The UK Prepares for the 2020-2021 Flu Season

The UK’s Joint Committee on Vaccination and Immunisation (JCVI) recently issued advice on vaccines in the National Health Service (NHS) annual seasonal flu vaccination program and reimbursement guidance for 2020-2021 flu season.

In a letter from Professor Stephen H. Powis, National Medical Director on December 20, 2019, the NHS suggests following the publication of scientific advice and recommendation by the JCVI.

“We encourage all providers delivering flu immunization services to procure vaccines from more than one flu vaccine supplier, where this is an option to do so, to minimize any potential risk to vaccine supply,” said Powis.

In this NHS letter, the following flu shot suggestion was made regarding seniors over 65 years of age:

The JCVI indicated an additional benefit from the use of a TIV or TIV-HD in those aged 65 years and over, compared with standard-dose egg-culture inactivated trivalent and quadrivalent vaccines (TIVe/QIVe).

When considering a preference between TIV-HD and aTIV the JCVI believed the level of uncertainty in the available evidence is considered too great to allow for a preferential recommendation between the vaccines. 

The JCVI advises the use of the following vaccines:

• Adjuvanted trivalent inactivated influenza vaccine (aTIV)
• High-dose trivalent vaccine (TIV-HD). As was the case for the 2019/2020 annual flu immunization program, the high-dose trivalent vaccine (TIV-HD) still has a significantly higher list price for 2020/21. This vaccine will not be commissioned by NHS E&I and will not be reimbursed by NHS E&I in 2020/21
• Quadrivalent influenza cell-culture vaccine (QIVc) is also suitable for use in this age group if aTIV or TIV-HD is not available
• JCVI advises that the QIVc is considered preferable to standard egg-culture influenza vaccines (TIVe/QIVe)

For people older than 9 years of age, and less than 65, the NHS offers the following advice:

• The JCVI advice states that evidence from recent influenza seasons indicates a clear additional benefit in the use of quadrivalent influenza vaccines in those under 65 years of age in a clinical at-risk group, compared with trivalent influenza vaccines. 

There is a potential advantage to using cell-culture influenza vaccines compared with egg culture influenza vaccines, due to the possible impact of “egg-adaption” on the effectiveness of influenza vaccines, particularly against A(H3N2) strains. 

The evidence on an additional benefit is reasonably consistent but available for only very few seasons.

The available limited evidence supports a slight preference for QIVc over QIVe because any impact will likely be limited to seasons in which the influenza season is dominated by well-matched H3N2 strains. 

A quadrivalent egg-culture inactivated vaccine (QIVe) can also be considered for use in this group. 

The JCVI advises the use of the following vaccines:

• Quadrivalent influenza cell-culture vaccine (QIVc)1
• Quadrivalent influenza egg-culture vaccine (QIVe) (as an alternative to QIVc subject to the JCVI considerations outlined above)

For those between the ages of 2 and 17, the JCVI advises the use of the following vaccine:

• Live attenuated influenza vaccine (LAIV)

For those aged 6 months to less than 9 years of age in an at-risk group, the JCVI advises the use of the following vaccine for whom there are contraindications for the use of LAIV:

• Quadrivalent influenza egg-culture vaccine (QIVe)

Furthermore, the Pharmaceutical Services Negotiating Committee urges ‘pharmacists to start ordering licensed influenza vaccines as per the guidelines and without any delay.’

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The US Centers for Disease Control and Prevention (CDC) suggests patients discuss their vaccination options with a licensed healthcare provider.

The CDC says ‘everyone 6 months of age and older should get a flu vaccine every season with rare exception.’

And, different flu vaccines are approved for use in different groups of people.

For the 2019-2020 flu season, the CDC recommends the use of any licensed, age-appropriate flu vaccine as an option for vaccination this season. These include injectable flu vaccines, or flu shots, (IIV and RIV), and live attenuated influenza vaccines or nasal spray.

Influenza vaccine news published by Precision Vaccinations.