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GPs told to order two different types of flu vaccines amid efficacy fears

GP practices have been advised by NHS England to order a separate adjuvanted vaccine, Fluad, to give to over-75s in the 2018/19 flu season.

A letter from NHS England’s Public Health Commissioning Team instructed practices order a separate flu vaccine for patients who are over 75 years of age, after PHE announced in September that last year’s vaccine was not ‘significantly effective’ in older patients.

However the directive has been met with concern by some GPs over the potential logistical and financial issues with ordering two separate vaccines.

NHS England's letter said: ‘The adjuvanted trivalent flu vaccine is currently considered to be the only licensed cost-effective option for this group.’

The Joint Committee on Vaccinations and Immunisations recommended the switch to an adjuvanted vaccine in over-75s last year.

It said in its November meeting minutes: ‘The committee agreed that if a change in approach were to be considered, switching vaccination of the 75 years and upwards age group to adjuvanted vaccine would be the first priority, given the un-adjuvanted inactivated vaccine showed no significant effectiveness in this group.’

But Dr Kieran Sharrock, medical director of Lincolnshire LMC, said that NHS England's advice had come 'too late' for many practices.

He said: 'Many practices have ordered early to ensure that they get the supply that they need and have therefore ordered similar quantities to the last flu season.

‘We are unsure if they will be able to amend their orders, and whether they will be financially disadvantaged due to this advice coming after the deadline for orders.’

But Dr George Kassianos, GP and RCGP immunisation lead, said GPs should follow NHS England's advice.

He said: 'We know from the PHE publications that last year, the effectiveness of the conventional influenza vaccines in the over-65s was not apparent. Over-75s fared particularly badly to the point that the JCVI called the effectiveness of the conventional vaccine in the elderly “disappointing”.

'It makes clinical sense to use the adjuvanted vaccine in the elderly for next influenza season and that is what NHS England is urging GPs to consider.'

The news comes as the UK is in the grip of the current flu season, with rates of GP consultations and hospitalisations increasing week by week.

In Scotland, early testing showed just over half of the circulating strains were the same as those for which this season's vaccine offers protection.

However, England data on hospitalisations suggested the dreaded 'Aussie flu' H3N2 was on the rise - with 112 hospitalisations in 19 hospitals last week, compared to five across 12 trusts the week before - for which there was no vaccine made available to patients.

Readers' comments (5)

  • Vinci Ho

    The latest NewScientist had dedicated the whole edition to influenza . Debora McKenzie’s article is worth a read.
    https://www.newscientist.com/article-topic/flu/
    And even more surprising, an article in latest edition of The Economist was insightful,supportive and sympathetic towards GPs:-
    A thinning front line
    The NHS’s latest problem: a shortage of GPs
    https://www.economist.com/news/britain/21734011-hospitals-struggle-winter-crisis-longer-term-problem-brewing-primary-care

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  • Whilst I realise flu vaccination is a source of valuable income for practices it seems crazy that something so important from a public health point of view is left to practice's commercial decisions when it comes to how much vaccine to order nearly a year in advance. Surely there must be a better way of doing this, especially when it comes to ordering different things for different age groups?

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  • Do you trust the establishment to organise this the couldn't get laid in a brothel with a thousand pound down their collective pants.

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  • Crazy set up. Children’s vacs are free to GPs and we simply order them in. obviously the only reason the NHSE doesn’t do this is because they are in thrall to the big pharma chains and have done some deal where there is an “understanding” that they won’t favour one over another by ordering en-bloc.
    just make a block deal with the suppliers and let us GPs or pharmacists get as much as we need. If demand is poor then we just bin the excess. If we need more we just order more. Does Nhse really think that we GPs can really predict demand, in a changing marketplace with competitor pharmacists, a whole year in advance?

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  • VH - Good article from the Economist. At least someone in the media has noticed and (more to the point) recognised the knock-on effects of a thinning front line. I spoke to a TV journalist recently, who was quite unaware of the crisis in GP. Hospitals get more headlines and always will.

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