Flu Vaccination – eligible patient groups
Flu Vaccination – eligible patient groups
The 2017/18 Flu Vaccination Service has now ended. Further details on the eligible patient groups for the 2018/19 Flu Vaccination Service will be issued in due course.
The service covers those patients most at risk from influenza aged 18 years and older, listed in Annex A of the service specification for the flu vaccination Advanced Service (and also listed below).
The selection of these eligible groups is informed by the NHS England, Public Health England and Department of Health annual flu plan.
Pharmacists are not authorised to administer flu vaccines to other patient groups as part of the Flu Vaccination Service. If a vaccine is administered to patients in other groups, the community pharmacy contractor will not be paid for that vaccination and the administration will have been undertaken outside the authority of the national Patient Group Direction.
The eligible groups for the 2017/18 service are:
- all people aged 65 years and over (including those becoming age 65 years by 31 March 2017);
- people aged from 18 to less than 65 years of age with one or more of the following medical conditions:
- chronic (long-term) respiratory disease, such as severe asthma, chronic obstructive pulmonary disease (COPD) or bronchitis;
- chronic heart disease, such as heart failure;
- chronic kidney disease at stage three, four or five;
- chronic liver disease;
- chronic neurological disease, such as Parkinson’s disease or motor neurone disease, or learning disability;
- immunosuppresion, a weakened immune system due to disease (such as HIV/AIDS) or treatment (such as cancer treatment);
- asplenia or splenic dysfunction;
- morbid obesity
- pregnant women aged 18 or over (including those women who become pregnant during the flu season);
- people aged 18 or over living in long-stay residential care homes or other long-stay care facilities*;
- social care workers;
- carers aged 18 or over; or
- household contacts of immunocompromised individuals who are aged 18 or over.
PSNC Briefing 066/17: Services Factsheet – Eligible Groups for the Flu Vaccination Service 2017/18 – this could be displayed and used as a ‘quick reference’ to assist with determining if a patient is eligible for a vaccination.
* Where a contractor is asked to provide flu vaccinations to eligible patients at a long-stay residential care home or other long-stay care facility they must first seek consent for this to be undertaken from the local NHS England team. Further details on this process are available on the providing the service in care homes page.
Q. At what stage of pregnancy should pregnant women be offered the flu vaccine?
All pregnant women should be offered an inactivated influenza vaccine whilst pregnant, regardless of their stage of pregnancy. Studies have demonstrated that pregnant women can safely receive influenza vaccine during pregnancy and that infants also receive some protection from maternal antibodies as a result of their mother having the vaccination whilst pregnant.
Q. Can the flu vaccine be given to women who are breastfeeding?
Yes. The flu vaccine can be given to breastfeeding women; however, breastfeeding women are not eligible for the community pharmacy Advanced Flu Vaccination Service unless in a clinical risk group.
Q. If a patient has already received a seasonal flu vaccine this year (e.g. in January 2017), do they still need a vaccine during this flu season (e.g. September 2017 – March 2018)?
Yes. If the patient received the vaccine produced for the 2016/17 season then they will still need a dose of the vaccine produced for the 2017/18 season as the vaccine for 2017/18 contains different strains from the previous year.
In addition, the protection gained from flu vaccine is thought to last for one season only so those eligible to receive the vaccine are recommended to have it every year to ensure on-going protection.
Q. Can immunosuppressed patients have the flu vaccine?
Yes, the inactivated influenza vaccine can be safely given to immunosuppressed individuals though they may have a sub optimal response to the vaccine. Individuals may be immunosuppressed because of a medical condition or because of medical therapy that they are taking. As these patients are at risk of increased morbidity and mortality if they develop influenza they should be offered the vaccine. Immunosuppression may continue for a number of months following completion of treatment. If there is any uncertainty regarding an individual’s level of immunosuppression, further advice should be taken from their consultant.
Q. Can patients taking steroids have the inactivated flu vaccine?
Yes, patients taking steroids can be safely vaccinated with inactivated flu vaccine. As systemic steroids at a dose equivalent to prednisolone 20mg or more per day are considered to be immunosuppressive, patients taking steroids are at risk of serious illness if they develop flu and so should be vaccinated. Patients that are receiving high-dose steroids may be immunosuppressed for at least 3 months after cessation of treatment.
Q. When should patients having chemotherapy have their flu vaccine?
Patients receiving chemotherapy should receive their vaccine at the earliest opportunity. For individuals due to commence immunosuppressive treatments, inactivated vaccines should ideally be administered at least two weeks before commencement. In some cases this will not be possible and therefore vaccination may be carried out at any time.
Q. If an individual has had confirmed influenza recently and they are in an at risk group should they still have the vaccine?
Yes, anyone eligible to receive the vaccine should still have it even if they have had confirmed influenza, either recently or in the past. Having the vaccine will help to protect against other circulating strains. The inactivated flu vaccine can be given at any time following recovery providing there are no contraindications to vaccination.
Q. I am unsure whether a patient is eligible to receive a vaccine under the NHS community pharmacy Advanced Flu Vaccination Service because their condition is not specifically mentioned as being part of an eligible group in the service specification. What is the best way to proceed?
Pharmacists will need to make a clinical decision as to whether an individual patient falls into an eligible group based on the information in the service specification and consider that eligible groups offered the flu vaccination are those that are most at risk of the complications of flu. If a pharmacist is unsure if a patient is eligible for an NHS flu vaccination, the patient should be referred to their GP.
Q. Can children receive a flu vaccination under the community pharmacy Advanced Flu Vaccination Service?
No. The NHS Advanced Flu Vaccination Service is for patients aged 18 years and over who fall into an eligible group; it does not cover children.
Q. Should pharmacy teams check with the patient’s GP practice if the patient has already had a flu vaccination?
In most cases the patient will be able to verify if they have received a flu vaccination at their GP practice; however, if the patient is unsure then the GP practice should be contacted to confirm whether they have already been vaccinated or not to prevent the risk of the patient being vaccinated twice. This is especially important for patients who fall into vulnerable groups such as those with dementia who may not remember if they have been vaccinated or not.
Q. Can children (2-17 years) be vaccinated under the national service if they are allergic to Fluenz Tetra nasal vaccine?
Q. Should pharmacy teams verify the eligibility of patients requesting flu vaccination under the service?
In many circumstances pharmacy teams will know the patients who are requesting vaccination under the service and they will therefore be able to determine whether a patient falls within an eligible group as a result of the knowledge of the patient and their patient medication record. There will, however, be circumstances where the patient is not known to the pharmacy team. In that case it will be necessary for the pharmacist to talk to the patient and to use their professional judgement to determine whether the patient falls within an eligible group. As part of the service patients must sign a form which contains a declaration that the information they have given in relation to the service is correct and complete.
Q. Are all people with asthma (aged 18 years or over) eligible for an NHS flu vaccination under the national Flu Vaccination Service?
No. People with asthma are entitled to an NHS flu vaccination if they have asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission as stated in the service specification. Therefore, patients who are only prescribed a short-acting β2 agonist, for example, salbutamol to manage their asthma are not entitled to an NHS flu vaccination unless they fall into another eligible group.
Q. Are pharmacy team members an eligible group for flu vaccination within the Advanced Service?
No. Employers may wish to offer pharmacy staff flu vaccinations as part of their occupational health arrangements, but this cannot be undertaken as part of the Advanced Service. If a pharmacy team member is eligible for an NHS flu vaccination and falls into one of the eligible patient groups for the Advanced Service, they would be able to use the service at the pharmacy.
Q. What should I do if a patient requests a vaccination but they are not eligible under the Advanced Service?
If a patient is not eligible for vaccination under the Advanced Service, but they are eligible for NHS vaccination (for example, a child in a clinical risk group), they should be referred to their GP practice. If a patient is not eligible for vaccination at NHS expense by any healthcare provider, the patient could be offered a private vaccination service (if the pharmacy has appropriate arrangements in place to provide such a service).
Q. Can a vaccination be provided to a patient in an eligible group who is registered with an NHS GP practice and lives elsewhere in England or one of the other home countries, for example, Scotland?
Yes. There are no geographical restrictions placed on provision of the service to eligible patients registered with an NHS GP practice.
Q. Is a patient with epilepsy eligible for an NHS flu vaccination under the national Flu Vaccination Service?
No. Epilepsy is not considered a high-risk group for flu; therefore, patients with epilepsy are not entitled to an NHS flu vaccination unless they fall into another eligible group.
Q. Do patients with HIV need to stop their antiretroviral treatment for two weeks after immunisation and not be immunised until 48 hours after stopping the antivirals?
No. The HIV Pharmacy Association of the UK has advised that there is no interaction between the influenza vaccine and antiretrovirals used to treat or prevent HIV infection and recommend that it is safe to give patients on antiretroviral therapy the influenza vaccine without compromising either the vaccine or the patient’s HIV treatment.
Q. Which care home and domiciliary care workers are eligible to receive the Flu Vaccination Advanced Service?
Only health and social care staff (aged 18 years and over) employed by a registered residential care/nursing home or registered domiciliary care provider who are directly involved in the care of vulnerable patients/clients who are at increased risk from exposure to influenza, meaning those patients/clients in a clinical risk group or aged 65 years and over, are eligible to be vaccinated by community pharmacies.
Q. If a person presenting is a care home and domiciliary care worker but is also eligible to receive the Flu Vaccination Advanced Service at the community pharmacy because they are part of an ‘at risk’ group, under which risk category should they be recorded?
The person presenting should be recorded under their ‘at risk’ group for their eligibility for the Flu Vaccination Advanced Service.
Q. Are health and social care staff working in sheltered housing accommodation, for example, warden controlled flats, eligible to receive the Flu Vaccination Advanced Service?
No. Sheltered housing providers are not regulated by the Care Quality Commission and are therefore not required to be registered, so their staff do not fall within the definition set out in the revised service specification and PGD. However, if a registered domiciliary care provider has staff that attend sheltered housing accommodation to support patients, then these staff will be eligible for vaccination.
Q. Are health and social care staff working in extra-care housing (also called assisted living) eligible to receive the Flu Vaccination Advanced Service?
Yes. Unlike sheltered housing, extra care housing is regulated by the Care Quality Commission. Therefore, these staff do fall in the definition outlined by the service if they are directly involved with the care of the patient.
Extra-care housing (also called assisted living) offers more support than sheltered housing, but still allows clients to live independently. Clients live in a self-contained flat, with their own front door, but meals may be provided. Personal care and support services are generally available on-site 24 hours a day. Some extra care housing is available to buy or rent privately and some is available from the local council following a needs assessment. This type of housing isn’t available in all areas.
Q. Are community pharmacies able to vaccinate eligible care home and domiciliary care workers who work with children?
Yes if the children they work with are already considered to be part of an ‘at risk’ group. Any health and social care staff (aged 18 years and over) employed by a registered residential care/nursing home or registered domiciliary care provider who are directly involved in the care of vulnerable patients/clients including children who are at increased risk from exposure to influenza, because they fall into a clinical risk group listed in Appendix A of the Patient Group Direction, are eligible to be vaccinated.
Q. Are all workers working within registered care home and domiciliary care organisations eligible to receive the Flu Vaccination Advanced Service?
No. Only those workers directly involved in the care of vulnerable patients/clients are eligible. A worker that has no direct contact with a patient/client is not eligible. For example, a member of catering staff that serves food to patient/clients would not be considered eligible.
Q. Does the care home and domiciliary care worker need to provide evidence that they work within a relevant organisation?
Yes. A care home and domiciliary care worker to be vaccinated under the Flu Vaccination Advanced Service should present evidence that they are eligible – they’ll have been told by their employer to bring some evidence with them. The types of appropriate evidence accepted could be an ID badge or payslip from their place of work. A letter on the employer’s letterhead would also be acceptable evidence. As with all patients who present for a vaccination, it’s up to the pharmacy to decide if they are satisfied that the patient is eligible under the advanced service.
PSNC has provided a template that pharmacies can give to local care provider organisations for them to add to their letterhead and provide to staff.