Healthcare professionals are reminded that in some circumstances, the recommendations regarding vaccines given in the Green Book chapters may differ from those in the SmPC for a particular vaccine. When this occurs, the recommendations in the Green Book are based on current expert advice received from the JCVI and this advice should be followed. The Green Book recommendations and/or further advice from the Department of Health and Social Care and UKHSA is reflected in PGDs. Children who have received 1 or more doses of any flu vaccine before should be considered as previously vaccinated. Children who are under 9 years of age and are in a clinical risk group should receive 2 doses if it is the first year they are receiving any flu vaccine. In subsequent years, they can be given a single dose as their immune system will already have been primed. The marketing authorisation holder’s Summary of Product Characteristics (SmPC) for Fluenz states that, for children who have not previously been vaccinated against seasonal flu, a second dose should be given after an interval of at least 4 weeks. The JCVI has considered this issue and has recommended that as a second dose of the vaccine provides only modest additional protection, children who are not in a clinical risk group should be offered a single dose of LAIV. Children under 9 years of age who are close/household contacts of immunocompromised persons should have 2 doses in their first year of influenza vaccination, in line with the recommendations for children in clinical risk groups (unless LAIV is contraindicated, for example if contact is severely immunocompromised). Age 0 to 6 months Flu vaccine is not licensed for use in infants less than 6 months old although they may develop some protection through the transfer of maternal antibodies if their mother is vaccinated during pregnancy. Age 6 months to 2 years and not in a clinical risk group Infants and children aged 6 months to 2 years who are not in a clinical risk group are not eligible to receive influenza vaccine as part of an NHS funded vaccination programme. Age 6 months to 2 years and is in a clinical risk group or is a household contact of an immunocompromised person Influenza vaccine is recommended for infants and children aged 6 months to 2 years who are in a clinical risk group or are close/household contacts of immunocompromised persons. LAIV is not licenced or recommended for use in this age group. Children aged 6 months to 2 years in either of these two categories who have never received influenza vaccine in previous flu seasons should receive 2 doses (0.5ml) of the cell based inactivated vaccine (QIVc) with a 4 week interval between doses. Those children who have received 1 or more doses of influenza vaccine in previous flu seasons should be considered as previously vaccinated and only require a single dose (0.5ml) of influenza vaccine each season. QIVe can also be considered for use in this age group if QIVc is not available. Age 2 years to less than 9 years in a clinical risk group or is a household contact of an immunosuppressed individual Children aged 2 to 9 years who are in a clinical risk group or are close/household contacts of an immunosuppressed individual and have never previously received any influenza vaccine should be offered 2 doses of LAIV with a minimum of a 4 week interval between them. Those children who have received a dose of flu vaccine in a previous flu season only require a single dose in subsequent years. If LAIV is contraindicated or is otherwise unsuitable for these children, 2 doses of a suitable age appropriate inactivated vaccine should be given with a 4 week interval between doses. The inactivated flu vaccines are interchangeable so the second dose does not have to be the same vaccine as given for the first dose. If the child is a close/household contact of a very severely immunosuppressed individual (for example, bone marrow transplant patients requiring isolation) an inactivated flu vaccine should be given instead of LAIV. Age 2 years to less than 9 years and not in a clinical risk group Children NOT in clinical risk groups (and who are not household contacts of immunocompromised persons) only require one dose of LAIV. A single LAIV dose is 0.2ml (administered as 0.1ml per nostril). Healthy children aged 2 to 9 years who cannot receive LAIV due to contraindications or whose parents request they receive inactivated flu vaccine instead of LAIV should be offered a single dose of inactivated vaccine (preferably QIVc), even if they have not previously received flu vaccine. Age 9 years to less than 18 years All eligible children aged 9 years to less than 18 years should be offered a single dose of LAIV (unless contraindicated). A single LAIV dose is 0.2ml (administered as 0.1ml per nostril). Children of this age who are in clinical risk groups or who are household contact of immunocompromised persons should receive a single dose even if it is the first season they are vaccinated against influenza. They are likely to have been primed by previous exposure to flu in previous seasons.
18 years and over (including pregnant women of any age) A single 0.5ml dose of an inactivated influenza vaccine is recommended for eligible adults aged 18 years of age or older each year that they are eligible. This includes pregnant women of any age, health and social care workers and those aged 65 years and over.