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Published 19 October 2022
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This publication is available at https://www.gov.uk/government/publications/vaccine-update-issue-332-october-2022-flu-special-edition/vaccine-update-issue-332-october-2022-flu-special-edition
As a result of coronavirus (COVID-19) restrictions, which reduced social contacts, there have been very low levels of influenza activity in the last 2 years. This means that there may be a rebound in influenza levels this coming winter because people will be mixing more and they may also be more susceptible to influenza as they have not been exposed to the virus. The potential for co-circulation of influenza, COVID-19 and other respiratory viruses could add substantially to pressures in the NHS in 2022 to 2023.
Influenza vaccination plays an important part of the government’s wider winter planning to reduce illness from influenza, and therefore the potential impact on the NHS.
Full details of those eligible this year are given below. An expanded flu vaccination programme will continue this year. The priority is for those most at risk from influenza (those in clinical risk groups, pregnant women and older people) to be vaccinated first and then the temporary cohort of those aged 50 to 64 years not in clinical risk groups will be eligible for vaccination from mid-October.
Routine influenza vaccination of children continues. Alongside children in clinical risk groups, all those aged 2 and 3 years old (on 31 August) continue to be eligible for vaccination through their GP surgery.
This pre-schooler cohort is particularly important this season as these children will have had very little exposure to circulating influenza in their lifetimes due to COVID-19 restrictions. Primary school-aged children will be eligible again and the priority will be to vaccinate them, with an offer later in the season as part of the expanded programme to some secondary school-aged children.
We want to build on the momentum of the last 2 years where we had the highest vaccine uptake rates ever achieved, exceeding the World Health Organization (WHO) target of 75% for those aged 65 years and over for 2 years in a row and achieving higher uptake in most other cohorts compared to previous years. This is a fantastic achievement given the challenges of COVID-19 and an expanded vaccination programme which meant that higher numbers of people were vaccinated than ever before.
This autumn we want to continue to encourage influenza vaccine uptake in those who are eligible and to achieve at least the uptake levels of 2021 to 2022 for each cohort, and ideally exceed them. Improved uptake in those in clinical risk groups, children aged 2 and 3 years old, and pregnant women should be achieved to provide direct protection to those at increased risk from influenza.
We also need to support those who have historically had lower uptake to take advantage of the protection that the flu vaccine provides, such as those living in the most deprived areas, some ethnic minorities and other underserved communities. A key part of this is tailored communications and engagement with local communities through local employers, faith and advocacy groups.
In this issue of Vaccine Update we provide links to our flu publications including leaflets, letter templates, consent forms and posters, with leaflets translated into 29 languages and provided in braille, British Sign Language (BSL), large print, simple text for those with low literacy, and easy read for those with a learning disability.
As there may be winter outbreaks of COVID-19, protecting those at high risk of flu, who are also those most vulnerable to hospitalisation as a result of COVID-19, is vitally important. Many of the groups eligible for the flu vaccine are also eligible for a COVID-19 mRNA booster vaccine. Co-administration of these 2 vaccines, where people are eligible for both, is permissible where operationally advantageous.
Communication key messages and questions and answers are already available in a combined flu and COVID-19 vaccination toolkit on CommsLink and materials will continue to be added.
A winter vaccinations marketing campaign will launch late October running through to mid-December, encouraging the uptake of influenza and COVID-19 booster vaccines. The campaign supports both vaccination programmes.
We would like to extend our thanks to all for their hard work delivering the programme.
The following are eligible for an NHS vaccine in 2022 to 2023:
For further information:
The influenza chapter in ‘Immunisation against infectious disease’ (the Green Book), which gives detailed descriptions about clinical risk groups advised to receive influenza vaccination and guidance for healthcare workers (HCWs) on administering the influenza vaccine, was updated in September.
Every year the Joint Committee on Vaccination and Immunisation (JCVI) reviews the latest evidence on influenza vaccines and recommends the type of vaccine to be offered to individuals. NHS England (NHSE) then confirms which vaccines will be reimbursed on the NHS in the NHS reimbursement letter.
A poster for practices summarising this information is available to download.
For more information see the children’s flu vaccines section.
All healthcare professionals involved in administering the influenza vaccine must have the necessary knowledge, skills, training and mechanisms in place to supply and safely administer influenza vaccines.
The updated Flu immunisation training recommendations were published in August 2022. These include recommended training requirements by workforce group for influenza vaccination (Appendix A), suggested content that should be covered in theoretical and/or work-based training (Appendix B) and a competency assessment tool for new influenza vaccinators (Appendix C).
If training is not available locally, all those who advise on or administer influenza vaccines are also recommended to complete the flu specific e-learning programme, which is updated annually and is available free of charge with open access for all on the e-Learning for Healthcare (eLfH) website. This e-learning programme consists of a core knowledge module, separate modules on the inactivated and live influenza vaccines and accompanying knowledge assessments for each module.
The national flu immunisation programme for 2022 to 2023 slide set and a flu vaccination programme 2022 to 2023: information for healthcare practitioners document containing information about the current influenza programme, the vaccines available and commonly raised issues for influenza vaccination has also been published.
Patient Group Directions (PGDs) for the 2022 to 2023 influenza season are available on GOV.UK. These include a PGD for live attenuated influenza vaccine (LAIV), the LAIV PGD, and a separate inactivated influenza vaccine PGD. Practitioners must not use these PGDs until they have been authorised in Section 2. This is a legal requirement in accordance with the Human Medicines Regulations 2012. Practitioners should follow local policy and procedures to access authorised PGD documents.
There is a separate PGD for the community pharmacy seasonal influenza vaccine service, which is authorised nationally by NHSE and published on the associated NHS webpage for the community pharmacy seasonal influenza vaccine service.
For the 2022 to 2023 influenza season, there is a national protocol for the administration of inactivated influenza vaccine to individuals eligible for vaccination as part of the nationally commissioned influenza vaccination programme.
The national protocol allows for a mixed workforce model for vaccination similar to that used for COVID-19 vaccination. In accordance with the national protocol for inactivated influenza vaccine, administration of inactivated influenza vaccine may be by appropriately trained persons, following assessment of the individual by a specified registered professional as detailed in the national protocol.
All frontline health care and social care workers should be offered vaccination by their employer. This is an employer’s responsibility to help protect their staff and patients or clients and ensure the overall safe running of services. Employers should commission or implement a service which makes access to the vaccine easy for all frontline staff, encourages staff to get vaccinated, and monitors the delivery of their programme. The complementary NHS influenza vaccination offer for primary care staff has not been extended for the 2022 to 2023 influenza season. Influenza vaccinations for primary care staff, like other frontline healthcare staff, revert to being an employer’s occupational health responsibility.
As for last season, the definition of a frontline healthcare worker for the influenza programme will be aligned with that of the COVID-19 vaccination programme to include both clinical and nonclinical staff who have contact with patients. One of the quality indicators in the 2022 to 2023 Commissioning for Quality and Innovation (CQUIN) is a goal of vaccinating between 70 to 90% of staff.
The 2022 to 2023 general practice enhanced service specification for the seasonal flu programmes has been updated (26 September 2022) to include provision as part of general practice’s occupational health responsibilities to offer eligible frontline patient-facing staff a flu vaccination under the Clinical Negligence Scheme for general practice (CNSGP).
Vaccines delivered as part of general practice’s occupational health responsibilities will not be eligible for reimbursement of the flu vaccine cost nor an item of service payment, with the exception of where the eligible frontline patient-facing staff member is eligible under the NHS flu programme due to age or clinical risk and is a registered patient at their employing practice. Further guidance is available.
All frontline social care workers who are directly involved in the care of clinically vulnerable clients, and who are at increased risk from exposure to influenza, should receive a vaccination this season. This should be provided by their employer, in order to meet their responsibility to protect their staff and patients and ensure the overall safe running of services. Employers should commission a service which makes access easy to the vaccine for all frontline staff, encourage staff to get vaccinated, and monitor the delivery of their programmes.
Frontline social care staff are eligible under the NHS flu scheme where employer-led occupational health services are not in place and the social care or hospice worker is employed:
Vaccination will be available through community pharmacy and general practice in accordance with the relevant service specifications. Where the social care or hospice worker is employed by a registered residential care or nursing home or voluntary managed hospice provider they can be vaccinated by any general practice regardless of whether they are registered with the general practice.
This season, as COVID-19 remains in circulation, frontline social care workers should also take up the COVID-19 autumn booster as well as the flu vaccine (see information on health and social care marketing campaign below).
Additional information on influenza immunisation is available online for both social care staff, personal assistants and social care and hospice providers.
It is important that health and social care workers get vaccinated with both the COVID-19 and flu vaccines to protect themselves and their patients; the viruses can be life-threatening and getting both flu and COVID-19 at the same time increases the risk of serious illness.
A communications toolkit has been designed to support a proactive approach to staff engagement and contains useful resources and information to help maximise uptake.
Both communications toolkits are now available via the COVID-19 guidance and resources area on CommsLink. Please be aware that the toolkit will be updated regularly throughout the season so when signposting, please link to CommsLink where possible instead of sharing the attachment.
Orders for pre-print staff facing materials have now closed, and digital assets including A4 posters, Q&A leaflets, stickers and social media resources are available to download from the campaign resource centre.
This year the national marketing campaign to drive uptake of this winter’s essential vaccinations – influenza and COVID-19 boosters – will launch in late October, running through to mid-December. The campaign supports both vaccination programmes and aims to both protect the nation from these 2 dangerous viruses this winter and help to reduce the burden on the NHS over what is always a challenging time of the year.
The campaign narrative sets out that both influenza and COVID-19 can be life-threatening and will both be circulating at the same time this winter. Therefore, this autumn it’s more important than ever to take up the influenza vaccine, COVID-19 booster, or both if offered to protect ourselves and others ahead of winter.
The campaign will launch with broadcast, digital and multicultural marketing advertising supported by search, PR and partnership activity. It is aimed at the groups most at risk from influenza and COVID-19 and those who could spread them to people more vulnerable.
Printed materials will be available to order from the campaign resource centre.
Social media assets will be available from 17 October.
A flu and COVID-19 vaccination toolkit is available on CommsLink; it provides key communication messages and useful questions and answers.
Leaflets remain an effective way of communicating the need and the benefits of having a vaccine and inform the consent process. It is important that people receive a leaflet in a format that meets their needs. Accessible versions are an important resource to improve uptake in underserved communities. We also want everyone to have a positive vaccination experience and having accessible information is part of that experience.
Our leaflets and resources are all available to download and many can also be ordered. We have a wide range of leaflets in translated versions, simple text, easy read, large print, braille, British Sign Language (BSL) video versions, and easy read and video for those who have a learning disability.
There are also HTML versions, which are text only. This helps search engines on the web that look for content, people who use screen readers and assisted technology. HTML versions can also be signposted to in e-consent forms which need to include leaflets when asking for consent. If using e-consent it is important to recognise that not all parents and carers have access to digital resources, so it is important to provide the leaflets as paper copies as well.
Schools and the school-aged immunisation service can identify which accessible versions would be helpful for their cohorts. For example, if there are students who are deaf or use BSL, they can make the videos available on screens or share the link with parents and children. It is important to recognise that many BSL users rely on BSL resources as written literacy in this group can be lower.
Stay up to date with all of the publications to support the annual flu programme.
Available in 29 languages, this leaflet is for parents and carers. It explains why children are eligible for a flu vaccination, as well as describing the disease and the nasal flu vaccine.
Copies can be downloaded or ordered using product code 2022FCEN for the English version. Translated, English large print, Braille, BSL video and audio versions are also available.
Available in 29 languages, this leaflet explains to patients how they can help protect themselves and their children against flu this winter. It includes information about eligible children, adults and pregnant women.
This leaflet can be downloaded and ordered and translated versions will be available soon. A braille version of this leaflet is available to order and a BSL video is available to download.
This leaflet gives details about the flu vaccination programme for primary school-aged children including how the programme is delivered and the role schools play. It can be downloaded and ordered using product code 2022FBS.
This year there are 2 flu vaccine consents forms available for school-aged immunisation service providers to download. One is for the nasal spray flu vaccine and the other for the flu vaccine by injection.
A letter template for school-age immunisation provider teams to use can be downloaded.
This poster aimed at parents explains the benefits of vaccinating children against flu. It is available as translated versions. Copies can be downloaded or ordered.
This poster aimed at parents explains the benefits of vaccinating children against flu. It is available as translated versions. Copies can be downloaded or ordered.
Aimed at individuals with a low reading age, simple text versions ‘All about flu and how to stop getting it’ are available to download and order.
This leaflet can be downloaded and ordered using product code FLU2021STA.
This leaflet can be downloaded and ordered using product code FLU2021STC.
Several resources are available for those with a learning disability.
Our easy-read guides for individuals in all settings with a learning disability are available for the 2022 to 2023 flu season. These resources are aimed at people who have a learning disability or who have autism or who care for someone with a learning disability.
They provide advice on:
Easy-read guides can be downloaded and ordered.
Two short films about the importance of the flu vaccination for people with a learning disability and autistic people with certain health conditions. The film covers why it is important, who is eligible for a free vaccine, where you can get the vaccine and reasonable adjustments.
The importance and range of reasonable adjustments that can be made so people with a learning disability or other disabilities have good access to healthcare are explained in this film. Resources and tools to support this legal requirement are available.
Available to download, this leaflet is about the annual flu vaccination programme for pre-school children. It informs those working in the early years sector about the programme and how they can support it. It is aimed at nursery and pre-school managers, staff and childminders delivering the Early years foundation stage framework, and those who provide informal childcare, such as nannies.
We have new design flu stickers with 2 designs. Each sheet contains 72 stickers, so if you order 2 sheets you get 144 stickers. You can order them using product code SCHFLSTK from Health Publications.
GP practices can use this template to invite parents and guardians to get their child vaccinated at the local surgery.
Template for GPs to invite patients at risk of flu due to a medical condition, pregnancy or age, and those who receive a carer’s allowance or are the main carer for an older or disabled person, to have their annual flu vaccine.
Poster showing the different types of flu vaccines available for the 2022 to 2023 flu season and the clinical risk groups that they apply to.
A quick reference guide to the childhood flu vaccines for winter 2022 to 2023.
Influenza and COVID-19 disease surveillance reporting is combined into one report to create the ‘Weekly national influenza and COVID-19 surveillance report’, which is published weekly on Thursdays at 2pm.
The report summarises information from the surveillance systems that are used to monitor influenza, SARS-CoV-2 (the virus that causes COVID-19), and other seasonal respiratory viruses in England. As per previous seasons from week 41 (13 October 2022) onwards ‘top lines’ on vaccine uptake by cohorts will be included in the weekly surveillance report.
For the 2022 to 2023 season, monthly vaccine uptake will be published as official statistics at 2pm on the following dates:
Further communication on data collection tools, collection timelines, and user guides will be shared with stakeholders separately. For any queries related to the data collections or official statistics, please contact the relevant mailbox as follows:
Links to the monthly data for the 2022 to 2023 season will be published under ‘Seasonal flu vaccine uptake’.
Note that as for previous seasons there will be specific webpages for each collection, but the webpage addresses are not available in advance of the pages being published. However, the collections will be named as follows:
As in previous years, all flu vaccines for the 2022 to 2023 children’s flu programme are available to order by NHS programme providers in England via the UK Health Security Agency (UKHSA)’s ImmForm website.
Please note that UKHSA does not supply any flu vaccines for patients aged 18 years and over.
For arrangements in Scotland, Wales and Northern Ireland, please refer to guidance from your respective health departments.
The latest and most accurate information on availability of centrally supplied vaccines for the children’s flu programme is available on the ImmForm news page at all times. It is strongly advised that all parties involved in the provision of influenza vaccines to children ensure they remain up to date with this.
The table below shows the 3 vaccines available, and the groups these vaccines should be ordered for:
As in previous years, ordering controls are in place for general practices, to enable UKHSA to balance incoming supply with demand. These controls work by allocating an amount of LAIV based on the number of registered eligible patients and are tailored to each practice.
Please note the following if you are ordering for general practice:
Please note that GP practices or groups that operate over multiple sites but are part of the same organisation will have a joint allocation for LAIV and quadrivalent influenza vaccine, cell based (QIVc), even where each site has a unique ImmForm account. This means that it is possible for one site to potentially order all of the available vaccine for the group, unless there is local agreement on how the allocated volume is shared. UKHSA recommends that this agreement is in place before ordering opens.
The allocation information above should allow practices to estimate the amount of LAIV they will initially have access to, and how it should be split between all sites (remember that LAIV allocations are per season, and not per week). For QIVc, the total amount available per week will simply be 8 doses per site, multiplied by the number of sites in the organisation.
School teams are able to place 2 orders and receive 2 deliveries of LAIV per week, to assist in the management of vaccine volumes required across limited storage space at delivery points.
This will operate on a 48-hour delivery schedule requiring the order to be placed before the 11:55am cut-off 2 working days before the required delivery day. The table below illustrates the respective delivery days versus ordering day.
Customers must ensure that the point of delivery will be open and manned on the delivery day when placing orders.
Please note that this does not affect the ordering and delivery schedule of any other vaccines (including inactivated flu vaccines) ordered from ImmForm and is applicable to Fluenz® Tetra (LAIV) only.
A default weekly ordering cap of 400 packs (4,000 doses) per week is in place for school provider accounts. This can be split as required across 2 orders or placed as one order if preferred.
Where this cap is insufficient and a provider needs a larger weekly volume of vaccine to deliver the programme (for example where a provider covers a large area using a single account), a higher weekly cap should be requested via the UKHSA Flu Vaccine Operations team by emailing childfluvaccine@ukhsa.gov.uk. Please ensure that this request is made at least 48 hours before an order larger than 400 packs needs to be placed, to allow time for your account to be set up correctly.
For one-off larger orders during the ordering period, requests should be made via helpdesk@immform.org.uk
Two inactivated flu vaccines are also available for children for the 2022 to 2023 season:
For one-off larger orders of inactivated vaccines, requests should be made via helpdesk@immform.org.uk in good time before your order cut-off.
Order and delivery days for inactivated vaccines for school providers will be made as per the routine ordering and delivery days set for other childhood vaccines, and not per the 48-hour delivery schedule available for LAIV.
Information on all influenza vaccines that have been marketed in the UK for the 2022 to 2023 season are available.
Of the eligible cohorts listed above, those marked with an asterisk may be vaccinated by any general practice, regardless of whether they are registered with that general practice. ↩ ↩2 ↩3 ↩4
Unless clinically contraindicated or otherwise unsuitable. ↩
Children in clinical risk groups (and children who are household contacts of immunocompromised persons) aged 2 to less than 18 years, healthy children aged 2 and 3 years, and those in eligible school age cohorts. ↩
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