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Now that summer has officially ended and autumn is here, we should all be thinking about how we keep ourselves fit and well over the long winter months. Winter vaccines play an important part in keeping you healthy and with this in mind the flu jab should be at the top of your list.
Although we may just ask for a flu jab, interestingly, there are many flu vaccinations available in the UK this winter. Your family doctor will usually offer you one that's most appropriate for your circumstances but if you’re getting your flu vaccine through a private clinic, you need to do a bit of homework to see which is the most appropriate one for you. We can help.
To complicate this further, the flu virus can mutate or change its form each winter to try and evade your immune system. Scientists called this ‘antigenic drift’ and therefore the vaccines need to be modified in such a way so that they closely resemble the circulating virus for the current flu season. Each year, the World Health Organisation inform the flu vaccine manufacturers which flu strains will be circulating for the forthcoming season. The flu vaccines are then manufactured according to a very strict and tight schedule to make sure they are available on time.
There are three main influenza virus types, A, B and C but C is quite uncommon, so the manufacturers produce a flu vaccine that covers two subtype strains of flu A and another two subtypes of flu B. As a result, most flu vaccines are quadrivalent in that they cover the four subtypes.
In this article, we’ll run through your various options, particularly if you choose to have your flu jab through a private clinic.
What we’ll cover:
The different types of flu vaccines
This winter, there are 5 main types of flu vaccines available in the UK and all but one are inactivated. There’s actually a 6th type of flu vaccine called the recombinant quadrivalent influenza vaccine (QIVr) but it’s not available this winter.
1. Live attenuated influenza vaccine (LAIV)
The live attenuated influenza vaccine (LAIV), otherwise known as the nasal flu vaccine is a weakened form of the virus licensed for use in children. The virus has been modified so that it can only replicate slightly below the body temperature of 37°C. This makes it ideal to be applied as a spray in the nasal passage as it's cooler here than the core body temperature.
The nasal flu vaccine is ideal for children because it only needs to be given as single dose and can be conveniently applied as a spray rather than a painful injection. It's more effective than the injectable forms in children and has a broader protective cover so that even if the flu virus changes slightly mid-season, it will still provide some immunity.
LAIV is licensed for children aged 2 to 17 years but if your child is less than two years old there are other possibilities (see below)
2. Egg cultured quadrivalent influenza vaccine (QIVe)
As the name suggests, this vaccine is an inactivated flu virus that’s cultured in eggs. Over the years it's been noticed that when the virus is manufactured using this process, it's able to undergo ‘egg adaptation’, which means that it has developed the ability to change its form. That means it can end up very different to the circulating strain. For this reason, these vaccines have not been very effective in past seasons as it creates a mismatch. The Joint Committee on Vaccination and Immunisations in the UK (JCVI) therefore do not recommend egg cultured vaccines unless there are no options available.
3. Cell cultured quadrivalent influence of vaccine (QIVc)
This injectable inactivated influence a vaccine is cultured in mammalian cells and is therefore egg free and suitable for people with egg allergies. It's also effective and suitable for most age groups. The vaccine is licensed from the age of 6 months with no upper age limit. QIVc is now available at Health Klinix.
4. Adjuvant quadrivalent influenza vaccine (aQIV)
During the 2016/2017 UK flu season, we found that the available vaccines at the time were not very effective for older people. When this was investigated, the vaccines were simply not good enough to adequately stimulate an immune response, especially in those aged over 70.
After further research, a new vaccine with an adjuvant was developed. This adjuvant is an extra compound attached to the vaccine and helps stimulate a better immune response in older people. This aQIV vaccine has been licensed for people aged 65 and over
5. High dose quadrivalent influenza vaccine (QIV – HD)
This flu jab contains up to 4 times the usual dose of most flu vaccines which means it's able to stimulate a better immune response in all other people. It is currently licensed for 60 years of age and over.
Why different types of flu jabs exist?
As soon as you can see, over the years a number of flu jabs have been developed in response to the evolving nature of the flu virus and its ability to change its form depending on the environment it exists in.
As such, scientists have had to adapt the manufacturing methods to the varying immune responses overtime. We have now fine-tuned the various flu jabs to make them as effective as possible for different population groups. But this fine tuning is a constant process that occurs every year because of the flu virus’ remarkable ability to change itself and invade the immune system. This is why you need a flu jab every year because the latest influenza vaccine is matched to the circulating virus strain in any given year.
Who should get which flu vaccine?
In most countries, the flu jab is given routinely to those who are at higher risk. There are five main groups who may have a most severe illness with influenza
1. Individuals with pre-existing medical conditions
If you have a chronic medical condition such as respiratory, cardiac, gastrointestinal, kidney and neurological disease then your family doctor will routinely invite you for a flu vaccination. Examples include asthma, heart failure kidney failure and multiple sclerosis and you can find more details of medical conditions in the Green Book.
2. Adults aged 65 and over
As we've already discussed, older people are more likely to have severe complications such as pneumonia, with influenza infection. They should either receive the adjuvant (aQIV) or high dose quadrivalent influenza vaccine (QIV-HD) as these will be more effective at this age
3. Individuals who are immunocompromised
This includes people with leukaemia, cancer and those who may have received chemotherapy or any drugs that might weaken their immune system. Individuals should receive the relevant vaccine for the age groups but please note that the live weakened nasal flu vaccine (LAIV) should be avoided. The cell cultured quadrivalent influenza of vaccine would be suitable (QIVc)
4. Pregnant women
If you're pregnant, catching influenza can put you at risk of various pregnancy related complications such premature delivery or your baby not growing as well as it should. Babies in the first 6 months life are also more likely to have severe influenza and therefore it's crucial that you are vaccinated if you are pregnant. Most pregnant women will be offered the QIVc.
5. Children
Kids tend to gather together in large communal groups such as nurseries, schools, etc which means they end up becoming ‘super spreaders’ of influenza. Importantly, they can pass it onto their more vulnerable family members. This is why the UK government started routine flu vaccinations for all children 8 to 17 years in 2013. LAIV is most effective vaccine in children.
We've already discussed which vaccines should be administered for each of these groups but here’s a summary table as guidance.
Summary of flu vaccination UK recommendations for 2024/2025
Age/Risk group | Preferred flu vaccine | Alternative flu vaccine if preferred not available |
≥ 65 years | aQIV QIV -HD | QIVc |
60-64 years | QIV-HD, QIVc, | QIVe |
18-64yrs | QIVc | QIVe |
2-17 years | LAIV | QIVc |
2-17 years but unable to have LAIV | QIVc | QIVe |
6 months - 2 years | QIVc | QIVe |
Adapted from JCVI Statement on influenza vaccines 2024-25
Definitions:
aQIV - Adjuvant quadrivalent influenza vaccine
QIV-HD - High dose quadrivalent influenza vaccine
QIVc - Cell cultured quadrivalent influenza vaccine
QIVe - Egg cultured quadrivalent influenza vaccine
LAIV - Live attenuated influenza vaccine
People with allergies
The cell cultured quadrivalent influenza of vaccine is egg free and therefore can be given for those who have egg allergies
Influenza vaccination and gelatine
Only the nasal flu vaccine contains gelatine. Very small amounts are used as a stabiliser and is highly purified. It's also hydrolysed (broken down by Water) and so is different to the Del contained in foods. More guidance can be found on the University of Oxford Vaccine Knowledge Website.
When should you get your flu vaccination?
It's important to remember that most of the flu cases in the UK occur from late December through to February. As the immune response to a flu jab is not long lasting you need to carefully consider the optimal time for your flu jab. The JCVI have advised that children and pregnant women should receive their flu vaccination from the 1st of September onwards whereas adults should have theirs from the 3rd of October as their immunity is not as long lasting.
Conclusion
If you’re belong to a vulnerable group, you should have the flu jab. Usually, your family doctor will guide you on the most appropriate flu vaccine based on your individual circumstances. Otherwise talk to vaccine experts like Health Klinix for high quality, trusted information.
Health Klinix believes that all individuals should protect themselves from influenza and its potentially serious complications. We now have flu jabs in stock and at a very affordable cost of £21.50.
References
Written and approved by
Dr Ravi Gowda, Consultant Physician
MBBS, MRCP, DCH, DTM&H, DRCOG, DFFP, MRCGP
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