JCVI have advised moving the start of the programme for most adults to the beginning of October. This is on the understanding that the majority of the vaccinations will be completed by the end of November, closer to the time that the flu season commonly starts. It is preferable to vaccinate individuals closer to the time when the flu virus is likely to circulate (which typically peaks in December or January), as this will provide optimal protection during the highest risk period. As flu circulation in children normally precedes that in adults, the Committee agreed that the children’s programme should continue to start in September as early as delivery and supply allows. No change in the timing of the offer for the maternal programme was advised (see paragraph on pregnant women below).

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. As the public health impact of vaccination is greater in younger children, where possible, school-aged immunisation providers are encouraged to schedule vaccination of primary school children early in the season. For school-aged cohorts, vaccination should be completed by the second Friday in December (13 December 2024).

Pregnant women are an exception to the advice on a later start date (see section on timing). There are 3 clinical reasons to vaccinate pregnant women against flu:

• to protect the pregnant women themselves (they are at higher risk from complications from flu)
• to protect the baby during pregnancy (for example flu infection increases the risks of the baby being premature or stillborn)
• to protect the baby in the first few months of life (babies aged under 6 months are at high risk of complications from flu)

Although the first and second of these reasons would align with the advice to provide maximal protection during the expected flu season, the third reason requires women to be vaccinated prior to delivery and therefore vaccination of pregnant women should begin from 1 September. Pregnant women are not expected to lose protection as rapidly as the elderly population and therefore starting vaccination (particularly in those women who are in the later stages of pregnancy) earlier than for those in other clinical risk groups, will still offer protection to women themselves in the peak season. Commencing vaccination early will, however, ensure that as many newborn babies as possible are protected during the flu season and help to optimise uptake.

Following clinical assessment, there may be a small number of other adults for whom it would be better not to delay flu vaccination until October. For example, for those who are due to commence immunosuppressive treatment (such as chemotherapy) before October, having flu vaccine before they start treatment would allow them to make a better response to their vaccination. GPs should use clinical judgement to bring forward vaccination in exceptional circumstances, as outlined in the Green Book, and offer vaccination as soon as vaccine comes available in line with contractual arrangements.

Recommended vaccines

Every year JCVI reviews the latest evidence on flu vaccines and advises the type of vaccine to be offered to different age groups.

Adult vaccines eligible for reimbursement

No changes were recommended by JCVI for adult flu vaccines for 2024 to 2025. Providers should ensure that they have ordered adequate supplies of the recommended vaccines to vaccinate all eligible individuals included within this letter.

The following vaccines will be reimbursed for adults in the programme:

Aged 65 years and over	Aged 18 to 64 years in eligible groups
Offer: Adjuvanted quadrivalent influenza vaccine (aQIV) [note 1] Recombinant quadrivalent influenza vaccine (QIVr) The cell-based quadrivalent influenza vaccine (QIVc) can also be considered only when every attempt to use aQIV or QIVr has been exhausted – evidence of this may be requested by the commissioner before reimbursement is agreed.	Offer: Cell-based quadrivalent influenza vaccine (QIVc) Recombinant quadrivalent influenza vaccine (QIVr) The egg-grown quadrivalent influenza vaccine (QIVe) can also be considered only when every attempt to use QIVc or QIVr has been exhausted – evidence of this may be requested by the commissioner before reimbursement is agreed.

[note 1] As in previous years, aQIV may be offered ‘off-label’ to those who become 65 years of age before 31 March 2025.

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If you have a supply of QIVr, preliminary UKHSA evidence in the UK from the 2022 to 2023 season and international evidence suggests that the potential additional benefit may be greatest in adults aged 65 years and older (compared to those aged 18 to 64 years). Therefore, the clinical recommendation would be to prioritise the use of any QIVr for use in the 65 years and over age group.

Contractual requirements for all commissioned NHS flu vaccination providers will state that to receive payment for flu vaccination and reimbursement of flu vaccine they will need to use the specific flu vaccines outlined above for the appropriate cohort and administer vaccines in line with the announced and authorised cohorts. Please note that commissioners will actively reclaim any payments made for the incorrect vaccine administered. The GP and Community Pharmacy service specifications will be updated and published in due course following usual engagement with relevant representative bodies.

Every effort should be made to use the best available flu vaccines. Providers should only purchase the alternative second line vaccines outlined above, if all attempts to secure the recommended first line vaccines have failed. Providers may be asked to provide evidence to show this upon request from their commissioner.

With the exception of frontline workers in certain social care settings (see paragraphs above on eligibility), please be aware the vaccination of all other frontline health care staff (for example, those working in NHS Trusts, Primary Care organisations, and private sector health care organisations) will not be reimbursed and does not qualify for a payment under the NHS flu programme.

Due to manufacturing processes and commissioning arrangements, some vaccines may only be available in limited quantities or batches of vaccine may be subject to delay. Therefore, it is recommended that orders are placed with more than one manufacturer to ensure providers receive sufficient stock. Providers should remain flexible when scheduling vaccination sessions and be prepared to reschedule if necessary.

Children’s vaccines

No changes were recommended by JCVI for children’s flu vaccines for 2024 to 2025.The UK Health Security Agency (UKHSA) supplies all flu vaccines for the children’s programme and these will be available to order through ImmForm and are not reimbursable.

The following vaccines will be available to order:

Children aged 6 months to less than 2 years in clinical risk groups	Children aged 2 to less than 18 years in eligible groups (including clinical risk groups)
Offer: Cell-based quadrivalent influenza vaccine (QIVc) [note 2]	Offer in the following order of preference: 1. Live attenuated influenza vaccine (LAIV) 2. Cell-based quadrivalent influenza vaccine (QIVc) [note 2] is available where LAIV is contraindicated or otherwise unsuitable (for example, parents object to LAIV on the grounds of its porcine gelatine content)

[note 2] The egg-grown quadrivalent influenza vaccine (QIVe) can also be considered if QIVc is not available. As this is a second line vaccine, it is not supplied by UKHSA’s ImmForm website.

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As in previous seasons, ordering controls will be in place for LAIV in 2024 to 2025 to enable UKHSA to balance vaccine availability and demand appropriately across the programme. The latest information on ordering controls and other ordering advice for UKHSA supplied flu vaccines will be featured on the ImmForm news page, both prior to and during the flu vaccination period. Information will also be featured in Vaccine Update and disseminated via the National Immunisation Network as appropriate. It is strongly advised that all parties involved in the provision of flu vaccines to children ensure they remain up to date with this information at all times.

Co-administration

Further guidance will follow on how the flu programme should be aligned to any autumn COVID-19 vaccination programme. Providers are encouraged to align delivery of the flu vaccination programme with other commissioned vaccination programmes for which the patient may be eligible (for instance shingles, pertussis, or pneumococcal vaccines) where it is clinically acceptable, operationally feasible, and where the patient is content. Where co-administration may not be feasible providers must make every effort to encourage individuals to take up the offer of every vaccine they are eligible for.

Data collection

1. UKHSA is responsible for monitoring vaccine coverage and for publishing vaccine uptake for frontline healthcare workers (HCWs) (DAPB2204), school aged children (DAPB2195) and eligible GP registered patients (DCB2211 and DCB2205). These national Official Statistics collections are managed through the ImmForm website, reported to the World Health Organization and used in public notices. Providers should ensure they complete these data returns through ImmForm during the appropriate time windows throughout the season.

2. During the 2024 to 2025 flu immunisation programme monthly data collections for frontline HCWs and eligible GP registered patients will take place over 5 months (November to March publications), and for school aged children over 4 months (November to February publications).

3. The NHS England automated data collection to monitor uptake and inform payment of flu and COVID-19 vaccinations to frontline HCWs will continue in 2024 to 2025, as commissioned under the NHS Standard Contract (DAPB4075).

All corresponding Data Alliance Partnership Board (DAPB) approvals for the above collections are available.

1. NHS Trusts delivering vaccinations must use an NHS-endorsed Point of Care (PoC) system for vaccination event data capture. This will feed back to relevant systems, such as the service user’s GP record, and national and local reporting tools. Primary care providers must use their relevant systems for vaccination event data capture and where required share the vaccination event details with the service user’s registered practice.

Further information

The influenza chapter in ‘Immunisation against infectious disease’ (the ‘Green Book’), gives detailed descriptions of the clinical risk groups and guidance for HCWs on administering the influenza vaccine.

See Annexe A for links to resources that will become available to support the 2024 to 2025 programme.

Conclusion

We would like to thank everyone for their continued hard work in support of the annual flu immunisation programme.

Yours sincerely,

Dr Thomas Waite, Deputy Chief Medical Officer for England

Dr Mary Ramsay, Director of Public Health Programmes, UK Health Security Agency

Steve Russell, National Director for Vaccinations and Screening, NHS England

Any enquiries regarding this publication should be sent to [email protected]  and [email protected].

For operational immunisation queries, providers should contact their regional NHS England Public Health Commissioner.

For operational immunisation queries, providers should contact their regional NHS England Public Health Commissioner.

Annexe A: Key resources to support the programme

Further information on the 2024 to 2025 programme will be available from:

Annual flu programme

Flu vaccines poster – aide memoire

Flu immunisation PGD templates

Flu immunisation training

e-learning programme

ImmForm Survey User guides

Flu vaccine uptake figures

Health Publications

Campaign Resource Centre

Future NHS – Collaboration platform

Vaccine Update – UKHSA monthly newsletter