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New flu vaccine for the over 75s

Sharon Graham discusses what the latest government advice on age-related flu vaccinations means in practice. 

Sharon Graham discusses what the latest government advice on age-related flu vaccinations means in practice. 


Picture: iStock

The June 2017 Joint Committee on Vaccination and Immunisation (JCVI) commented on the trivalent inactivated influenza vaccine (TIV), saying that in those 18-64 years old, effectiveness of the vaccine was modest for all strains, but in those 65 years and over, TIV effectiveness was significantly lower.

The JCVI went on to say that the TIV effectiveness seen in in those 65 years and over was disappointing and that there was a trend for lower vaccine effectiveness against H3N2 in older people due potentially to immunosenescence (JCVI 2017a).  

This news broke briefly in the national press without too much furore and it remains to be seen if it had an impact on the uptake for the 2017/18 season (BBC 2017).

For a number of years there has been an awareness of the lack of efficacy of the TIV in our oldest members of the population due to immunosenescence; 'the weakening immune system of the older adult'. Introducing the live nasal influenza vaccine to younger people is designed to protect the older adult, particularly knowing that children are considered the ‘super spreaders’.

Higher efficacy vaccines

In June the JCVI referred to a higher dose vaccine, that is not available in UK, and also to an unlicensed adjuvanted trivalent inactivated vaccine (aTIV). aTIV was licensed in UK in August 2017, too late to be recommended for changes to the 2017/18 season. Both of these vaccines are reported to have higher efficacy in older people. 

By the October we had heard via the media about the potential impact during our flu season from an influenza A(H3N2) strain seen in the southern hemisphere during their winter. The media was highlighting the importance of influenza vaccine in eligible categories to reduce the burden of disease on the NHS during the winter season.

The October JCVI reiterated the concerns about the NHS and winter pressures should the UK experience the same intense influenza activity as had been seen in the southern hemisphere (JVCI 2017b). They highlighted that mortality in the previous six years caused by Influenza A(H3N2) was higher in 65-75 year olds than A(H1N1) in previous seasons, but even worse was that influenza attributed mortality was estimated to be seven times high in those 75 and over (PHE 2017).

What’s new

In December 2017 the Public Health England Commissioning Team (NHS England 2017) sent a letter acknowledging the JCVI advice and, along with advising the use of more than one supplier for vaccines in the 2018-19 season to reduce the impact of production supply or batch failure, they advocate the use of ‘age appropriate vaccine’.

The letter identifies the newly licensed aTIV vaccine to be available for the 2018-19 season and the JCVI concludes that it is more effective and cost effective if used in those age 65 and over. They do, however, emphasise and fully support the JCVI advice that the priority group for this aTIV vaccine are those 75 and above, and say this is the only licenced cost-effective option for that age group.

GPs will be reimbursed the cost for influenza vaccines they purchase and administer to eligible patients, which includes funding for the use of the aTIV vaccine in those 75 and above. I interpret this as implying that the funding is the £9.80 a practice gets (2017-18 price) for each flu vaccine administered in the practice to an eligible person will not be paid if aTIV given to under 75 year olds. I would like to see further clarification. 

What’s next

What does this mean for primary care? Another vaccine in the fridge. Remembering that the current aTIV licence is for 65 and over, but the recommendation is for 75. So assuming your practice purchases for 75 and over, there will be a need to educate everyone involved in which vaccine to use for which patient. I envisage lots of signs on fridges and desktops.  

Hopefully the use of aTIV in the 75 and older age group will bring about a significant reduction of the burden flu can have in older populations, reduced consultation numbers and overall cost savings to the NHS. 

The vaccine has been used in Canada and Italy. A little more local pain is reported post adminstration but it does come with a longer length needle, otherwise contraindications and side effects are largely the same as with TIV.

References


About the author 

Sharon Graham is senior lecturer in adult, primary care and general practice nursing at the Shrewsbury Centre of Excellence, Staffordshire University

 

 

Conflict of interest

Received honoraria for teaching and mentoring support and publications from Seqris over the past 12 months.

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