Concern over ‘inappropriate’ flu vaccine being given to people aged over 65 years

“A significant number” of people aged 65 years and over have been given the wrong flu vaccine, according to an NHS regional flu lead.

In a message to all community pharmacies in the NHS England West Midlands region on 29 September 2022, Tim Davies, consultant lead for screening and immunisation and regional flu lead NHS England Midlands, said the advice was that affected patients should be recalled and a risk assessment undertaken to consider revaccinating with an appropriate vaccine for their age group.

In guidance published on 20 September 2022, the Joint Committee on Vaccination and Immunisation (JCVI) advised the use of the adjuvanted quadrivalent influenza vaccine (aQIV) and the quadrivalent recombinant influenza vaccine (QIVr) for vaccination of people aged 65 years and over in the 2022/2023 flu season.

In the case that the aQIV and QIVr are not available, the JCVI states that the cell-based quadrivalent influenza vaccine (QIVc) may be given.

The QIVe vaccine, which is an inactivated quadrivalent vaccine grown in hens’ eggs, is not recommended for people aged 65 years and over owing to evidence that it is not effective in this age group.

However, Davies’s all-pharmacy message reported that concern has been “expressed nationally” that data have suggested there has been a “significant number of occurrences” where QIVe was given “inappropriately” to people aged 65 years and over.

Davies pointed out that QIVe could be used for those aged 18–64 years in a clinical risk group; for example, those with chronic heart disease or diabetes, if QIVc and QIVr were not available.

“At this stage in the programme, QIVc and QIVr should always be available somewhere in the vicinity so it is difficult to envisage a situation where the use of QIVe is appropriate in the adult at risk population,” he said, adding that NHS England would not reimburse episodes where QIVe had been given to those aged 65 years and over, in line with its previously published guidance.

“If QIVe has been given to anyone [aged over 65 years] the advice is that the patient is recalled and a risk assessment undertaken to consider the issue of revaccinating with an appropriate vaccine for their age group (aQIV or QIVr).”

An NHS spokesperson told The Pharmaceutical Journal that “a small number of people over 65 have been recorded as receiving the QIVe flu vaccine instead of the recommended vaccine type for this age group” but that “there is no clinical risk [for] those affected”.

“Local NHS teams regularly check in with providers to ensure the recommended vaccines have been administered correctly and, on the small number of occasions where this isn’t the case, to see if it is appropriate to invite the patient back,” they added.

On 29 September 2022, the Pharmaceutical Services Negotiating Committee (PSNC) published a reminder to community pharmacy contractors saying that they “must ensure” the correct flu vaccines are being used for each patients cohort within the NHS flu vaccination service.

“Contractors are encouraged to review their clinical practice to ensure their vaccination provisions are in line with the appropriate guidance and any risk of inappropriate vaccination has been considered and the risks mitigated,” the reminder said.