The flu vaccination: who should have it and why

The flu vaccination: winter 2021 to 2022

This guide explains how you can help protect yourself and your children against flu this coming winter, and why it’s very important that people who are at increased risk from flu have their free vaccination every year.

Flu isn’t just a heavy cold

Flu occurs every year, usually in the winter, which is why it’s sometimes called seasonal flu. It’s a highly infectious disease with symptoms that come on very quickly.

Colds are much less serious and usually start gradually with a stuffy or runny nose and a sore throat. A bad bout of flu can be much worse than a heavy cold.

The most common symptoms of flu are fever, chills, headache, aches and pains in the joints and muscles, and extreme tiredness. Healthy individuals usually recover within 2 to 7 days but, for some, the disease can lead to hospitalisation, permanent disability or even death.

The causes of flu

Flu is caused by influenza viruses that infect the windpipe and lungs. And because it’s caused by viruses and not bacteria, antibiotics won’t treat it. However, if there are complications from getting flu, antibiotics may be needed.

How you catch flu

When an infected person coughs or sneezes, they spread the flu virus in tiny droplets of saliva over a wide area. These droplets can then be breathed in by other people or they can be picked up by touching surfaces where the droplets have landed.

You can prevent the spread of the virus by covering your mouth and nose when you cough or sneeze, and you should wash your hands frequently or use hand gels to reduce the risk of picking up the virus.

But the best way to avoid catching and spreading flu is by having the vaccination before the flu season starts.

How we protect against flu

Flu is unpredictable. The vaccine provides the best protection available against a virus that can cause severe illness. The most likely viruses that will cause flu are identified in advance of the flu season and vaccines are then made to match them as closely as possible.

The vaccines are given in the autumn ideally before flu starts circulating. During the last 10 years, the vaccine has generally been a good match for the circulating strains.

Flu vaccines help protect against the main types of flu virus circulating.

The harm flu can do

People sometimes think a bad cold is flu, but having flu can often be much worse than a cold and you may need to stay in bed for a few days. Some people are more susceptible to the effects of flu. For them, it can increase the risk of developing more serious illnesses such as bronchitis and pneumonia, or can make existing conditions worse. In the worst cases, flu can result in a stay in hospital, or even death.

Those at increased risk from the effects of flu

Flu can affect anyone, but if you have a long-term health condition, the effects of flu can make it worse even if the condition is well managed and you normally feel well. You should have the free flu vaccine if you are:

pregnant

or have a long-term condition such as:

a heart problem
a chest complaint or serious breathing difficulties, including bronchitis, emphysema or some people with asthma
a kidney disease
lowered immunity due to disease or treatment (such as steroid medication or cancer treatment)
liver disease
had a stroke or a transient ischaemic attack (TIA)
diabetes
a neurological condition, such as multiple sclerosis (MS) or cerebral palsy
a learning disability
a problem with your spleen, such as sickle cell disease, or you have had your spleen removed
you are seriously overweight (BMI of 40 and above)

This list of conditions isn’t definitive. It’s always an issue of clinical judgement. Your GP can assess you to take into account the risk of flu making any underlying illness you may have worse, as well as your risk of serious illness from flu itself.

Those who should consider having a flu vaccination

All those who have any condition listed above, or who are:

aged 65 years or over
living in a residential or nursing home
the main carer of an older or disabled person
a frontline health or social care worker
pregnant, see below
children of a certain age

Those aged 50 to 64 years old will also be offered flu vaccination this year.

If you are pregnant

Pregnancy alters how the body handles infections such as flu. Flu infection increases the chances of pregnant women and their babies needing intensive care.

All pregnant women should have the flu vaccine to protect themselves and their babies. The flu vaccine can be given safely at any stage of pregnancy, from conception onwards.

Pregnant women benefit from the flu vaccine because it can:

reduce their risk of serious complications, such as pneumonia, particularly in the later stages of pregnancy
reduce the risk of miscarriage or having a baby born too soon or with a low birth weight
help protect their baby, who will continue to have some immunity to flu during the first few months of their life
reduce the chance of the mother passing infection to her new baby

If you are pregnant and think you have flu

If you have flu symptoms, you should talk to your doctor urgently, because if you do have flu there is a prescribed medicine that might help (or reduce the risk of complications), but it needs to be taken as soon as possible after the symptoms appear.

You can get the free flu vaccine from your GP, or it may also be available from your pharmacist or midwife.

Children and the flu vaccination

If you have a child over 6 months of age who has one of the conditions listed above, they should have a flu vaccination. All these children are more likely to become severely ill if they catch flu, and it could make their existing condition worse.

Talk to your GP about your child having the flu vaccination before the flu season starts.

The flu vaccine does not work well in babies under 6 months of age so it is not recommended. This is why it is so important that pregnant women have the vaccination – they will pass on some immunity to their baby that will protect them during the early months of their life.

Some other groups of children and young people are also being offered the flu vaccination. This is to help protect them against the disease and help reduce its spread both to other children, including their brothers or sisters, and, of course, their parents and grandparents. This will help you to avoid the need to take time off work because of flu or to look after your children with flu.

The children being offered the vaccine this year, are:

all children aged 2 or 3 years old on 31 August 2021
all primary school-aged children
all year 7 to year 11 secondary school-aged children
children with a health condition that puts them at greater risk from flu

Children aged 2 and 3 years will be given the vaccination at their general practice usually by the practice nurse. School-aged children and young people will be offered the flu vaccine in school. For most children, the vaccine will be given as a spray in each nostril. This is a very quick and painless procedure.

For more information on children and flu vaccination, visit gov.im/flu

The types of flu vaccine available

There are several types of flu vaccine. You will be offered one that is most effective for you, depending upon your age, from the following:

children aged 2 to 17 are offered a live vaccine as a nasal spray. The live viruses have been weakened so it cannot give you flu
adults aged 18 to 64 are offered an injectable vaccine. It is an inactivated vaccine that does not contain any live viruses and cannot give you flu. There are different types available depending on how they were manufactured
adults aged 65 and over are offered an injected vaccine. It is an inactivated vaccine that does not contain any live viruses and cannot give you flu. Usually, you will be offered one that contains an adjuvant that helps the immune system create a stronger response to the vaccine. It is offered to people in this age group because as people age their immune system responds less well to vaccines

If your child is aged between 6 months and 2 years old and is in a high-risk group for flu, they will be offered an injected flu vaccine as the nasal spray is not licensed for children under the age of 2. Some children over the age of 2 who are in a high-risk group will also need to have an injected vaccine if the nasal spray vaccine is not suitable for them.

The flu vaccine be given to your child at the same time as other vaccines.

The flu vaccine can be given at the same time as all routine childhood vaccines. The vaccination can go ahead if your child has a minor illness such as a cold but may be delayed if your child has an illness that causes a fever.

People who shouldn’t have the vaccination

Almost everybody can have the vaccine, but you should not be vaccinated if you have ever had a serious allergy to the vaccine, or any of its ingredients. If you are allergic to eggs or have a condition that weakens your immune system, you may not be able to have certain types of flu vaccine – check with your GP. If you have a fever, the vaccination may be delayed until you are better.

Children who shouldn’t have the vaccination

Children may not be able to have the nasal vaccine if they:

are currently wheezy or have been wheezy in the past 72 hours, they should be offered a suitable injected flu vaccine to avoid a delay in protection
have needed intensive care due to asthma or egg allergic anaphylaxis (children in these 2 groups are recommended to seek the advice of their specialist and may need to have the nasal vaccine in hospital)
have a condition, or are on treatment, that severely weakens their immune system or have someone in their household who needs isolation because they are severely immunosuppressed
are allergic to any other components of the vaccine
have a condition that needs salicylate treatment

Also, children who have been vaccinated with the nasal spray should avoid close contact with people with very severely weakened immune systems for around 2 weeks following vaccination because there’s an extremely remote chance that the vaccine virus may be passed to them.

The nasal vaccine contains gelatine derived from pigs (porcine gelatine)

The nasal vaccine contains a highly processed form of gelatine (porcine gelatine), which is used in a range of many essential medicines. The gelatine helps to keep the vaccine viruses stable so that the vaccine provides the best protection against flu.

The nasal vaccine is offered to children as it is more effective in the programme than the injected vaccine. This is because it is easier to administer and considered better at reducing the spread of flu to others, who may be more vulnerable to the complications of flu.

However, if your child is at high risk from flu due to one or more medical conditions or treatments and can’t have the nasal flu vaccine they should have the flu vaccine by injection.

For those who may not accept the use of porcine gelatine in medical products, an alternative injectable vaccine is available this year. You should discuss your options with your nurse or doctor.

Potential side effects

Side effects of the nasal vaccine may commonly include a runny or blocked nose, headache, tiredness and some loss of appetite. Those having the injected vaccine may get a sore arm at the site of the injection, a low-grade fever and aching muscles for a day or two after the vaccination. Serious side effects with either vaccine are uncommon.

Level of protection

Because the flu virus can change from year to year there is always a risk that the vaccine does not match the circulating virus. During the last 10 years, the vaccine has generally been a good match for the circulating strains.

Protection period

The vaccine should provide protection throughout the current flu season.

What you need to do

If you belong to one of the groups mentioned in this guidance, it’s important that you have your flu vaccination.

Speak to your GP or practice nurse, or alternatively your local pharmacist, to book a vaccination appointment and get the best possible protection. For pregnant women, the vaccine may also be available through maternity services.

The flu vaccine is free, so make an appointment to receive one.

Organisations wishing to protect their employees against flu (unless they are at risk) will need to make arrangements for the vaccinations to be given through their occupational health departments. These vaccinations are not available on the NHS and will have to be paid for by the employer.

If you are a frontline health or social care worker, find out what arrangements have been made at your workplace for providing flu vaccination. It’s important that you get protected.

Summary of those who are recommended to have the flu vaccine

They include:

everyone aged 65 and over
everyone under 65 years of age who has a medical condition listed above, including children and babies over 6 months of age
all pregnant women, at any stage of pregnancy
all 2 and 3 year old children (provided they were aged 2 or 3 years old on 31 August of the current flu season)
all children in primary school
all Year 7 to Year 11 secondary school-aged children
everyone living in a residential or nursing home
everyone who cares for an older or disabled person
all frontline health and social care workers