Flu jab cost by main UK pharmacies
Pharmacy insights

Flu vaccines 2019 / 2020

Last year, during 2018/2019 flu season, community pharmacist delivered over 1.4 mln flu vaccinations to patients under NHS Flu Vaccination Service (PSNC, n.d.). Although flu season 2019/2020 seems far away, updated details for this service and flu vaccines 2019 /2020 are already known.

The main changes introduced for NHS flu service 2019/2020

There is an update in eligibility criteria for this flu season 2019/2020, however, this criteria is not applicable to the service delivered by community pharmacists.

Two new influenza vaccines will be available during the upcoming season. Including nasal flu vaccination, this brings a variety of five different flu vaccinations. Under NHS flu vaccination programme pharmacies will only be reimbursed for for three of them.

NHS flu vaccination 2019-2020 eligibility criteria

Department of Health & Social Care announced the following eligibility for NHS national flu immunisation programme 2019/2020:

  • All children aged two to ten (if a child becomes 11 on 31/08/2019 they will not fall in this category). This group is not vaccinated by community pharmacists.
  • Patients aged six months to 65 years of age with certain medical conditions such as diabetes
  • Pregnant women
  • Residents of long-stay care homes
  • Carers
  • People with close contact with immunocompromised patients
  • People aged 65 and over

During the 2019/2020 flu season, three main types of flu vaccine used last year will be available again:

  • Injectable adjuvanted trivalent inactivated vaccine (aTIV)
  • Injectable quadrivalent inactivated vaccine (QIVe)
  • Live nasal spray-quadrivalent (children and adolescents aged 2-17)

Additionally, two new flu vaccines will be available.

New flu vaccines 2019/2020

  • new inactivated quadrivalent vaccine cultured on mammalian cells (QIVc) as opposed to QIVe which is cultured on eggs. This vaccine will be licensed for those aged 18-64 and those aged 65 years and over.
  • new higher dose trivalent vaccine (TIV-HD), available for those aged 65 and over, however, pharmacies will not receive reimbursement for use of this vaccine (due to its price). This vaccine may be available on the basis of private service for which patients will have to pay.

What is the new, higher dose trivalent vaccine (TIV-HD)?

TIV-HD contains four times more of the antigen contained in other flu vaccines.

An antigen is the viral part of vaccine which causes an immune response in the body, for example in trivalent vaccine three different viral antigens are present.

A higher dose of antigen present supposed to provide for better immune response, and therefore give better protection from the flu (CDC, 2018).

Initial clinical trials with new TIV-HD vaccine showed that this vaccine is 24.2% more effective in preventing flu in people aged 65+ (DiazGranados et al, 2014). Another study found that use of high dose influenza vaccine can reduce the risk of hospital admissions from care home residents aged 65 years and older (Gravenstein et al, 2017).

Pharmacies and other contractors will not get paid for the costs of this vaccine from NHS should they decide to offer it to suitable patients under NHS flu vaccination programme (very unlikely).

New inactivated quadrivalent vaccine cultured on mammalian cells (QIVc:  Flucelvax Tetra)

QIVc vaccine (Flucelvax Tetra) does not offer any additional protection against influenza. Initial studies in over 5000 patients showed similar levels of protective antibodies produced (EMA, 2018).

Some advantages of the new QIVc vaccine:

  • production of the vaccine based on cell cultures, allowing large production and quick-scaling up e.g. in case of pandemic (Bühler & Ramharter, 2018)
  • the vaccine does not contain egg, therefore it can be used in individuals allergic to eggs
  • QIVc vaccine is licensed for individuals aged 18-64 and those aged 65 years and over, therefore it is possible that this vaccine may be used by GP surgeries to immunise their patients and to make vaccination process simpler

Flu vaccines 2019/2020 recommendations (JCVI, 2018)

Influenza vaccines 2019-2020

For vaccination of population aged 65 years and over Joint Committee on Vaccination and Immunisation (JCVI) advises the use of any one of the following vaccines:

  • Adjuvanted trivalent inactivated influenza vaccine / Fluad (aTIV). This vaccine is preferable in the above individuals due to clinical and cost-effectiveness (NHS England, 2019).
  • Quadrivalent influenza cell culture vaccine (QIVc)These vaccines are considered equally suitable for use in those aged 65 years and over

At-risk patients (including pregnant  women)  and for vaccination of those aged less than 65 years of age JCVI advises the use of any one of the following vaccines:

  • Quadrivalent influenza cell culture vaccine (QIVc)
  • Quadrivalent egg-based inactivated vaccine (QIVe)

Both vaccines are considered equally suitable.

Only three recommended vaccines: aTIV, QIVe, and QIVc will be eligible for reimbursement by NHS England.

Conclusion

As complicated as it may be, during 2019/2020 flu season a wider range of flu vaccinations will be offered to the public. These will be of course subject to availability. It will be interesting to see which vaccine will be the main vaccine offered to those 18-64 of age by community pharmacies privately and under NHS flu vaccination programme. Is it going to be QIVc  (cell based) or QIVe (egg based) or both?

Since higher dose trivalent vaccine (TIV-HD) will not be reimbursed by NHS to individuals 65+it will also be interesting to see if this vaccine is going to be offered on the basis of private service and at what cost.

Lastly, for those who want to know the viral composition of vaccines in the coming season, see details below.

Viral composition of flu vaccines 2019/2020

Trivalent 2019/2020 vaccine will contain 2 influenza A and 1 influenza B viral strain:

A/Brisbane/02/2018 (H1N1) pdm09-like virus

A/Kansas/14/2017 (H3N2)-like virus

B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage)

Quadrivalent 2019/2020 vaccine will contain 2 influenza A and 2 influenza B viral strain:

A/Brisbane/02/2018 (H1N1) pdm09-like virus

A/Kansas/14/2017 (H3N2)-like virus

B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage)

B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage)

Live nasal 2019/2020 vaccine will contain four live, attenuated influenza viruses, 2 influenza A and 2 influenza B viral strain:

A/Brisbane/02/2018 (H1N1) pdm09-like virus

A/Kansas/14/2017 (H3N2)-like virus

B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage)

B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage)

References:

Bühler S, Ramharter M Flucelvax Tetra: a surface antigen, inactivated, influenza vaccine prepared in cell cultures ESMO Open 2019;4:e000481. doi: 10.1136/esmoopen-2018-000481 Available at: http://dx.doi.org/10.1136/esmoopen-2018-000481 Accessed on 12/06/2019

CDC (2018). Fluzone High-Dose Seasonal Influenza Vaccine. Available at: https://www.cdc.gov/flu/prevent/qa_fluzone.htm Accessed on 12/06/2019

DiazGranados Carlos A., M.D., Andrew J. Dunning, Ph.D., Murray Kimmel, D.O., Daniel Kirby, B.Sc., John Treanor, M.D., Avi Collins, B.Sc.N., Richard Pollak, D.P.M., Janet Christoff, R.N., John Earl, M.D., Victoria Landolfi, M.Sc., M.B.A., Earl Martin, D.O., Sanjay Gurunathan, M.D., Richard Nathan, D.O., David P. Greenberg, M.D., Nadia G. Tornieporth, M.D., Michael D. Decker, M.D., M.P.H., and H. Keipp Talbot, M.D., M.P.H. (2014). Efficacy of High-Dose versus Standard-Dose Influenza Vaccine in Older Adults. Available at: https://www.nejm.org/doi/full/10.1056/NEJMoa1315727?query=featured_home#article_citing_articles Accessed on 12/06/2019

EMA (2018). Flucelvax Tetra. Influenza vaccine surface antigen inactivated prepared in cell cultures. Available at: https://www.ema.europa.eu/en/medicines/human/EPAR/flucelvax-tetra 12/06/2019

Gravenstein, Stefan, Prof, MD, H Edward Davidson, PharmD, Monica Taljaard, PhD, Jessica Ogarek, MS Pedro Gozalo, PhD Lisa Han, MPH Prof Vincent Mor, PhD (2017). Comparative effectiveness of high-dose versus standard-dose influenza vaccination on numbers of US nursing home residents admitted to hospital: a cluster-randomised trial. Available at: https://doi.org/10.1016/S2213-2600(17)30235-7 Accessed on 12/06/2019

NHS England (2019). Update on vaccines for 2019/20 seasonal flu vaccination programme. Available at: https://www.england.nhs.uk/wp-content/uploads/2019/01/vaccines-for-19-20-seasonal-flu-vaccination-programme.pdf Accessed on 13/06/2019

PSNC (n.d.). Flu vaccination data for 2018/19. Available at: https://psnc.org.uk/services-commissioning/advanced-services/flu-vaccination-service/flu-vaccination-statistics/flu-vaccination-data-for-2018-19/ Accessed on 12/06/2019

I am a community pharmacist working in UK. I blog about drugs, health and pharmacy.

One Comment

  • Ros

    Read the article interest. Did ask local pharmacy about paying privately for the Quad Strain jab,, which although it can be given to over 65s, will not be reimbursed by the NHS. Pharmacist said go with the ‘freebie’. Wish I had followed my instinct. Husband and self have got the flu, in a very bad way. Husband coughing really badly and this, or the virus, has triggered double vision. Now he has to go to an eye hospital for prisms to be fitted over his glasses. So not really that cost effective for the NHS!
    I should add we are not alone. My hairdresser has had cancellation after cancellation. – almost unheard of in the run up to Christmas

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