Guidance

The flu vaccination: who should have it and why (winter 2024 to 2025)

Updated 9 September 2024

Applies to England

This guide explains how you can help protect yourself and your children against flu this coming winter, and why it’s very important that people who are at increased risk from flu have their free vaccination every year.

Introduction

Flu is not just a heavy cold. Flu occurs every year, usually in the winter, which is why it’s sometimes called seasonal flu. It’s a highly infectious disease with symptoms that come on very quickly. Colds are much less serious and usually start gradually with a stuffy or runny nose and a sore throat. A bad bout of flu can be much worse than a heavy cold.

The most common symptoms of flu are fever, chills, headache, aches and pains in the joints and muscles, and extreme tiredness. Healthy individuals usually recover within 2 to 7 days, but for some the disease can lead to hospitalisation, permanent disability or even death.

Flu vaccines help protect against the main types of flu virus circulating.

Summary of those recommended to have a flu vaccine

They include:

• everyone aged 65 years and over

• everyone under 65 years of age who has a medical condition listed below, including children and babies over 6 months of age

• all pregnant women, at any stage of pregnancy

• all children aged 2 and 3 years (provided they were aged 2 or 3 years on 31 August before flu vaccinations starts in the autumn)

• all children in primary school

• some secondary school-aged children (Years 7 to 11)

• everyone living in a residential or nursing home

• everyone who receives a carer’s allowance, or are the main carer for an older or disabled person

• all those living with someone who has lowered immunity due to disease or treatment

• all frontline health and social care workers

For advice and information about flu vaccination, speak to your GP, practice nurse, pharmacist or school immunisation team.

It is best to have your flu vaccination in the autumn or early winter before flu rates increase. Remember that you need it every year, so don’t assume you are protected because you had one last year.

Check NHS.UK for information on whether you are eligible.

The causes of flu

Flu is caused by influenza viruses that infect the windpipe and lungs. And because it’s caused by viruses and not bacteria, antibiotics won’t treat it. However, if there are complications from getting flu, antibiotics may be needed.

How you catch flu

When an infected person coughs or sneezes, the flu viruses can be breathed in by other people or they can be picked up by touching surfaces where the viruses have landed. You can prevent the spread of the virus by covering your mouth and nose when you cough or sneeze (ideally with a tissue, or else into the bend of your elbow), and you can wash your hands frequently or use hand gels to reduce the risk of picking up the virus.

But the best way to avoid catching and spreading flu is by having the vaccination before the flu season starts.

How we protect against flu

Flu is unpredictable. Flu vaccination provides the best protection. There are different strains of flu virus. The strains that are most likely to cause illness are identified in advance of the flu season. Vaccines are then made to match them as closely as possible. Even if the vaccine doesn’t perfectly match a strain it usually provides some protection against it.

The vaccines are given in the autumn ideally before flu starts circulating.

The harm flu can do

People sometimes think a bad cold is flu, but having flu can often be much worse than a cold and you may need to stay in bed for a few days. In the worst cases, flu can result in a stay in hospital, or even death.

Some people are more susceptible to the effects of flu. For them, it can increase the risk of developing more serious illnesses such as bronchitis and pneumonia, or can make existing conditions worse.

Those at increased risk from the effects of flu

Flu can affect anyone but if you have a long-term health condition, the effects of flu can make it worse even if the condition is well managed and you normally feel well.

You should have the free flu vaccine if you are pregnant, seriously overweight (BMI of 40 and above) or have a long-term condition, such as:

• a heart problem

• a chest complaint or serious breathing difficulties, including bronchitis, emphysema or some people with asthma (needing a steroid inhaler or tablets)

• a kidney disease

• lowered immunity due to disease or treatment (such as steroid medication or cancer treatment)

• liver disease

• had a stroke or a transient ischaemic attack (TIA)

• diabetes

• some neurological condition, such as multiple sclerosis (MS) or cerebral palsy

• a learning disability

• a problem with your spleen, such as sickle cell disease, or you have had your spleen removed

This list of conditions isn’t definitive. It’s always an issue of clinical judgement. Your GP can assess you to take into account the risk of flu making any underlying illness you may have worse, as well as your risk of serious illness from flu itself.

Those who should consider having a flu vaccination

You should consider having the vaccine if you have any long-term health condition listed above, or you are:

• aged 65 years or over

• pregnant

• children of a certain age

• living in a residential or nursing home

• the main carer of an older or disabled person

• living with someone who has lowered immunity due to disease or treatment

• a frontline health or social care worker

Flu vaccination for pregnant women

Pregnancy alters how the body handles infections such as flu. Flu infection increases the chances of pregnant women and their babies needing intensive care.

All pregnant women should have a flu vaccine to protect themselves and their babies. Flu vaccine can be given safely at any stage of pregnancy, from conception onwards.

Pregnant women benefit from flu vaccination because it can:

• reduce their risk of serious complications such as pneumonia, particularly in the later stages of pregnancy

• reduce the risk of mother or baby needing intensive care

• reduce the risk of the baby being stillborn or premature

• help protect their baby who will continue to have some immunity to flu during the first few months of its life

• reduce the chance of the mother passing infection to her new baby

If you are pregnant and think you have flu

If you have flu symptoms you should talk to your doctor urgently, because if you do have flu there is a prescribed medicine that might help (or reduce the risk of complications), but it needs to be taken as soon as possible after the symptoms appear.

You can get the free flu vaccine from your GP, or it may also be available from your pharmacist or midwife.

Children and the flu vaccination

The following children are being offered the flu vaccine this year:

• those over 6 months of age with certain health conditions

• all 2 and 3 years of age on 31 August

• all primary school-aged children

• some secondary school-aged children (Years 7 to 11)

If you have a child over 6 months of age who has one of the long-term health conditions listed above, they should have a flu vaccination. Any children with these conditions are more likely to become severely ill if they catch flu, and it could make their existing condition worse. Talk to your GP about your child having the flu vaccination before the flu season starts.

If your child has one of the health conditions that puts them at greater risk from flu and is school-aged, you can choose whether they have the vaccine at school or at their GP practice if that is what you prefer. For most children, the vaccine will be given as a spray in each nostril. This is a very quick and painless procedure.

Flu vaccines do not work well in babies under 6 months of age so it is not recommended. This is why it is so important that pregnant women have the vaccination – they will pass on some immunity to their baby that will protect them during the early months of their life

Children aged 2 and 3 years will be given the vaccination at their general practice, usually by the practice nurse.

School aged children will be offered a flu vaccine in school or can be vaccinated at community clinics. This is to help protect them against the disease and help reduce its spread to both other children and their parents and grandparents. This will help you to avoid the need to take time off work because of flu or to look after children who are sick with flu.

NHS.UK has more information on children and flu vaccination.

Having the vaccine every flu season

If you had the flu vaccination last year, you need another one this year.

The flu viruses can change from one winter to the next. Flu vaccines are updated for each winter to give protection against the strains of flu that are most likely to be going around. For this reason, we strongly recommend that even if you were vaccinated last year, you should be vaccinated again this year.

Also, protection from flu vaccination goes down with time so even if some of the strains are the same you should have a flu vaccine again each flu season.

The vaccine should provide protection throughout the current flu season.

Being vaccinated after having flu

If you think you’ve already had flu, you will need a vaccination as it will still help protect you. Other viruses can give you flu-like symptoms, or you may have had flu but because there is more than one type of flu virus you should still have the vaccine even if you think you’ve had flu.

Types of flu vaccine

There are several types of flu vaccine. You will be offered one that is most appropriate for you. Most children are offered the vaccine as a nasal spray and adults are offered an injectable vaccine. None of the vaccines can give you flu.

If your child is aged between 6 months and 2 years old and is in a high-risk group for flu, they will be offered an injected flu vaccine as the nasal spray is not recommended for children under the age of 2 years old. Some children over the age of 2 years who are in a high-risk group will also need to have an injected vaccine if the nasal spray vaccine is not suitable for them.

The flu vaccine can be given at the same time as all routine vaccines. The vaccination can go ahead if you or your child has a minor illness such as a cold but may be delayed for illnesses that include a fever.

People who shouldn’t have the vaccination

Almost everybody can have the vaccine, but you should not be vaccinated if you have ever had a serious allergy to the vaccine, or any of its ingredients. If you are allergic to eggs or have a condition that weakens your immune system, you may not be able to have certain types of flu vaccine – check with your GP. If you have a fever, the vaccination may be delayed until you are better.

Children who shouldn’t have the nasal spray vaccination

Children may not be able to have the nasal vaccine if they:

• are currently wheezy or have been wheezy in the past 72 hours, including those needing extra puffs of asthma reliever inhalers; they should be offered a suitable injected flu vaccine to avoid a delay in protection

• have needed intensive care due to asthma or egg allergic anaphylaxis (children in these 2 groups are recommended to seek the advice of their specialist and may be advised to have the nasal vaccine in hospital)

• have a condition, or are on treatment, that severely weakens their immune system or have someone in their household who needs isolation because they are severely immunosuppressed (such as bone marrow transplant)

• are allergic to any other components of the vaccine

• have a condition that needs salicylate treatment

Also, children who have been vaccinated with the nasal spray should avoid close contact with people with very severely weakened immune systems (for example those who have just had a bone marrow transplant) for around 2 weeks following vaccination because there’s an extremely remote chance that the vaccine virus may be passed to them. If this person is a household member then the child should be offered an injected vaccine.

Nasal vaccine contents

The nasal vaccine contains a highly processed form of gelatine (porcine gelatine), which is used in a range of many essential medicines. The gelatine helps to keep the vaccine viruses stable so that the vaccine is able to work properly and provides the best protection against flu.

The nasal vaccine is easy to give and painless. Each child who has the nasal spray vaccine gets the best protection against flu. It is also considered to be the best at reducing the spread of flu. That way children protect one another and others who might be vulnerable to flu. For those who may not accept the use of porcine gelatine in medical products, injected flu vaccine is available as an alternative. You should discuss your options with your nurse, doctor, or school aged immunisation team.

Side effects

Side effects of the nasal vaccine may commonly include a runny or blocked nose, headache, tiredness and some loss of appetite.

Those having an injected vaccine may get a sore arm at the site of the injection, a low-grade fever and aching muscles for a day or 2 after the vaccination.

Serious side effects with either vaccine are uncommon.

Effectiveness of flu vaccination

The effectiveness of flu vaccination will vary from year to year, depending on the match between the strain of flu in circulation and that contained in the vaccines. Because the flu virus can change from year to year there is a risk that the vaccine does not match the circulating virus.

Even if the vaccine is not a perfect match it will usually offer some protection. Major mismatches do not happen very often.

What you need to do

If you belong to one of the groups mentioned in this guidance, it’s important that you have your flu vaccination.

Speak to your GP or practice nurse, or alternatively your local pharmacist, to book a vaccination appointment.

For pregnant women, the vaccine may also be available through maternity services. The flu vaccine is free.

Organisations wishing to protect their employees against flu (unless they are at risk due to a medical condition will need to make arrangements for the vaccinations to be given through their occupational health departments. These vaccinations are not available on the NHS and will have to be paid for by the employer.

If you are a frontline health or social care worker, find out what arrangements have been made at your workplace for providing flu vaccination. It’s important that you get protected. Some social care workers who cannot get the vaccine through an occupational health scheme can get the vaccine through the NHS from their GP or a pharmacy.

Check NHS.UK for information on whether you are eligible.