Flu vac: important reminder


Contractors are reminded that they must ensure the correct flu vaccines are being used for each patient cohort within the NHS flu vaccination service.

Please note, there is no provision for the use of standard egg-cultured quadrivalent influenza vaccine (QIVe) in the 65 years and over patient cohort.

As set out in the reimbursement flu letter from the Department of Health and Social Care, NHS England and the UK Health Security Agency, the following recommended vaccines should be used for their respective adult patient groups:


Eligible group Type of influenza vaccine

Aged 65 years and over*



  • aQIV (Adjuvanted Quadrivalent Influenza Vaccine Seqirus ▼) or
  • QIVr, (quadrivalent Influenza vaccine (recombinant prepared in cell culture)) (Supemtek ▼)


  • offer QIVc (Cell-based quadrivalent influenza vaccine▼ or Flucelvax® Tetra▼) (only where aQIV or QIVr is not available).**

It is recommended that aQIV is offered ‘off-label’ to 64-year-olds turning 65 years of age before 31 March 2023.

At-risk adults, including pregnant women, aged 18 to 64 Offer:

  • QIVc (Cell-based quadrivalent influenza vaccine▼ or Flucelvax® Tetra▼) or
  • QIVr, (Supemtek ▼)


  • offer QIVe (only where QIVc or QIVr is not available).
50- to 64-year olds NOT in a clinical at-risk group From 15th October 2022 (not before), offer:

  • QIVe or
  • QIVc / QIVr (these should only be offered where it does not divert stock from clinical at-risk groups and those age 65 years and over)

* The JCVI recommended the high dose quadrivalent influenza vaccine (QIV-HD) is offered alongside aQIV because of the additional benefit from the use of aQIV and QIV-HD in those aged 65 years and over. However, QIV-HD is not currently available in the UK market.

**QIVe is not recommended in this age group as aQIV, QIVc and QIVr are preferable on the grounds of clinical effectiveness.

QIVe is not to be used in the aged 65 and over cohort, as the Joint Committee on Vaccination and Immunisation (JCVI) has advised it is not an effective intervention.

QIVe can be used for those aged 18-64 in a clinical at-risk group but only if QIVc and QIVr are 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.

QIVe is an acceptable vaccine for use in those aged 50-64 not in a risk group, however these patients should not be vaccinated prior to 15th October 2022 in line with the service specification and legal frameworks.

A poster that summarises which flu vaccines should be used for which cohorts can be found on the GOV.UK website: Flu vaccines 2022 to 2023 season

Contractors are also reminded that NHS England will not reimburse or remunerate  incidences where the wrong vaccination has been administered.

Managing incorrect provision

If QIVe has been given to anyone aged 65 years or over, the available guidance advises that the patient is recalled and a risk assessment undertaken to consider re-vaccinating with an appropriate vaccine for their age group.

Guidance on this can be found in The national influenza immunisation programme 2022 to 2023: Information for healthcare practitioners.

If this situation occurs/has occurred, please contact your local NHS England screening and immunisation team for advice, as they may be able to share additional supporting information.

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.

Further details on the service and guidance

Further information on the service, guidance and resources can be found via our Flu Vaccination Hub page.

Discover how we are working to improve the outlook for community pharmacy at an event near you.

Click Here