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INFLUENZA

Find most of the information you need in these resources

Always refer to your local signed PGD's in practice, and remember the Green Book takes priority over the SPmC - and sometimes WHO takes priority over the Green Book! They don't always say the same!

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Keeping up to date: Things to know in practice currently:

EVERYTHING YOU NEED TO KNOW ABOUT DELIVERING THE CURRENT INFLUENZA SEASON IS HERE. Definitely have a browse on that link – you will find everything you need regarding the latest information on flu including slide sets, posters, training modules, and administration videos.

NHS England have provided some staff flu vaccination campaign resources. They include a range of visuals, messaging, scripts, Q&As, a leaflet and top tips. A call to action letter was cascaded to system leaders in 2025 to support improving staff flu vaccine uptake as a national priority. Together with UKHSA, a winter vaccination communications toolkit for stakeholders has been published.

NHSE has now published the GP additional guidance for seasonal vaccinations 2026/27. This provides information on recording COVID-19 and influenza vaccination events and payments, including where practices are collaborating in their PCNs. In previous years this guidance has only covered the influenza programme. For 2026/27 it has been expanded to cover both the COVID-19 and influenza programmes. To support vaccinations for people experiencing homelessness aged 16+ who will be included in the national flu vaccination programme from 1 October, the GP additional guidance for seasonal vaccinations has been updated.

Very pleased to see resources arriving in preparation for the new flu/pneumococcal eligible groups: Vaccination resources for people experiencing homelessness (PEH). These resources are to promote the availability of the flu and pneumococcal vaccines for those experiencing homelessness. And here is some useful guidance (and examples of good practice) Supporting vaccination of people experiencing homelessness: A multi-agency toolkit for planning and delivery of vaccinations to people experiencing homelessness. This was published in June 2026 and is also worth checking out: Understanding and addressing immunisation inequities toolkit

  • Oct 2026: Another important update: Fluenz; be aware of increased risk of fainting following administration. The product information for Fluenz has been updated to reflect that there is an increased risk of syncope (fainting) immediately following administration of the nasal spray, particularly if the individual has previously fainted following vaccination. Procedures should be put in place to prevent injury from fainting and manage syncopal reactions. Due to timing constraints, this information is not included in the patient information leaflet for this season’s campaign. Therefore, please ensure that parents and patients are informed of this potential risk before administration.

  • Have you had your flu jab yet? As a reminder under the Seasonal Vaccination Enhanced Service Specification, practices may offer flu vaccinations to registered and non-registered eligible frontline workers in social care settings without an employer led occupational health scheme where the practice is administering flu vaccinations to residents of a registered residential care home / nursing home or voluntary managed hospice provider; and the person is directly involved in the care of vulnerable patients at increased risk of flu exposure.

  • 9th Sept: Vaccine update has landed! It's a flu bonanza!!! This was highlighted and I found it very interesting: webinar recording: Seasonal flu vaccine 2026/27 – preparing your school for the autumn programme.

  • 3rd September 2026: All vaccines supplied by UKHSA for the 2026 to 2027 children’s flu programme are now available to order on ImmForm

  • 3rd September 2026: The FLU POSTER is here! I don't know about you but I always finally feel like it all makes more sense when this arrives...

  • 27 August 2026: Flu Green Book chapter update!! Updated sections on history and epidemiology of disease, vaccine effectiveness, age specific advice on vaccine type, contraindications (salicylate use and LAIV) and precautions (egg allergy).

  • 27th August 1026: New flu blog inspired by these pesky shortages: Flu Vaccine Supply 2026/27: WHAT WENT WRONG? And what clinics need to do now.

  • 26th Aug 2026: IMPORTANT 2026/27 SUPPLY UPDATE: Manufacturing and supply problems mean some inactivated flu vaccines are limited or arriving later than planned. For this season, IIVc and IIVr should be prioritised for younger adults (under 50), with aIIV and IIV-HD preferentially used in the over 50s where appropriate. But, if aIIV or IIV-HD are unavailable, it is better to vaccinate an eligible person with another JCVI-preferred vaccine for their age group than risk them remaining unvaccinated. See this link for the reference.

  • 25th Aug: New mRNA Flu Vaccine Makes This Flu Season ‘One to Watch’. In clinical trials, mFLUSIVA (mRNA-1010) was about 26.6% more effective at preventing laboratory-confirmed influenza illness than a traditional flu vaccine. It also produced a stronger immune response than traditional vaccines in adults 65 and older, with similar rates of severe side effects, which remained rare.

  • 10th August: These are very vaulable guidance docments for any vaccines and here is the latest one specific to Flu which has just been updated: Flu vaccination programme 26-27: information for healthcare practitioners

  • 6th August: Exciting development! The mRNA technology behind Moderna’s Covid vaccine reaches the flu

  • 23rd July 2026: The interactive flu immunisation e-learning programme, written by UKHSA, and produced by Health Education England’s e-Learning for Healthcare has been published. Get your flu stickers here!

  • 21st July 2026: Few tweaks to the Influenza vaccines marketed in the UK poster.

  • 20th July 2026: Template for GPs to invite patients at risk of flu due to a medical condition or age, and their carers, to have their annual flu vaccine updated

  • 20th July 2026: Children's flu poster is here!

  • 16th July 2026: The national flu vaccination programme training slide set 2026 to 2027 is here!! Check them out :-)

  • 16th July 2026: Flu vaccines 2027 to 2028: JCVI advice is here... check out the addition of aIIVc - and a possible (but-unlikely-due-to-cost) mRNA flu vaccine!

  • 18th June 2026: We have a flu VGD!!! And also the PGD has landed.

  • 9th June 2026: There has been an amendment or two to the annual flu letter. The Green Book chapter has also been updated to reflect that people experiencing homelessness have been added to eligible risk groups.

  • 4th June 2026: Flu briefings for primary and secondary schools added to the 2026 to 2027 flu collection. And here are some useful resources: Flu vaccination guidance and resources for schools and Adolescent vaccination programme in secondary schools for 2026 to 2027 (Information on the adolescent vaccination programme delivered in secondary schools and the role that schools play.)

  • 28th May 2026: All the flu vaccine uptake data has landed for 25/26. Seems to be the usual patterns but slight increases across most eligible risk groups. Also the annual epidemiological report has come in too. If you just want the summary, The main messages of the 2025 to 2026 season are:

    • The season started in the second half of October 2025 in children and young adults with rising influenza A(H3N2) activity. It peaked around the second week of December (2025) and declined after.

    • The 2025 to 2026 season was dominated by influenza A(H3N2) subclade K.

    • Activity started earlier than in the 2024 to 2025 season but also declined earlier and the overall level of activity over the course of the season was lower.

    • Mortality estimates were lower than in the 2024 to 2025 season.

    • Vaccine coverage in adults and children was overall similar to the 2024 to 2025 season.

    • Overall vaccine effectiveness (VE) in adults was lower than last season at 21 to 34%. In children, VE was 51 to 68%.

    • Modelling indicated that, in England, the vaccination programme prevented an estimated 104,000 hospital admissions and 7,100 deaths.

  • 14th May 2026: Flu chapter of the Green Book updated to include advice on those living with homelessness. Evidence shows that people with egg allergy are not at an increased risk of severe allergic reactions to egg-based influenza vaccines. Based on this, JCVI advises that egg allergy is no longer a contraindication to any influenza vaccine used in the UK and there is no need to ask about egg allergy before administering an influenza vaccine (although remain cautious that some people might also be allergic to a different component in the vaccine). Whilst the Green Book chapter has been updated to reflect this for the 2026 to 2027 season, patient leaflets, informed consent forms and other resources (including PGDs and VGDs) will not be updated until next season.

  • 22nd April 2026: Bird flu vaccine trial against potential pandemic strain begins

  • 26th March 2026: Flu uptake data updated. Check out the GP patients uptake here and frontline healthcare workers here. Summary is overall: 65+: 74.5%, clinical risk groups: 40.6%, pregnant women, 38.4%: 2 yr olds: 43.5%, 3yr olds: 44.8%, frontline HCPs: 46.1% (better than the 37.5% compared to last year).

  • 25th March 2026: Wondering why there is no protocol yet? Soon we will say goodbye to National Protocols and a new legal mechanism is coming our way - the VGD. Read all about it here.

  • 26th Feb 2026: The Flu letter is in for 26/27! Accompanied by the poster showing the vaccines marketed for 26/27.

  • 23rd Feb 2026: Moderna’s 2-in-1 flu and COVID vaccine shows encouraging results in small trial

  • 18th Feb 2026: Intriguing and pleasing headline from WHO: Next-generation influenza vaccines could save millions of lives, finds WHO. Finally- a universal flu vaccine is getting closer!!

  • 19th Jan 2026: Updated versions of the GP and community pharmacy seasonal vaccination service specifications have been published. These have been updated to reflect changes to the COVID-19 vaccine ordering process, and new terminology for patients who may require a COVID-19 vaccination outside of usual campaign timing.

  • 8th Jan 2026: Flu uptake update: Over 18.6 million eligible people have been vaccinated so far and nationally, reminders are going out to 300,000 at risk children next week. With flu still circulating please continue to do all you can to encourage eligible people to have their vaccine. Don't forget yourself too! Uptake of the vaccine among HCP's was 44% up to the 31st Dec.

  • 18th Dec 2025: 40.1% of all frontline healthcare workers have been vaccinated for influenza (437,874 of 1,091,164). This includes NHS trusts and GP practices. Read all about the other recent uptake data in these docs: Seasonal influenza vaccine uptake in GP patients and Seasonal influenza vaccine uptake in children of school age.

  • 15th Dec 2025: Service specification is out for community pharmacy seasonal vaccination services – COVID-19 and influenza vaccination advanced services. For the first time the COVID-19 and adult influenza vaccination service specifications have been combined into one document, although contractors can still sign up to deliver adult influenza vaccinations only. Communications about the two-three-year-old flu vaccination service will be separate, pending the outcomes of the evaluation of this year’s pilot.

  • 27th November 2025: Well this is interesting: Of all frontline healthcare workers 29.8% have been vaccinated for influenza (285,622 of 958,296) up to now. This includes NHS trusts (secondary care) and GP practices (primary care). NHS trusts (secondary care) represent data from acute, ambulance, care, community, mental health, other NHS trusts and independent sector health care providers (ISHCPs). Broken down by primary and secondary care, the totals are 29.7% (282,046 of 949,918) for NHS trusts, and 42.7% (3,576 of 8,378) for GP practices. The over 65's are at 60.9%, at risk groups 28.5%, pregnant women 29.5%, 2 and 3 year olds are at 33% each. On the schools programmes, reception and year one are doing the best at 33% (as well) and it goes downhill from there with the lowest uptake (18.1%) being 15-16 year olds.

  • 11th Nov 2025: Fortunately, the 2025/26 vaccine is currently 70 to 75% effective at preventing hospital attendance in children aged 2 to 17 years and 30 to 40% effective in adults. This is encouraging since the rogue mutation in the summer where a drifted influenza A(H3N2) strain (also now known as subclade K) currently dominates cases in England. The protection levels observed in children are particularly encouraging this year.

  • 6th Nov 2025: Over 5 million under 65s with a long-term health condition could miss out flu vaccine. The UKHSA (and me) is concerned that many people at risk may not know they are eligible for a flu vaccine.

  • 23rd October 2025: Update to the Guidance for healthcare practitioners on the national influenza immunisation programme. New Common Issue added: Inadvertent administration of the recombinant inactivated influenza vaccine (IIVr) to a child under 18 years.

  • 23rd October 2025: To date we have vaccinated over 10.4 million (10,436,395) against flu and almost three million (2,987,313) against COVID. Well done all!!

  • 16th October 2025: US documents dozens of new avian flu cases in wild birds as PAHO notes human case

  • 9th October 2025: Amazing job everyone!!! You have vaccinated nearly a million more people against flu so far this autumn compared to last year.

  • 3rd September 2025: Useful new guidance has just appeared with loads of good tips for planning for flu uptake increases. Do have a browse! Flu vaccine for children: best practice guide for GPs: Guidance and Leaflet for GPs and practice staff to support the nasal spray flu vaccination programme for children. I've put it in the hesitancy and uptake section as well so it doesn't get lost in the news feed. This Astrazeneca site has some useful resources around Fluenz too.

  • 1st September 2025: To kick off September a Vaccine Update flu special arrived. Good luck to the school nurses and staff providing maternity services on the commencement of the flu programme for those groups.

  • 21st August 2025: The flu poster for this year has finally landed!

  • Something new for the 2025 to 2026 flu season is that it will be possible for community pharmacies to offer vaccination to children aged 2 and 3 years.

  • 25th June 2025: Previous Flu immunisation training recommendations withdrawn due to new National Minimum Standards being published.

  • 16th July 2025: Statement from the Joint Committee on Vaccination and Immunisation (JCVI) about vaccines for the 2026 to 2027 influenza seasonProgramme (updated Nov 2025 following JCVI advice in October 2025 that IIV-HD can be considered for use from the age of 50 years.)

  • 29th May 2025: One or two additions to the annual flu programme resources - take a look. Also - an update to the Green Book chapter: Updated information on co-administration, seasonal timing of vaccination, vaccine terminology (to future proof wording on quadrivalent and trivalent vaccines), disease surveillance, vaccine uptake, risk groups and occupational health section. Also, the UK Influenza annual epidemiological reports are in.

  • 22nd May 2025: UKHSA data released today shows the flu vaccine prevented 96,000 to 120,200 hospitalisations in England during last winter. Lot of uptake data trickling through too today- see the school vaccine uptake here, the frontline HCP data here, and the GP patients data here. On the whole, it seems pretty disappointing with most risk groups and eligible people down on last years uptake stats. Pregnant women seem to have done slightly better for uptake though on last year.

"The World Health Organization (WHO) has concluded that B/Yamagata lineages are no longer circulating and are unlikely to cause future epidemics, and that inclusion of a B/Yamagata antigen as a component of influenza vaccines is no longer warranted. WHO has stated that every effort should be made to exclude this as soon as possible, across all vaccine types. To this end, manufacturers have been preparing to move to trivalent formulations"

Useful supplementary training documents:

Things to know in practice about previous years:
  • Vaccine uptake in 24/25 was similar to 2023/24, reaching almost 75% in adults over 65 years, 35% in pregnant women, and 40% in clinical risk groups.

  • Uptake in adults over 65 years increased during the COVID-19 pandemic but is now returning to pre-pandemic levels. However, as the size of the older adult population is increasing year on year, more people are being vaccinated to achieve the same uptake percentage (e.g. 5.9 million in 2009/10 vs 7.6 million in 2019/20). The same pattern is not seen for clinical risk groups, with uptake remaining relatively stable during the COVID-19 pandemic and dropping now to the lowest levels recorded since before 2009/10.

  • The programme for pregnant women was introduced in 2010/11 with the highest uptake in 2017/18 (47%). Uptake has been falling since. The JCVI commented in their June minutes this:

    "It was noted that there had been a shift towards maternity services providing vaccination since the COVID-19 pandemic, instead of GPs, which was challenging as it was not something midwives had previously done, whereas GP surgeries have typically had a designated immunisation nurse to advocate for vaccination. This may be a factor in the recent decline of vaccine coverage in pregnant women."

  • In the children’s programme, 24/25 vaccine uptake in children aged 2 and 3 years old was almost 44% and 42%, respectively, almost 55% in primary school children and almost 45% in secondary school children. Uptake in 2- and 3-year-olds increased during the COVID-19 pandemic but has since returned to previous levels.

  • Vaccine uptake in frontline healthcare workers dropped in 24/25 to almost 38%, (lowest in midwives) and this is the lowest recorded level since 2010/11. The highest uptake (almost 77%) was recorded during the first year of the COVID-19 pandemic in 2020/21. That's us guys. Get your own flu vaccine appointments booked in this year and let's get those disappointing stats up!

  • During 24/25 influenza season in the UK, the predominant circulating strains were:

    Influenza A(H1N1)pdm09: This strain, originally responsible for the 2009 Swine Flu pandemic, has continued to circulate and was a significant contributor to the season’s cases.

    Influenza A(H3N2): Co-circulated with A(H1N1)pdm09, contributing to the seasonal influenza burden.

    Influenza B/Victoria lineage: Detected towards the end of the season.

    Notably, no wild-type B/Yamagata strain viruses have been detected since March 2020, suggesting possible eradication.

  • So, Influenza A(H1N1) dominated for most of the 24/25 season, with influenza B activity increasing in January in younger age groups. There was limited influenza A(H3N2) activity. In subtype-specific analyses across the age groups, moderate VE was demonstrated against influenza A(H1N1) and A(H3N2). Protection against influenza B was good across all age groups. Waning effectiveness for influenza A, but not influenza B, was seen in adults.

  • the 2025 to 2026 season was dominated by influenza A(H3N2) subclade K

    EVOLUTION OF THE FLU PROGRAMME

  • Late 1960s: annual flu immunisation recommended to directly protect those in clinical risk groups who are at a higher risk of influenza associated morbidity and mortality

  • 2000: flu vaccine policy extended to include all people aged 65 years or over

  • 2010: pregnancy added as a clinical risk category for routine flu immunisation

  • 2013: phased introduction of an annual childhood flu vaccination programme using the live attenuated nasal spray vaccine for all children aged 2 to 16y began with vaccine offered to all children aged 2 and 3 years and 7 geographical pilots in primary school aged children

  • 2014: phased introduction of childhood flu vaccination programme continued with vaccine offered to all children aged 2, 3 & 4 years and geographical pilots in primary & secondary school aged children

  • 2015: in addition to vaccinating 2-, 3- & 4-year-olds in primary care, a national programme began in primary schools in a phased roll-out starting with the youngest school-aged children first

  • 2016–2019: phased introduction of the childhood flu vaccination programme, with an additional school year included each year.

  • 2020: programme offered to all children aged 2 years to School Year 7 and extended to adults aged 50–64 years.

  • 2021: temporary expansion to all children aged 2 years to School Year 11 and adults aged 50–64 years due to concerns about co-circulation of influenza and COVID-19.

  • 2022: offer adjusted to children aged 2 years to School Year 9, while maintaining the temporary extension to adults aged 50–64 years.

  • 2023–2025: routine programme offered to eligible risk groups, all adults aged 65 years and over, and all children aged 2–15 years (School Year 11).

    Planning considerations: the rapid expansion to secondary school-aged children in 2021/22 and the restoration of the full School Year 11 offer in 2023/24 were implemented with compressed planning and mobilisation timelines.

  • 2026: programme extended to include people experiencing homelessness (defined as rough sleepers and those using homeless hostels or night shelters

Vaccine Uptake data & Trends

Check out the GP patients uptake here and frontline healthcare workers here. Find the kids programme data here.

Summary for 25/26 is:

  • 65+: 74.5% (was 74.9% last year)

  • Clinical risk groups: 40.6%, (was 40.0% last year)

  • Pregnant women: 38.4% (was 35% last year)

  • 2-3 yr olds: 44.2% (was 42.6% last year)

  • Primary school: 55.5% (was 54.5% last year)

  • Secondary school: 48% (was 44.6% last year)

  • Frontline HCPs: 45% (again, better than the 37.5%

    compared to last year).

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Reminders:
  • No need to expel the air bubble in pre-filled syringes

  • Don't forget travellers!

  • Store at 2–8°C; IM injection or nasal spray

  • Look out for any info on combined flu and COVID-19 vaccines appearing.

  • Don't forget to use that appointment to check for any other outstanding or eligible vaccines!

  • Children under 9yrs in clinical risk groups who have never received a vaccine for flu before should be offered two doses 1 month apart.

  • People with mild or no symptoms of flu can still infect others

    Have YOU checked your own vaccine status as a HCP?

Other useful links and resources
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Want to geek out? Go deeper here:

What is Influenza anyway?

Influenza (aka “flu) is a contagious virus that comes around every year, just like bad Christmas telly. It mutates fast, spreads faster, and comes in seasonal waves. It’s not just a heavy cold. It can floor the fittest of us and cause serious complications, especially in vulnerable groups.

What happens If you catch it?

Think fever, chills, muscle aches, sore throat, cough, and “hit by a bus” fatigue. For most, it’s a week or two of misery. But for some - especially the very young, the elderly, or those with underlying health conditions - it can lead to pneumonia, hospitalisation, or worse.

How does It Spread?

It’s airborne—spread through coughs, sneezes, and shared air in crowded places (yes, public transport counts). You can also pick it up from surfaces if you touch your face before washing your hands. The virus can live for around 24 hours on surfaces. Most UK cases of flu occur between December and February.

Does getting flu make you Immune?

Not for long. Flu mutates regularly, so immunity to one strain doesn’t mean you’re protected against the next. That’s why the vaccine changes yearly and why an annual jab is essential for those at risk.

Can it be treated?

Antivirals like oseltamivir can help, but only if taken early (within 48 hours). Mostly, it’s about managing symptoms, staying hydrated, and letting it run its course. For high-risk individuals, early treatment is more important.

Who’s most at risk?

Infants under 6 months (especially before they can be vaccinated - hence the maternal vaccination program), pregnant people, adults over 65, healthcare workers and carers of young babies, and adolescents, people with long-term conditions (e.g. asthma, diabetes) and immunocompromised individuals.

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Top reasons to encourage vaccination (when indicated):

  • flu immunisation is one of the most effective interventions we can provide to reduce harm from flu and pressures on health and social care services during the winter

  • it is important to increase flu vaccine uptake in clinical risk groups and other risk groups because of increased risk of death and serious illness if people in these groups catch flu

  • flu during pregnancy may be associated with perinatal mortality, prematurity, smaller neonatal size, lower birth weight and increased risk of complications for the mother

  • by preventing flu infection through vaccination, secondary bacterial infections such as pneumonia are prevented. This reduces the need for antibiotics and helps prevent antibiotic resistance

  • for a number of years, only around half of patients aged 6 months to under 65 years in clinical risk groups have been vaccinated

  • the childhood flu programme should reduce the impact of seasonal flu on children and reduce transmission of flu within the community. Children under 5 have one of the highest hospitalisation rates every season

  • by reducing transmission of flu, it should also avert many cases of severe flu and flu-related deaths in older adults and people in clinical risk groups

  • Required in many healthcare roles. Protect yourself, your colleagues, and your patients. Plus, prevent time off work (or worse, working while unwell)

  • Influenza leads to hundreds of thousands of GP visits and more than ten thousand hospital stays each year.

  • Flu epidemics can kill thousands or even millions of people. The 1918 flu epidemic is estimated to have affected half the world's population. 40-50 million people died worldwide. It could literally save a life

  • In the UK it is estimated that an average of 600 people a year die from complications of flu. In some years it is estimated that this can rise to over 10,000 deaths. The WHO estimates that between 250,000 and 500,000 people around the world die from the flu every year.

  • Protect the community. Around 1 in 3 people infected by the flu virus will not show any symptoms.