Influenza vaccines and eligible cohorts for the 2024 to 2025 season (WHC/2023/047)

Issue date: 

21 December 2023. (Revised June 2024)

Status:

Compliance/Action

Category:

Public health

Title:

Influenza vaccines and eligible cohorts for the 2024 to 2025 season

Date of expiry / review:

Not applicable

For action by: 

Chief executives, Health Boards/Trusts 
Immunisation leads, Health Boards/Trusts  
Immunisation coordinators, Health Boards 
Vaccination operational leads, Health Boards/Trusts 
Medical directors, Health Boards/Trusts 
Directors of Primary Care, Health Boards/Trusts 
Nurse executive directors, Health Boards/Trusts 
Directors of Therapies and Health Sciences, Health Boards/Trusts 
Chief pharmacists, Health Boards/Trusts 
Directors of Public Health, Health Boards/Trusts 
Directors of maternity services, Health Boards 
Directors of Workforce and Organisational Development, Health Boards/Trusts Executive Director of Public Health, Public Health Wales 
Nurse director, Public Health Wales 
Head of Vaccine Preventable Disease Programme, Public Health Wales 
Director of planning, vaccination programme Wales 
General practitioners 
Community pharmacists 
Digital Health and Care Wales 

For information to:

Welsh NHS Partnership Forum 
General Practitioner Council, Wales 
Royal College of GPs 
Royal College of Nursing 
Royal College of Midwives 
Royal College of Paediatrics and Child Health 
British Dental Association 
Royal Pharmaceutical Society 
Community Pharmacy Wales 
Care Inspectorate Wales 
Chief Executive, Welsh Local Government Association for onward issue to: Directors of Social Services, Local authorities 
Directors of Public Protection, Local authorities 
Directors of Education, Local authorities 
Social Care Wales 
Health Education and Improvement Wales 

Action required by:

N/A.

Sender:

Dr Frank Atherton, Chief Medical Officer / Medical Director NHS Wales

Welsh Government contact:

Vaccination Division, Welsh Government, Cathays Park, Cardiff CF10 3NQ

Email: wg.vaccinationsprogrammeteam@gov.wales

Enclosure(s):

None

Dear Colleagues,

This revised Welsh Health Circular replaces the version issued on 19 December 2023 and is being published to confirm:

• eligible cohorts for the 2024 to 2025 influenza (flu) season
• reimbursable vaccines for the 2024 to 2025 flu season (including changes made from the previous version of this Welsh Health Circular)
• changes to the start of the 2024 to 2025 adult flu vaccination programme (except for pregnant women)

Eligible cohorts for the influenza (flu) season in 2024 to 2025

The JCVI has not recommended any changes to the eligibility criteria which applied for the 2023 to 2024 programme. Therefore, the groups eligible for a flu vaccine in Wales as part of the routine national flu programme in 2024 to 2025 will be as follows:

• children aged two and three years on 31 August 2024
• school aged children from reception to year 11 (inclusive)
• people aged 6 months to 64 years in a clinical risk group 
• people aged 65 years and older (age on 31 March 2025)
• all adult residents in Welsh prisons
• pregnant women
• carers of a person whose health or welfare may be at risk if the carer falls ill
• frontline health and care workers
• people experiencing homelessness
• household contacts of the immunocompromised 

Reimbursable vaccines in 2024 to 2025

Taking into account the vaccines recommended by the JCVI for the 2024 to 2025 flu season, the vaccines eligible for reimbursement in Wales for the different age cohorts will be as follows:

Those aged 65 years and over 

• aQIV ^{[footnote 1]}
• QIV- HD ^{[footnote 2]}
• QIVc where aQIV/QIV-HD is not available ^{[footnote 3]}

Those aged 18 to less than 65 years (including pregnant women)

• QIVc
• QIV HD (those aged 60 years and over only)  

Children aged 2 to less than 18 years who are contraindicated/ decline LAIV

• QIVc

Children aged 6 months to 2 years in risk groups

• QIVc

Key:

aQIV - adjuvanted quadrivalent influenza vaccine
QIVc - quadrivalent cell culture influenza vaccine
QIV-HD - high dose quadrivalent inactivated influenza vaccine

This revised Welsh Health Circular is being issued following a notification from the manufacturer of QIVr - quadrivalent recombinant influenza vaccine - that this product will not be available as expected in the UK for the 2024 to 2025 ^{[footnote 4]}season. Orders for an appropriate alternative should be placed as soon as possible.  Vaccination Programme Wales will work closely with health boards to support contractors impacted by this change.  General practices, community pharmacies and health boards/trusts should ensure that flu vaccine orders are sufficient to facilitate high uptake.

For the children’s programme, live attenuated influenza vaccine (LAIV) is the recommended vaccine for eligible children aged 2-17 years of age, unless contraindicated or declined due to gelatine content. Where there is a clinically determined need for a less invasive procedure, such as for some adults with a learning disability, the use of LAIV may be considered a reasonable adjustment (see here for more details on gov.uk's website). LAIV is supplied centrally and will be available to order through ImmForm.

Changes to the start of the 2024 to 2025 vaccination programme

JCVI has recently advised that the evidence on vaccination effectiveness supports the case for moving the start of the adult flu vaccination programme to early October. The committee has recommended there should be no change to the start of the children’s programme as evidence shows early vaccination of children provides the best protection against transmission.

It has also recommended pregnant women should continue to be vaccinated in September, if delaying until October would mean they risk missing out on vaccination.

In the light of the committee’s advice, we will adopt a phased approach to the commencement of the flu vaccination programme in 2024 as follows:

• During September, general practices and health boards should concentrate their efforts on maximising uptake in the children’s programme, both amongst school-age children and 2-and 3-year-olds.
• The main adult vaccination programme should begin at the start of October and be delivered at pace with an expectation that all eligible patients should be offered a vaccination by early December.

Where a Primary Care contractor does not have confidence that it will be possible to vaccinate their entire eligible adult cohort between October and early December, they should inform their health board.  In this event, the health board can agree for vaccination to begin in September, rather than risk failing to complete the programme in a timely way.

The flu vaccination programme is a vital element of our winter planning and resilience arrangements.  I have been disappointed to see lower than expected uptake in the 2023 to 2024 programme and I hope the details set out above will support colleagues to develop effective plans to ensure the 2024 to 2025 programme is a successful one. 

Finally, I would like to offer my sincere thanks for all the hard work that goes into delivering our vaccination programmes, which offer vital protection to eligible citizens and to our health service through the winter months.

Yours sincerely,

Sir Frank Atherton

Chief Medical Officer / Medical Director NHS Wales

[1] aQIV may be offered ‘off-label’ to those who become 65 years of age before 31 March 2025.

[2] QIV-HD was not previously available in the UK but its manufacturers have confirmed that it will now be made available for 2024 to 2025.

[3] Whether a vaccine is ‘available’ should be a balance of clinical and operational judgement. The potential delay in sourcing the preferred vaccine (due to a temporary or localised shortage or a national batch failure) should be weighed against the protection afforded by the alternative vaccine. Whether the flu virus is circulating or is imminent at the time would be a factor in making this judgement.

[4] JVCI recommended QIVr for the vaccination of those aged 18 years and over and this product was identified as eligible for reimbursement in the previous version of this Welsh Health Circular.