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Flu Vaccines 2019 / 2020

Flu vaccines 2019/2020

Last year, during the 2018/2019 flu season, community pharmacists 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. To get information on flu season 2020/2021, including pricing information and changes to eligibility for NHS free flu jab, visit 10 facts you must know – FLU SEASON 2020/2021.

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 the NHS Flu vaccination program. Pharmacies will only be reimbursed for three of them.

NHS flu vaccination 2019-2020 eligibility criteria

NHS flu vaccination eligibility criteria

Department of Health & Social Care announced the following eligibility for NHS national Flu immunization program 2019/2020:

1. 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.

2. Patients aged six months to 65 years of age with certain medical conditions such as Diabetes

3. Pregnant women

4. Residents of long-stay care homes

5. Carers

6. People with close contact with immunocompromised patients

7. 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

NHS flu vaccination eligibility criteria

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.

A new higher dose trivalent vaccine (TIV-HD), available for those aged 65 and over.

However, pharmacies will not receive reimbursement for the 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 the vaccine which causes an immune response in the body; for example, in a trivalent vaccine, three different viral antigens are present.
A higher dose of antigen present is supposed to provide for better immune response, and therefore give better protection from the Flu (CDC, 2018).

Initial clinical trials with the 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 the 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 the 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 eggs; 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 immunize their patients and to make the 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 the 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 the 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)

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