Ask PSNC: Flu FAQs


Ask PSNC: Flu FAQs

September 25, 2018

The team at PSNC has received a number of queries on the NHS Flu Vaccination Service 2018/19. Below are some of the questions asked in recent weeks.

Q. I have accidentally administered a quadrivalent influenza vaccine (QIV) to a patient aged 65 years instead of the adjuvanted trivalent influenza vaccine (aTIV); what should I do?
Although aTIV has been preferentially recommended in England for those aged 65 years and over, QIV is licensed in this age group and should provide protection against flu. For this reason, and also because the safety and effectiveness of administering aTIV shortly after QIV has not been established, no further vaccination is recommended this flu season for an individual who has inadvertently received QIV. The patient should be offered reassurance, the local Screening and Immunisation team should be informed and systems reviewed to prevent this happening again.

Q. I have accidentally administered aTIV to a patient under the age of 65 years instead of QIV; what should I do?
Although aTIV is not licensed for those under 65 years of age in the UK, the vaccine should still provide protection to those under 65 years who receive it inadvertently. No further vaccination is required this flu season. The patient should be offered reassurance and advised of the risk of local reactions. The local Screening and Immunisation team should be informed and systems reviewed to prevent this happening again.

Q. A 68 year old patient has asked if it would be better to have QIV now because it is in stock, rather than returning later in the season for Fluad® (aTIV). What should I advise?
The aTIV is the recommended flu vaccine for all people aged 65 years and over. This is because the aTIV is likely to give better protection against flu. It would therefore be best to wait until further supplies of aTIV have arrived which are known to offer the best protection for this age group.

Q. If a patient is 64 but will be turning 65 during the flu season (i.e. between 1st September 2018 and 31st March 2019), which vaccination should be administered?
The PGD states that Fluad® may be administered under the PGD to 64 year olds turning 65 years of age by 31st March 2019 in accordance with the recommendations for the national immunisation programme for 2018/19. However, this is an off-label use.

Where a vaccine is recommended off-label, as part of the consent process, pharmacists should consider informing the individual/carer that the vaccine is being offered in accordance with national guidance but that this is outside the product licence.

Q. The Patient Group Direction (PGD) states that I can vaccinate patients on stable anticoagulation therapy (including patients on warfarin who are up-to-date with their scheduled INR testing and whose latest INR was below the upper threshold of their therapeutic range) via the intramuscular route using a 23G or finer needle. Does the PGD allow the administration of Fluad, which has a 25G needle, on such patients?
Yes. The 25G needle, which is the size of needle that Fluad is supplied with, is finer than the 23G needle (the higher the gauge, the finer the needle) and therefore acceptable to use when vaccinating patients on stable anticoagulation therapy.

Further FAQs can be found at:

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