The national influenza immunisation programme 2021 to 2022 (WHC/2021/004)

General practitioners
Community pharmacists
Chief Executives, Health Boards/Trusts
Immunisation Leads, Health Boards/Trusts
Immunisation Coordinators, Health Boards/Trusts
Medical Directors, Health Boards/Trusts
Directors of Primary Care, Health Boards/Trusts
Nurse Executive Directors, Health Boards/Trusts
Directors of Public Health, Health Boards/Trusts
Executive Director of Public Health, Public Health Wales
Head VPD Programme, Public Health Wales
Community Pharmacy Wales
General Practitioner Council, Wales
Sender: Chief Medical Officer for Wales

HSSG Welsh Government Contact(s):

Health Protection Services, Department for Public Health, Welsh Government, Cathays Park, Cardiff CF10 3NQ

Dear Colleague,

I would like to thank everyone involved in the delivery of this winter’s influenza vaccination campaign for the extra work undertaken to maximise vaccine uptake and keep the people of Wales safe. Despite the challenges, I am very pleased that uptake across all priority risk groups has increased and more people than ever before in Wales have received an influenza vaccination. For the first time, over one million influenza vaccinations have been given during the season.

This letter provides guidance on ordering supplies of influenza vaccines for the 2021-2022 season. It is based on advice from the Joint Committee on Vaccination and Immunisation (JCVI). The JCVI’s statement on influenza vaccines for the 2021-2022 season can be found at: JCVI or NHS Wales Intranet (NHS Wales staff only)

General practices, community pharmacies and health boards/trusts should plan their influenza vaccine ordering to at least equal the high levels of uptake achieved in 2020-21.

Groups who are most at risk from influenza and of catching influenza and infecting other members of the community remain the priority for next season. These are:

• children aged two and three years on 31 August 2021
• children in primary school from reception class to year 6 (inclusive)
• people aged six months to less than 65 years in clinical risk groups
• people aged 65 years and older (55 years if in prison)
• pregnant women
• carers
• people with a learning disability
• healthcare workers (including healthcare students) with direct patient contact
• staff in nursing homes and care homes with regular client contact
• staff providing domiciliary care

As with this winter, there may be policy developments to extend the cohorts eligible for NHS influenza vaccination during the 2021-22 season.These developments will be informed by the levels and impact of COVID-19 infection in the population and the ongoing roll out of the COVID-19 vaccination programme. Should additional cohorts be introduced or existing groups expanded, further advice will be communicated as soon as possible.

For the NHS vaccination programme, reimbursement for influenza vaccines will only be made for the vaccines recommended in this circular. Payment for general practices will be outlined in Directions in due course.

Adult programme

The recommended vaccines are:

Adults aged 65 years and over

• adjuvanted quadrivalent influenza vaccine (aQIV)
• quadrivalent cell culture influenza vaccine (QIVc) where a QIV is not available

At-risk adults aged 18 to 64 years (including pregnant women)

• quadrivalent cell culture influenza vaccine (QIVc)
• quadrivalent egg based influenza vaccine (QIVe) where QIVc is not available

The JCVI considers High-Dose quadrivalent influenza vaccine (QIV-HD) also effective in those aged 65 years and over. However, because of a significantly higher list price QIV-HD is not eligible for reimbursement in the NHS vaccination programme for 2021-22.

The JCVI considers Quadrivalent Recombinant influenza vaccine (QIVr) also effective in both those aged over 65 years and those aged 18 to 64 years. However, it is not eligible for reimbursement in the NHS vaccination programme at this time.

Children’s programme

The recommended vaccines are:

Children aged 2 to 17 years in an at-risk group or an eligible age group

• live attenuated quadrivalent influenza vaccine (LAIV) is the recommended vaccine for use in all eligible children aged 2-17 years of age unless contraindicated

Children aged 2 to 17 years in an at-risk group or an eligible age group where LAIV is contraindicated or declined due to its gelatine content*

• quadrivalent cell culture influenza vaccine (QIVc)
• quadrivalent egg based influenza vaccine (QIVe)

* An injectable vaccine may be offered to those children whose parents/guardians refuse the live attenuated influenza vaccine (LAIV) due to the porcine gelatine content.

Children aged 6 months to under 2 years of age in a clinical risk group

• quadrivalent influenza egg-culture vaccine (QIVe)

LAIV is supplied centrally via ImmForm. Practices should order appropriate amounts of injectable vaccines for eligible children.

NHS Wales Health Board and Trust staff

Health boards and trusts should order sufficient injectable vaccine for all staff with direct patient contact. The recommended vaccines are:

• quadrivalent cell culture influenza vaccine (QIVc)
• quadrivalent egg based influenza vaccine (QIVe) where QIVc is not available
• adjuvanted quadrivalent influenza vaccine (aQIV) for staff aged 65 years and over

Workers in adult residential care and nursing homes (including hospices) with direct client contact, and domiciliary care staff

Community pharmacies will continue to be the main provider of NHS influenza vaccinations to eligible social care staff with regular client contact working in adult residential care homes, nursing homes and children’s hospices or those providing domiciliary care. In some areas, a more flexible approach may be required with delivery thorough general practices. In these instances, health boards should agree delivery models locally with primary care partners to ensure vaccine supplies are ordered accordingly.

For social care workers the recommended vaccines are:

• quadrivalent cell culture influenza vaccine (QIVc)
• quadrivalent egg based influenza vaccine (QIVe) where QIVc is not available
• adjuvanted quadrivalent influenza vaccine (aQIV) for staff aged 65 years and over

Thank you for your continued support to increase influenza vaccination uptake and protect more people from this potentially serious vaccine preventable disease.

Dr Frank Atherton
Chief Medical Officer / Medical Director NHS Wales