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Flu vaccination guidance updated with new evidence on older age groups

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National vaccination guidance has been updated to reflect evidence suggesting that adjuvanted trivalent influenza vaccines (aTIVs) work better for older patients than other flu jabs.

The Green Book has been revised to reflect recent conclusions from immunisation experts that giving a new type of influenza vaccine to people aged 65 and over would be “more effective”.

A circular has also been sent to primary care providers in Wales highlighting the recommendations made in October by the Joint Committee on Vaccination and Immunisation, which advises ministers.

As previously reported by Nursing Times, the JCVI asked bodies in charge of immunisation policy to consider switching to the new jab for older patients, starting with the over 75s.

The JCVI stated in minutes from its last meeting that existing non-adjuvanted influenza vaccines demonstrated little or no efficacy in the 75 plus age-group, and limited efficacy in the 65-74 group.

The JCVI has said that the use of this adjuvanted vaccine in those aged 65 years and over “would be both more effective than the non-adjuvanted vaccines currently in use, and also cost-effective.”

So far, only one aTIV – called Fluad – has been approved and is available to order for use in the 2018-19 flu season, as reported in August.

Public Health England and the Welsh chief medical officer have now responded to the JCVI guidance. PHE has revised the Green Book chapter on influenza, and a Welsh Health Circular was issued on 29 November to all general practices in Wales.

The circular states that the aTIV is “cost effective when administered to those aged 65 to 74 years” and is the “only clinically effective and cost effective option for those aged over 75 years”.

Meanwhile, the revised Green Book entry on influenza vaccines reiterates the JCVI’s comments on the potential benefits of moving to aTIVs in seasons dominated by flu virus subtype A(H3N2).

Primary care immunisation expert Dr George Kassianos said the update to the Green Book was “welcome”, but suggested it should be stronger in stating which vaccine clinicians should use for different age groups, rather than simply providing information on the JCVI’s conclusions as a guide.

“We would like to see the health authorities in England follow the Welsh CMO’s example and give direct guidance to GP practices and pharmacists as to the specific vaccines recommended by the JCVI for specific ages for the next influenza season,” he said.

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