Revised flu process: Inadvertent administration of inappropriate flu vaccine type

Revised flu process: Inadvertent administration of inappropriate flu vaccine type

October 1, 2018

Public Health England (PHE) has updated its inactivated influenza vaccine guidance for healthcare practitioners which includes a small number of changes from its previously published version.

The most significant change is in relation to the process to follow when individuals have inadvertently been given a flu vaccine type that is not recommended for their age group.* The previous version of the guidance advised healthcare practitioners not to administer a second dose and to report this incident to their local Screening and Immunisation team.

The revised process is:

  • inform the patient of the error and its potential implications;
    • advise the patient that although the quadrivalent influenza vaccine (QIV) and adjuvanted trivalent influenza vaccine (aTIV) will offer some protection to all age groups, individuals aged 65 years and over (particularly those more than 75 years of age) may not respond as well to the QIV as they would to the aTIV, and individuals aged under 65 years will not benefit from the opportunity to make protection against an additional flu strain if they have been given aTIV;
  • following a discussion about the risks and benefits, advise the patient that they could, if they wish, be given a second dose of the vaccine they should have had;
    • the clear benefit is the additional protection that may be offered by the correct vaccine, but they should be alerted to the potential increased risk of a local or systemic reaction. Although there is no data available on the safety and effectiveness of administering a second flu vaccine shortly after the first in adults, this advice is based on general principles of vaccination, experience of flu revaccination following cold chain and administration incidents and information about the high dose flu vaccine used in the United States (which contains four times the amount of antigen that is in a single dose of QIV or aTIV);
  • if a decision is made to offer the vaccine the patient should have received, it is recommended that this is done as soon as possible after the first dose was given and ideally within a week. This will enable protection to be made as soon as possible. It can, however, still be given if more than a week has elapsed.

This advice also applies to those who have inadvertently been given non-adjuvanted trivalent influenza vaccine (TIV).

*Please note, PHE will be publishing an addendum to the community pharmacy influenza Patient Group Direction to reflect this change as currently the PGD does not allow for revaccination if a patient has already received a flu vaccination for the current flu season. PSNC will alert contractors through their normal communication channels when this is published (pharmacists will not be required to sign up to the addendum). Contractors are therefore advised, at the moment, not to revaccinate patients and should advise patients to return at a later date for revaccination once the addendum has been published.

Contractors are encouraged to read the updated PHE guidance as it contains important information regarding the Flu Vaccination Service.

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