Flu vaccination FAQs

This page answers Frequently Asked Questions (FAQs) about admnistering the flu vaccine under the 2023/24 Greater Manchester flu vaccination programme.

Useful resources to support the flu vaccination programme 2023-24

Are there specific precautions regarding patients who report hypersensitivity to fish and the Seqirus aQIV vaccine?

The squalene in the aQIV vaccine is obtained from the spiny dog fish and shark liver oil forms around 80% of the squalene for MF59C.1. The aQIV is not tested for residual fish protein and there is no data available as to whether or not residual fish protein remains in the vaccine following the purification process (page 14). Patients who report hypersensitivity to fish should be assessed as to the nature and severity of their allergy before the vaccine is given (page 19).

Are there specific precautions regarding pregnant women and the nasal flu vaccine?

There are no specific precautions regarding pregnant women who are exposed to children who have been vaccinated with LAIV as the likelihood of onward transmission is considered very low (page 15).

Are pregnant women still eligible for the vaccine once they have delivered?

They would only be eligible if they are under another at-risk category otherwise no longer eligible once they have had the baby.

Can the flu vaccine be given at the same time as pertussis vaccination for pregnant women?

Yes these vaccines can be given at the same time or at any interval from each other.

Which vaccine should be offered to the different age cohorts?

The UKHSA flu vaccines for 2023-24 poster details which vaccines should be offered to each age group

Flu vaccines poster

Are there specific precautions regarding patients with asthma and the flu vaccine?

LAIV is contraindicated in children or adolescents expiring an acute exacerbation of asthma symptoms (page 37).

There are no such contraindications with the inactivated flu vaccines normally given to adults. Please see PGD for full list of contraindications (page 8 of PGD).

Inactivated influenza PGD

There are no such contraindications with the inactivated flu vaccines normally given to adults. Please see PGD for full list of contraindications (page 8 of PGD).

National flu immunisation programme 2023 to 2024 letter

Inactivated influenza PGD

Who is responsible for administering the vaccine to school aged children?

Children who were aged 3 on 31/08/23 but subsequently turn 4 during the flu season are the responsibility of GP practices.

Intrahealth are commissioned to provide LAIV to healthy school children.

General practice should only offer vaccination to children and young people from reception – 18 years if they fall into an at risk group, in addition to all children aged 2 or 3.

What happens if a school aged child misses vaccination at school?

If a school aged child who is not in an at risk group misses vaccination at school, their parents should contact Intrahealth – telephone: 03333 583 397 Option 1 & 3, email: contactimms@intrahealth.co.uk

Can a child who lives with someone who is severely immunocompromised have a live flu vaccine?

Children who are household contacts of very severely immunocompromised people, for example bone marrow transplant patients requiring isolation, should also be offered inactivated rather than live flu vaccine (page 42).

Does the flu vaccine contain gelatine?

LAIV contains a highly processed form of gelatine (derived from pigs) as one of its additives. Gelatine is commonly used in a range of pharmaceutical products, including many capsules and some vaccines. The gelatine in LAIV is used as a stabiliser to protect the live viruses from the effects of temperature (page 55).

Can children whose parents refuse the flu vaccine because it contains gelatine be offered an inactivated influenza vaccine?

Children whose parents refuse LAIV due to the porcine gelatine content can be offered an inactivated influenza vaccine. Vaccine (QIVc) for this cohort is available to order by General Practice and school aged immunisation teams via ImmForm (page 56).

Can the nasal vaccine be offered to adults with a BMI over 40?

Individuals eligible for vaccination with LAIV in accordance with national recommendations for the 2022 to 2023 influenza season including: morbidly obese adults (aged from 16 years) with a BMI ≥ 40kg/m2 (LAIV PGD page 7).

Live attenuated influenza vaccine nasal spray suspension (LAIV) Patient Group Direction

National flu immunisation programme 2023 to 2024 letter

Can a Health Care Assistant (HCA) or Health Care Support Worker (HCSW) administer the nasal flu vaccine in a general practice?

The PGD allows “0.2ml of LAIV to be supplied to the individual for immediate self-administration or administration by another person within the clinic setting.” (PGD, page 12).

If competent a non-registered member of staff may administer LAIV under a PSD. (RCN page 12)

Live attenuated influenza vaccine nasal spray suspension (LAIV) Patient Group Direction

Immunisation training standards for healthcare practitioners

Health Care Support Workers Administering Inactivated Influenza, Shingles and Pneumococcal Vaccines for Adults and Live Attenuated Influenza Vaccine (LAIV) for Children, RCN

Can unregistered health care professionals administer the flu vaccine under a PGD or the national protocol?

Non registered health care professionals are not able to work under a PGD, they therefore require a prescriber to issue a PSD for each named patient, OR work under the national protocol which must be used inconjunction with a registered HCP.

Please see link for information on what constitutes a PSD

An unregistered HCA cannot use the national protocol on their own. The assessment, giving of information, obtaining of consent and giving of advice must be completed by a registered healthcare professional. The vaccine preparation, administration and record keeping can then be completed by a competent non-registered member of staff.

GP mythbuster 19: Patient Group Directions (PGDs)/Patient Specific Directions (PSDs), Care Quality Commission

National protocol for inactivated influenza vaccine

GP mythbuster 57: Health Care Assistants in General Practice, Care Quality Commission

Can a Health Care Assistant (HCA) or Health Care Support Worker (HCSW) administer the flu vaccine alone during home visits?

The Royal College of Nursing (RCN) guidance states that there should be “a registered practitioner on site available at all times so that the HCSW can refer any queries outside of their area of knowledge to them” (page 9).

Health Care Support Workers Administering Inactivated Influenza, Shingles and Pneumococcal Vaccines for Adults and Live Attenuated Influenza Vaccine (LAIV) for Children, RCN

GP mythbuster 57: Health Care Assistants in General Practice, Care Quality Commission

Can Trainee Nurse Associates administer the nasal flu vaccine in a general practice?

Trainee Nurse Associates can offer vaccination as an unregistered healthcare professional using a PSD or the national protocol in conjunction with a registered health care professional.

National protocol for inactivated influenza vaccine

Nursing associates should have a registered HCP immediately available for any queries

The Role of Nursing Associates in Vaccination and Immunisation

Do you need a separate PGD signed by the practice GP if administering the flu vaccine during bank shifts?

Yes, unless there is a specific agreement in place across a Primary Care Network (see Care Quality Commission guidance).

Please see link for information on what constitutes a PSD

An unregistered HCA cannot use the national protocol on their own. The assessment, giving of information, obtaining of consent and giving of advice must be completed by a registered healthcare professional. The vaccine preparation, administration and record keeping can then be completed by a competent non-registered member of staff.

GP mythbuster 19: Patient Group Directions (PGDs)/Patient Specific Directions (PSDs), Care Quality Commission

National protocol for inactivated influenza vaccine

GP mythbuster 57: Health Care Assistants in General Practice, Care Quality Commission

Can Pharmacy Technicians use a Patient Group Direction (PGD)?

Please see SPS advice on pharmacy roles and who can work under a PGD.

Pharmacy Technician registered with GPhC

This group can:

  • work under the National Protocol (stages 2-4)
  • work under a PSD written by an appropriate practitioner

This group cannot:

  • act as clinical supervisor for the National Protocol under Regulation 3A
  • write a Patient Specific Direction (PSD)
  • work under the Patient Group Direction (PGD)

Pharmacy professionals giving COVID-19 vaccines legally – SPS – Specialist Pharmacy Service – The first stop for professional medicines advice

Can staff in general practices vaccinate fellow members of staff?

Please see Specialist Pharmacy Service guidance on vaccinating GP practice staff.

GP practice staff flu vaccination advice, Specialist Pharmacy Service May 2022

Can patients be given the Flu, Covid-19 and Shingles vaccines during the same visit?

Yes, Flu, Covid 19 and Shingles vaccines can be given at any time before or after each other.

Please see individual PGDs for more detailed advice before commencing vaccination at https://gmprimarycare.org.uk/screening-and-immunisation/patient-group-directions

What are the training requirements for health care professionals to administer the flu vaccine?

Please see Flu immunisation training recommendations for full training requirements to deliver flu vaccine.

Should the air be left in for injectable flu vaccines?

The flu guidance for healthcare professionals advises:

Inactivated flu vaccines are presented as prefilled syringes for intramuscular injection. Vaccines in prefilled syringes may contain an air bubble. This should not be expelled unless it is specifically stated to do so in the vaccine SmPC. To try to expel it risks accidently expelling some of the vaccine and therefore not giving the patient the full dose. Once injected, the air bubble forms an airlock preventing the vaccine seeping out along the needle track into subcutaneous tissue and onto the skin. The small bolus of air injected following administration of the vaccine clears the needle and prevents a localised reaction to the vaccination 

Information for healthcare practitioners

When can people receive shingles vaccination after having shingles infection?

Individuals with a previous history of a shingles infection are still eligible for a shingles vaccine.

The shingles vaccine can be given at any time following natural infection. As long as the individual is eligible, has recovered from acute infection and has no active vesicles, there is no additional wait period.

Shingles vaccination: guidance for healthcare practitioners

Can the second dose of shingles vaccine be given earlier than the six month interval for immunocompetent patients?

The GPES payment extract will only count second doses given over 186 days after the first dose for the immunocompetent cohort.