Website of the Department of Health

Flu vaccine target groups

The target groups for the 2007/08 influenza season are listed below.

The national policy is for flu vaccine to be offered to the following groups:

1.    Those aged 65 years and over

2.    Those aged 6 months and over with underlying medical conditions such as:

• Chronic respiratory disease, including asthma*;
• Chronic heart disease;
• Chronic renal disease;
• Chronic liver disease;
• Chronic neurological disease, including stroke and transient ischemic attack (TIA);
• Diabetes;
• People with impaired immunity due to disease or treatment;
• Individuals with Multiple Sclerosis and related conditions;**
• Those with hereditary and degenerative diseases of the Central Nervous System **
  

Note:

* Asthmatics who require continuous or repeated use of inhaled or systematic steroids, or with previous exacerbations requiring hospital admission.
** GPs should consider on an individual basis the clinical needs of their patients in these groups

3.    Those living in long-stay residential care homes or other long-stay care facilities (but not including prisons, young offender institutions, and university halls of residence).

4.    Those who are in receipt of a carer's allowance, or those who are the main carer for an elderly or disabled person whose welfare may be at risk if the carer falls ill. This should be given on an individual basis at the GP's discretion in the context of other clinical risk groups in their practice.

5.    In addition, NHS employers should offer immunisation to employees directly involved in patient care, and social care employers should consider similar action for staff in nursing and care homes who look after older people. Influenza immunisation of staff can reduce the likelihood of transmission of influenza to vulnerable patients.

Further information on the clinical risk groups is available in the CMO/CNO/CPO letter for the 2007/08 flu season.

• PL CMO (2007)3: Influenza Immunisation Programme 2007/2008

Influenza vaccine composition for 2007 to 2008

The World Health Organization (WHO) recommends flu vaccine strains based on careful mapping of flu viruses as they move around the world. This monitoring is continuous and allows experts to make predictions of which strains are most likely to cause influenza outbreaks in the northern hemisphere in the coming winter.

Current vaccines are trivalent, containing two subtypes of influenza A and one type B virus. In recent years these have closely matched viruses that are circulating. 

The strains of influenza virus recommended by WHO to be used in the 2007/2008 season (northern hemisphere winter) are:

• an A/Solomon Islands/3/2006(H1N1)-like virus 
• an A/Wisconsin/67/2005 (H3N2)-like virus 
• a B/Malaysia/2506/2004-like virus

About flu viruses

Different flu viruses circulate each winter, and frequently more than one virus will circulate at the same time.

Influenza A and Influenza B viruses are responsible for most clinical illness. The flu A virus is more serious than flu B virus and is responsible for outbreaks in most years. Flu B tends to cause less severe disease and smaller outbreaks. When flu B does appear, it mostly affects young children, because they have not been exposed to it before and thus have acquired no immunity.

Once flu B takes hold in an enclosed environment such as schools and nurseries, it transmits very rapidly.

The symptoms of flu include a high temperature, fever, headache, chills, sore throat, aches and pains, and sometimes vomiting or a feeling of nausea. I n most people symptoms will last from two to seven days.

Flu immunisation programme for people who work in close contact with poultry

Free seasonal flu vaccinations will also be offered to those who work in close contact with poultry as a precautionary public health measure. This is the second year that this programme has been run.

The vaccination programme, which is voluntary, is being implemented to guard against the slight risk that those who work in close contact with poultry could catch the avian flu virus if an outbreak were to occur in birds.

If these individuals caught human flu at the same time, the avian and human flu viruses could mix in their body to create a new flu virus. 

A new flu virus produced in this way could potentially be very infectious and cause serious illness in other people, as they would not have any immunity to a new virus.

Seasonal flu vaccine protects against ordinary human flu thus reducing the risk of a new virus emerging. Seasonal flu vaccination does not protect against bird flu.

• Flu vaccination leaflet for poultry workers

Influenza activity this season

During week 15/08 (week ending 13 April), influenza activity remained below the baseline levels in England, Scotland and Wales; thresholds for Northern Ireland have not been set.

The baseline level is reached at 30 per 10,000 population. This is the threshold at which the National Institute of Clinical Excellence (NICE) guidelines on the use of antiviral drugs are triggered. The use of antiviral drugs for the prevention or treatment of influenza is now recommended.

• Seasonal Influenza - Weekly Reports (opens new window)
• Influenza Season 2007/08 - Use of antivirals (opens new window)

Table 1: Visits to doctor's surgery

Number of people in England going to general practitioner with flu and flu-like illnesses: week 15 [ending 13 April] and week 14 [ending 6 April] and the same weeks during 2007.

Table 2: Incidence of flu by area

Number of people with flu and flu-like illnesses going to a general practitioner: week 15 [ending 13 April] and week 14 [ending 6 April] and the same weeks during 2007.

Table 3: Vaccine coverage of at-risk groups at the end of the previous year's flu vaccine campaigns (%)

Table 4: Vaccine coverage of at-risk groups by the end of each month

Coverage of at-risk groups

Last season's flu activity (2006 to 2007

The United Kingdom experienced low levels of influenza activity during the 2006/2007 season. Clinical activity started to increase late, from week 06/2007 (early February), and the episode incidence rate peaked at 43.7 per 100,000 in week 07/2007 (mid February).

 In England and Wales rates for influenza and influenza-like illness remained close to or below baseline levels during the whole season.

The CfI Respiratory Virus Unit at the Health Protection Agency identified the dominant influenza virus this season as influenza A, with 99% of influenza detections between week 40/2006 and 20/2007 being influenza A.

This influenza A dominant season was also seen in most European countries participating in the European Influenza Surveillance Scheme (EISS).

History of the influenza immunisation programme

Influenza immunisation has been recommended in the UK since the late 1960s, with the aim of directly protecting those most likely either to suffer from the complications associated with influenza such as bronchitis and pneumonia, or to die from the effects of influenza itself.

Vaccination was first offered to people of any age who have an underlying health condition that means they are particularly vulnerable, e.g. chronic heart disease, and to those living in long-stay residential accommodations where influenza, once established, would rapidly spread. 

In 1998, the programme was extended to include those aged 75 years and over.

In 2000, this was further extended to those aged 65 years and over, based on evidence by the Joint Committee for Vaccines and Immunisation (JCVI) that showed that there were significant health benefits to extending the service to include this group.

In addition, NHS and social care employers were now required to include influenza immunisation in their winter plans for front line employees.

Since 2004, the influenza campaign has focused on increasing uptake among those with chronic conditions like asthma and diabetes, as well as continuing to target those aged 65 years and over.

 The JCVI keep the flu immunisation programme under constant review. Additional risk groups have been added to the programme and will be added following careful consideration of available medical and scientific evidence.

• Summary of flu immunisation policy

Vaccination uptake

The Department of Health measures the annual uptake of flu vaccine both by risk groups and those aged 65 and over.

The World Health Organization encourages uptake of flu vaccine in the elderly and set a target uptake rate of 50% by 2006 and 75% by 2010.

The NHS achieved the WHO 50% target in 2000/01 reaching 65.4%. Uptake in those aged 65 and over in 2006/07 was 74%, so well on the way to reaching the 75% target by 2010.

Uptake in the younger at risk groups has some way to go before achieving similar levels of uptake and the Department of Health’s aim is to achieve an even greater number of at risk groups vaccinated this winter to reduce the thousands of deaths that are attributed to seasonal flu every year.

Pneumococcal immunisation

The pneumococcal immunisation programme was launched in August 2003, to offer the 'pneumo'  (pneumococcal polysaccharide) vaccine to older people. This vaccine offers protection against serious pneumococcal infections such as pneumonia, meningitis and septicaemia (blood poisoning), which can be particularly serious in older people.  The immunisation programme was phased in over 3 years.  This started with those aged 80 years and over in August 2003, those aged 75 years and over in April 2004 and since April 2005 all those 65 years and over have been recommended pneumo vaccine.

On 4th September 2006, pneumococcal conjugate vaccine was added to the routine childhood immunisation programme at 2, 4 and 13 months of age.  A pneumococcal catch-up programme for all children under two years of age is underway.

People aged 2 months to under 65 years of age who are at higher risk from pneumococcal disease are also recommended pneumococcal vaccination. This includes people who have a heart condition, chronic lung disease, diabetes mellitus, a weakened immune system, a damaged spleen or no spleen.

Further information is available in the CMO Letter, 'Important changes to the childhood immunisation programme'.

• PL CMO (2006) 1: Important changes to the childhood immunisation programme

Further information

Members of the public who want to know more are advised to talk to their GP, ring NHS Direct on 0845 4647, or visit the NHS Immunisation Information website.

• NHS Direct (opens new window)
• NHS immunisation information (opens new window)
• Explaining Pandemic Flu - October 2005 edition
• Bird flu and pandemic influenza: what are the risks?