Seasonal influenza vaccine uptake in children of school age in England: winter season 2023 to 2024
Updated 18 November 2024
Applies to England
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In 2023 to 2024, the following school-aged cohorts were offered influenza vaccinations: all primary school-aged children in Reception to Year 6, and secondary school-aged children in Years 7 to 11.
This report describes the final influenza vaccine uptake for the school-aged programme targeted at all school children aged 4 to 16 years old (Reception to Year 11) in England during 2023 to 2024.
All data in this report represents data returned from 100% (154 of 154) of local authorities (LAs) in England on cumulative influenza vaccinations administered from 1 September 2023 to 31 January 2024.
Comparison data is given to last season (2022 to 2023). Because of differences in the programme between seasons (see background information and appendix), throughout this report, comparison data to last season (2022 to 2023) is for Reception to Year 9 aged children, unless otherwise stated. Last season, Years 10 and 11 were vaccinated subject to vaccine availability, and at a national level very little activity took place in these years groups.
Main points
This season:
- 52.2% (3,498,576 out of 6,708,016 ) of school-aged children who were eligible in both seasons (Reception to Year 9 combined) were vaccinated, compared with 51.9% (3,502,566 out of 6,747,523) in the 2022 to 2023 season
- 55.1% (2,554,536 out of 4,631,343) of primary school children (Reception to Year 6) combined were vaccinated, compared with 56.3% (2,647,295 out of 4,705,474) during the 2022 to 2023 season
- 45.6% (946,040 out of 2,076,673) of secondary school children (Year 7 to Year 9) combined were vaccinated, compared with 41.9% (855,271 out of 2,042,049) during the 2022 to 2023 season (Year 7 to Year 9)
- 42.9% (1,472,280 out of 3,432,207) of secondary school children (Year 7 to Year 11) combined were vaccinated, compared with 26.7% (867,651 out of 3,254,203) (Year 7 to Year 11)
- 49.9% (4,022,141 out of 8,063,277) of all school-aged children in Reception to Year 11 combined were vaccinated, compared with 44.2% (3,514,946 out of 7,959,677) (Reception to Year 11)
Cumulative influenza vaccine uptake by academic year for the national programme in England this season, as presented in table 3 of the supplementary data, was:
- 55.9% (342,744 out of 612,943) of children in Reception (aged 4 rising to 5 years) compared with 56.7% during the 2022 to 2023 season
- 56.4% (359,476 out of 637,143) of children in school Year 1 (aged 5 rising to 6 years) compared with 56.4% during the 2022 to 2023 season
- 55.6% (365,212 out of 656,633) of children in school Year 2 (aged 6 rising to 7 years) compared with 57.5% during the 2022 to 2023 season
- 55.8% (375,706 out of 673,407) of children in school Year 3 (aged 7 rising to 8 years) compared with 57.3% during the 2022 to 2023 season
- 55.1% (372,891 out of 676,420) of children in school Year 4 (aged 8 rising to 9 years) compared with 56.2% during the 2022 to 2023 season
- 54.1% (367,822 out of 679,847) of children in school Year 5 (aged 9 rising to 10 years) compared with 55.6% during the 2022 to 2023 season
- 53.3% (370,401 out of 695,083) of children in school Year 6 (aged 10 rising to 11 years) compared with 54.2% during the 2022 to 2023 season
- 49.2% (341,077 out of 692,900) of children in school Year 7 (aged 11 rising to 12 years) compared with 45.2% during the 2022 to 2023 season
- 45.1% (313,576 out of 694,772) of children in school Year 8 (aged 12 rising to 13 years) compared with 40.7% during the 2022 to 2023 season
- 42.5% (293,077 out of 688,904) of children in school Year 9 (aged 13 rising to 14 years) compared with 39.6% during the 2022 to 2023 season
- 41.6% (282,801 out of 679,095) of children in school Year 10 (aged 14 rising to 15 years) compared with 1% during the 2022 to 2023 season. Note that in 2022 to 2023, Years 10 and 11 were vaccinated subject to vaccine availability and at national level very little activity took place in these years groups
- 35.7% (241,749 out of 676,536) of children in school Year 11 (aged 15 rising to 16 years) compared with 1% during the 2022 to 2023 season. Note that in 2022 to 2023 Years 10 and 11, were vaccinated subject to vaccine availability and at national level very little activity took place in these years groups
The national ambition for the 2023 to 2024 flu season was to demonstrate a 100% offer and to achieve at least the uptake levels of 2022 to 2023. Of 154 local authorities (LAs) in England, 81 (52.9%) had an uptake equal or above that of the 2022 to 2023 season.
This season (2023 to 2024) influenza vaccine uptake across primary school-aged children (Reception to Year 6) was 1.2 percentage points lower than it was in the 2022 to 2023 season (as described earlier in the section).
Comparability between seasons for secondary school-aged vaccine uptake is limited. However, this season has seen the greatest number of secondary school-aged children vaccinated in a season (1,469,605 children, see supplementary Table 6a).
For the first time since the school-aged programme was introduced, influenza vaccine uptake in excess of 90% was achieved in a school year group at an LA level (this was seen in 3 year groups: Reception, Year 2 and Year 7).
Results of influenza vaccine uptake in school-aged children
Full data tables and graphs showing final influenza vaccine uptake for children in school years Reception to Year 11 at NHS region and local authority level are described and shown throughout this section. Data for this season and prior seasons is also available at vaccine uptake guidance and the latest coverage data.
Response rates
All data in this final end of season report represents data returned from 100% (154 of 154) of local authorities (LAs) in England on cumulative influenza vaccinations administered from 1 September 2023 to 31 January 2024. Data from last season’s annual report (2022 to 2023) also represented a 100% return (153 of 153 LAs).
Throughout the 2023 to 2024 season, provisional uptake data was published on GOV.UK on a cumulative monthly basis. The final end of season response rate for this annual report (100%) was higher than that observed in the provisional monthly surveys (Table 7a and Table 7b). This includes the last monthly survey (data up to 31 January 2024, published February 2024) which had a response rate of 88.3%. In that survey, a total of 50.0% of all school-aged children (Reception to Year 11), 55.2% of primary school-aged children (Reception to Year 6) and 43.0% of secondary school-aged children (Year 7 to Year 11) received the influenza vaccine in England. Caution should be used when interpreting provisional monthly data as the vaccine uptake percentages are based on denominators of those LAs returning data that month. Differences in response rates account for the slight decrease in vaccine uptake seen between the provisional monthly January 2024 survey and the end of season data presented in this report.
National uptake
This season (2023 to 2024) an estimated 4,022,141 children from school years Reception to Year 11 in England were vaccinated with an influenza vaccine between 1 September 2023 to 31 January 2024. Cumulative influenza vaccine uptake based on combined data for the target populations (Reception to Year 11) was 49.9% (4,022,141 out of 8,063,277) and the median uptake is given in Table 1.
Last season (2022 to 2023) an estimated 3,514,946 children from school years Reception to Year 11 in England were vaccinated with an influenza vaccine between 1 September 2022 to 28 February 2023. This season (2023 to 2024), 507,195 more children were vaccinated than in the 2022 to 2023 season.
Table 1. Total number of children in primary school, in secondary school and all school years between Reception to Year 11 eligible for influenza vaccination, total number who received vaccination, vaccine uptake and median vaccine uptake in England for the 2023 to 2024 season by interquartile range (IQR)
| School year | Total number of eligible children | Total number of children vaccinated | Influenza vaccine uptake (%) | Median influenza vaccine uptake (%) |
|---|---|---|---|---|
| Primary school-aged children (Reception to Year 6) | 4,631,343 | 2,552,536 | 55.1 | 54.5% (IQR 46.2% to 63.5%) |
| Secondary school aged children (Year 7 to Year 11) | 3,431,934 | 1,469,605 | 42.8 | 40.1% (IQR 31% to 50.3%) |
| All eligible school-aged (Reception to Year 11) | 8,063,277 | 4,022,141 | 49.9 | 48.5% (IQR 40.0% to 57.3%) |
Year group
For primary school-aged children (Reception to Year 6), the cumulative uptake and the median uptake is shown below by year group (Table 2a and Table 2b and Figure 1).
Figure 1. Influenza vaccine uptake (%) for children in primary school years Reception to Year 6 by year group and season
Table 2a. Total number of children in primary school years Reception to Year 6 eligible for influenza vaccination, total number who received vaccination, vaccine uptake (%) and median vaccine uptake in England for the 2023 to 2024 season
| School year | Total number of eligible children in LA | Total number of children vaccinated | Flu vaccine uptake (%) | Median flu vaccine uptake (%) |
|---|---|---|---|---|
| Reception | 612,937 | 342,475 | 55.9 | 55.7% (IQR 47.3% to 63.2%) |
| Year 1 | 637,204 | 359,273 | 56.4 | 56% (IQR 48.2% to 63.6%) |
| Year 2 | 656,681 | 364,986 | 55.6 | 55.1% (IQR 47.3% to 63.6%) |
| Year 3 | 673,407 | 375,488 | 55.8 | 55.6% (IQR 47.1% to 64%) |
| Year 4 | 676,465 | 372,657 | 55.1 | 54.6% (IQR 45.6% to 63.3%) |
| Year 5 | 679,801 | 367,566 | 54.1 | 53.9% (IQR 44.6% to 62.8%) |
| Year 6 | 694,848 | 370,091 | 53.3 | 52.8% (IQR 43.6% to 61.2%) |
| Total | 4,631,343 | 2,552,536 | 55.1 | 54.5% (IQR 46.2% to 63.5%) |
Table 2b. Total number of children in primary school years Reception to Year 6 eligible for influenza vaccination, total number who received vaccination, vaccine uptake (%) and median vaccine uptake in England for the 2022 to 2023 season
| School year | Total number of eligible children in LA | Total number of children vaccinated | Flu vaccine uptake (%) |
|---|---|---|---|
| Reception | 631,948 | 358,090 | 56.7 |
| Year 1 | 658,504 | 371,724 | 56.4 |
| Year 2 | 670,319 | 385,524 | 57.5 |
| Year 3 | 671,067 | 384,685 | 57.3 |
| Year 4 | 676,946 | 380,757 | 56.2 |
| Year 5 | 689,328 | 383,397 | 55.6 |
| Year 6 | 707,362 | 383,118 | 54.2 |
| Total | 4,705,474 | 2,647,295 | 56.3 |
The cumulative uptake and the median uptake for secondary school-aged children (Year 7 to Year 11) are shown in Table 3a and Table 3b. Note that for the 2022 to 2023 season, data for Year 10 and Year 11 is not comparable to the current season, as in 2022 to 2023 the programme was prioritised for those up to school Year 9.
Table 3a. Total number of children in secondary school years Year 7 to Year 11 eligible for influenza vaccination, total number who received vaccination, vaccine uptake (%) and median vaccine uptake for England for the 2023 to 2024 season
| School year | Total number of eligible children in the local authority geography | Total number of children vaccinated with influenza vaccine | Influenza vaccine uptake (%) | Median influenza vaccine uptake (%) | |
|---|---|---|---|---|---|
| Year 7 | 692,900 | 340,471 | 49.1 | 46.8% (IQR 37.2% to 56%) | |
| Year 8 | 694,868 | 313,021 | 45.0 | 42.6% (IQR 33.4% to 52.7%) | |
| Year 9 | 688,905 | 292,548 | 42.5 | 39.3% (IQR 31% to 50.4%) | |
| Year 10 | 678,974 | 282,270 | 41.6 | 39.0% (IQR 29.5% to 49.3%) | |
| Year 11 | 676,287 | 241,295 | 35.7 | 32.8% (IQR 23.9% to 42.7%) | |
| Total (Years 7 to 9) | 2,076,673 | 946,040 | 45.6 | 43.0% (IQR 33.3% to 52.5%) | |
| Total (Years 7 to 11) | 3,431,934 | 1,469,605 | 42.8 | 40.1% (IQR 31% to 50.3%) |
Table 3b. Total number of children in secondary school years Year 7 to Year 11 eligible for influenza vaccination, total number who received vaccination, vaccine uptake (%) and median vaccine uptake for England for the 2022 to 2023 season
| School year | Total number of eligible children in LA | Total number of children vaccinated | Flu vaccine uptake (%) |
|---|---|---|---|
| Year 7 | 687,562 | 311,033 | 45.2 |
| Year 8 | 681,751 | 277,775 | 40.7 |
| Year 9 | 672,736 | 266,463 | 39.6 |
| Year 10 [note 1] | 617,482 | 6,454 | 1.0 |
| Year 11 [note 1] | 594,672 | 5,926 | 1.0 |
| Total (Years 7 to 9) | 2,042,049 | 855,271 | 41.9 |
| Total (Years 7 to 11) | 3,254,203 | 867,651 | 26.7 |
For primary school-aged children (Reception to Year 6) influenza vaccine uptake decreased by 1.2 percentage points to 55.1% (2,554,536 out of 4,631,343) in the 2023 to 2024 season (Table 4). This was when compared to the corresponding groups in the previous 2022 to 2023 season (56.3%, at 2,647,295 out of 4,705,474) (Table 2a and Table 2b).
For secondary school-aged children (Year 7 to Year 9) influenza vaccine uptake increased by 3.7 percentage points to 45.6% (946,040 out of 2,076,673) in the 2023 to 2024 season (Table 4). This was when compared to the corresponding groups in the previous 2022 to 2023 season (41.9%, (855,271 out of 2,042,049) (Table 3a and Table 3b).
For secondary school-aged children (Year 7 to Year 11) influenza vaccine uptake increased by 16.1 percentage points to 42.8% (1,469,605 out of 3,431,934) in the 2023 to 2024 season (Table 4). This was when compared to the corresponding groups in the previous 2022 to 2023 season (26.7%, at 867,651 out of 3,254,203) (Table 3a and Table 3b). Note that in 2022 to 2023, Years 10 and 11 were vaccinated subject to vaccine availability and at national level very little activity took place in these years groups.
The total percentage of school-aged children vaccinated in 2023 to 2024 was 49.9% (Reception to Year 11). This is compared with 51.9% in 2022 to 2023 (Reception to Year 9).
For school-aged children who were eligible in both seasons (Reception to Year 9), influenza vaccine uptake was comparable between seasons (a 0.3 percentage point difference) (Table 4). This was 52.2% (3,498,576 out of 6,708,016) in the 2023 to 2024 season, compared with 51.9% (3,502,566 out of 6,747,523) in the 2022 to 2023 season.
Table 4. Change in vaccine uptake between 2022 to 2023 and 2023 to 2024
| School year | 2023 to 2024 influenza vaccine uptake (%) | 2022 to 2023 influenza vaccine uptake (%) | % point changes |
|---|---|---|---|
| Reception | 55.9 | 56.7 | -0.8 |
| Year 1 | 56.4 | 56.4 | 0.0 |
| Year 2 | 55.6 | 57.5 | -1.9 |
| Year 3 | 55.8 | 57.3 | -1.5 |
| Year 4 | 55.1 | 56.2 | -1.1 |
| Year 5 | 54.1 | 55.6 | -1.5 |
| Year 6 | 53.3 | 54.2 | -0.9 |
| Year 7 | 49.2 | 45.2 | 3.9 |
| Year 8 | 45.1 | 40.7 | 4.3 |
| Year 9 | 42.5 | 39.6 | 2.9 |
| Year 10 | 41.6 | 1.0 [note 1] | 40.6 [note 1] |
| Year 11 | 35.7 | 1.0 [note 1] | 34.7 [note 1] |
| Total primary school-aged (R to Y6) | 55.1 | 56.3 | -1.2 |
| Total secondary school-aged (Y7 to Y9) | 45.6 | 41.9 | 3.7 |
| Total secondary school-aged (Y7 to Y11) | 42.8 | 26.7 [note 1] | 16.1 |
| Total school-aged (R to Y9) | 52.2 | 51.9 | 0.3 |
| Total school-aged (R to Y11) | 49.9 | 44.2 | 5.7 |
Note 1: In 2022 to 2023, Years 10 and 11, were vaccinated subject to vaccine availability and at national level very little activity took place in these years groups
This season (2023 to 2024) the highest uptake was among children in Year 1 (56.4%) and the lowest in eligible children in Year 11 (35.7%) (Table 2a and Table 3a).
For this season (2023 to 2024), in primary school year groups, the difference between influenza vaccine uptake between 2 consecutive year groups was 1 percentage point or lower. For secondary school year groups, the difference in uptake between 2 consecutive year groups was greater and ranged between less than 1 percentage point (0.9% between Years 9 and 10) to 5.8 percentage points between Years 10 and 11 (Table 2a and Table 2b, Table 4, and Tables 5a and 5b).
Ambitions
In the 2023 to 2024 season, out of 154 local authorities (LAs) in England, 81 (52.9%) had an uptake equal or above that of the 2022 to 2023 season. Therefore, a higher number of LAs achieved the national ambition this season (2023 to 2024) than the previous season (2022 to 2023), when 33.3% (51 out of 153 LAs) achieved uptake equal or above the season before that (2021 to 2022).
For the 2023 to 2024 season, in primary school-aged children, 40.2% (62 out of 154) of LAs had an uptake equal or above that of the 2022 to 2023 season. In secondary school-aged children, 69.3% (106 out of 154) LAs had an uptake equal or above that of the 2022 to 2023 season.
Trends in uptake over seasons
Comparability between seasons for school-aged influenza vaccine uptake is limited due to differences in cohort eligibility and planning and implementation challenges (see background information and appendix). The cumulative influenza vaccine uptake for all eligible year groups each season since the schools’ programme was rolled out nationally are shown in Tables 5a and 5b. The highest national uptake on record in England for school-aged children was during the 2020 to 2021 season (Reception to Year 7 were eligible that season). For most year groups (Year 1 to Year 7), the highest uptake was seen in the 2020 to 2021 season (the first year of the COVID-19 pandemic). For reception-aged children, the highest uptake was seen before the COVID-19 pandemic (2018 to 2019 and 2019 to 2020) with uptake of 64.3% in both seasons. The highest uptake in a year group was seen in 2020 to 2021 in Year 1 (64.5%).
For the ninth consecutive season, the general trend was one of decreasing uptake with increasing age of school-aged children (Tables 5a and table 5b).
Table 5a. Flu vaccine uptake (%) for primary school-aged children (Reception to Years 6) each season since the schools’ programme was rolled out nationally
| School year | Reception | Year 1 | Year 2 | Year 3 | Year 4 | Year 5 | Year 6 | Total |
|---|---|---|---|---|---|---|---|---|
| 2023 to 2024 | 55.9 | 56.4 | 55.6 | 55.8 | 55.1 | 54.1 | 53.3 | 55.1 |
| 2022 to 2023 | 56.7 | 56.4 | 57.5 | 57.3 | 56.2 | 55.6 | 54.2 | 56.3 |
| 2021 to 2022 | 56.9 | 58.9 | 58.8 | 58.0 | 57.3 | 56.2 | 55.8 | 57.4 |
| 2020 to 2021 | 64.2 | 64.5 [note 3] | 63.7 [note 3] | 63.2 [note 3] | 61.8 [note 3] | 61.1 [note 3] | 59.2 [note 3] | 62.5 |
| 2019 to 2020 | 64.3 [note 3] | 63.6 | 62.6 | 60.6 | 59.6 | 57.2 | 55 | 60.4 |
| 2018 to 2019 | 64.3 [note 3] | 63.6 | 61.5 | 60.4 | 58.3 | 56.5 | 60.8 | |
| 2017 to 2018 | 62.6 | 61 | 60.4 | 57.6 | 55.8 | 63.1 | ||
| 2016 to 2017 | [note 1] | 57.6 | 55.4 | 53.3 | 55.4 | |||
| 2015 to 2016 | [note 1] | 54.4 | 52.9 | 54.8 |
Table 5b: flu vaccine uptake (%) for secondary school-aged children Years 7 to years 11) each season since the schools’ programme was rolled out nationally
| School year | Year 7 | Year 8 | Year 9 | Year 10 | Year 11 | Total | Total school-aged |
|---|---|---|---|---|---|---|---|
| 2023 to 2024 | 49.2 | 45.1 | 42.5 | 41.6 | 35.7 | 45.6 | (Reception to Year 11) 52.2 |
| 2022 to 2023 | 45.2 | 40.7 | 39.6 | [note 2] | [note 2] | 41.9 [note 4] | (Reception to Year 9) 51.9 |
| 2021 to 2022 | 48.5 | 45.8 [note 3] | 42.2 [note 3] | 42 | 38.9 | 45.5 [note 5] | (Reception to Year 11) 53.8 |
| 2020 to 2021 | 56.2 [note 3] | 56.2 [note 6] | (Reception to Year 7) 61.7 |
Note 1: reception-aged children were vaccinated through GP practices, not school-aged delivery.
Note 2: figures not reported here (subject to vaccine availability, any remaining vaccine offered to years 10 and 11 once an offer had been made to younger children and at-risk groups).
Note 3: this figure shows the season with the highest uptake on record for that year group.
Note 4: shows total for years 7 to years 9 only.
Note 5: includes total for all secondary school-aged children, years 7 to years 11.
Note 6: shows total for year 7 only.
All primary school-aged children have been eligible for the national influenza vaccination programme since the 2019 to 2020 season (the last season prior to the COVID-19 pandemic). Across those 5 seasons, the 2023 to 2024 season has the lowest uptake (55.1%, 2,552,536 out of 4,631,343). Compared with the last pre-pandemic season (2019 to 2020), this season is 5.3 percentage points below that (60.4%, 2,876,531 out of 4,764,192). Compared with the season with the highest primary school uptake on record (2020 to 2021 season, the first year of the pandemic), this season is 7.4 percentage points below that (62.5%, 2,962,494 out of 4,740,044).
See supplementary Table 6a for the number of children vaccinated each season since the live attenuated influenza vaccine (LAIV) programme was introduced in the 2013 to 2014 season; and supplementary Table 6b for a summary of the total number of children vaccinated in each delivery setting.
Progress throughout the 2023 to 2024 season
The national level influenza vaccine uptake data in primary school-aged children during the 2023 to 2024 season showed an increase during the first 2 months of vaccination (October and November) which then plateaued during December and January. Please see supplementary Table 7a on influenza vaccine uptake (%) in each survey month in primary school-aged children.
For primary school-aged children when compared with the same timepoint in previous seasons, the 2023 to 2024 season saw the highest influenza uptake recorded by 31 October (supplementary Table 7a. After the robust start to the vaccination campaign, momentum was lost as the campaign continued. By 30 November, influenza vaccine uptake was comparable (less than 1 percentage point difference) to the highest season on record (2020 to 2021) at that time point. By 31 December, influenza vaccine uptake was comparable to the lowest on record and showed the lowest amount of vaccination activity occurring in primary schools between 1 and 31 December (less than a 6 percentage point increase during this time). Vaccine uptake data up to 31 January was the lowest on record (supplementary Table 7a). This was comparable to the uptake seen last season (2022 to 2023, 55.9%) and in the first 2 years of the schools’ programme roll out (2015 to 2017). In 2015 to 2016, only 2 year groups in primary school were vaccinated. In 2016 to 2017, 3 year groups in primary school were vaccinated (Table 5a).
In secondary school-aged children during the 2023 to 2024 season, influenza vaccine uptake increased during the first 3 months of vaccination (October, November and December) and plateaued in January. See supplementary Table 7b on influenza vaccine uptake (%) in each survey month in secondary school-aged children. Throughout the vaccination campaign, uptake in secondary school-aged children was lower than in primary school-aged children. In contrast to primary school activity during December, vaccination uptake in secondary school children saw almost a 12-percentage point increase during this time. Although the cumulative monthly influenza vaccine uptake data published during the 2023 to 2024 season demonstrated some variability in the prioritisation of school-aged cohorts early in the vaccination campaign, the national vaccination trends align with the Joint Committee on Vaccination and Immunisation (JCVI) advice to vaccinate the youngest age groups first (PDF, 484 KB).
NHS region
Variation in vaccine uptake was observed between the 7 NHS England Regions, ranging from 40.4% (London) to 57.5% (East of England). The East of England, South East, and South West were all above the national average uptake of 49.9% (Table 6).
Table 6. Estimated number and proportion of children in school years Reception to Year 9 who were vaccinated with influenza vaccine by NHS Region from 1 September 2023 to 29 February 2024
| NHS commissioning region | Number of children eligible for vaccination | Number of children vaccinated with at least one dose | Vaccine uptake (%) |
|---|---|---|---|
| East of England | 894,243 | 514,133 | 57.5 |
| London | 1,229,314 | 491,957 | 40.0 |
| Midlands | 1,584,184 | 750,621 | 47.4 |
| North East and Yorkshire | 1,228,048 | 571,933 | 46.6 |
| North West | 1,024,516 | 494,857 | 48.3 |
| South East | 1,350,803 | 772,130 | 57.2 |
| South West | 752,169 | 426,510 | 56.7 |
| Total | 8,063,277 | 4,022,141 | 49.9 |
Figure 2a. Number and estimated proportion of children in school years Reception to Year 11 who were vaccinated with flu vaccine by NHS region between 1 September 2023 to 31 January 2024
Figure 2b. Number and estimated proportion of primary school-aged children (Reception to Year 6) who were vaccinated with flu vaccine by NHS region between 1 September 2023 to 31 January 2024
Figure 2c. Number and estimated proportion of secondary school-aged children (Year 7 to 11) who were vaccinated with flu vaccine by NHS region between 1 September 2023 to 31 January 2024
Table 7a. Change in vaccine uptake between 2022 to 2023 and 2023 to 2024 in primary school-aged children (Reception to Year 6)
| Region | 2023 to 2024 influenza vaccine uptake (%) | 2022 to 2023 influenza vaccine uptake (%) | % point change |
|---|---|---|---|
| East of England | 62.1 | 62.7 | -0.6 |
| London | 45.8 | 43.9 | 1.9 |
| Midlands | 52.1 | 53.2 | -1.2 |
| North East and Yorkshire | 51.7 | 57.4 | -5.8 |
| North West | 56.1 | 57.3 | -1.2 |
| South East | 61.6 | 61.8 | -0.2 |
| South West | 62.0 | 62.4 | -0.5 |
| Total | 55.1 | 56.3 | -1.1 |
Table 7b. Change in vaccine uptake between 2022 to 2023 and 2023 to 2024 in secondary school-aged children (Year 7 to Year 9)
| Region | 2023 to 2024 influenza vaccine uptake (%) | 2022 to 2023 influenza vaccine uptake (%) | % point change |
|---|---|---|---|
| East of England | 54.9 | 49.7 | 5.2 |
| London | 33.9 | 24.5 | 9.4 |
| Midlands | 43.5 | 40.8 | 2.6 |
| North East and Yorkshire | 42.4 | 42.1 | 0.3 |
| North West | 40.7 | 35.7 | 5.0 |
| South East | 54.2 | 51.2 | 3.0 |
| South West | 52.7 | 50.9 | 1.9 |
| Total | 45.6 | 41.9 | 3.7 |
Table 7c. Change in vaccine uptake between 2022 to 2023 and 2023 to 2024 in all school-aged children (Reception to Year 9)
| Region | 2023 to 2024 influenza vaccine uptake (%) | 2022 to 2023 influenza vaccine uptake (%) | % point change |
|---|---|---|---|
| East of England | 59.9 | 58.7 | 1.2 |
| London | 42.3 | 38.5 | 3.8 |
| Midlands | 49.4 | 49.5 | -0.1 |
| North East and Yorkshire | 48.8 | 52.7 | -3.9 |
| North West | 51.3 | 50.8 | 0.5 |
| South East | 59.2 | 58.5 | 0.8 |
| South West | 59.0 | 58.8 | 0.2 |
| Total | 52.2 | 51.9 | 0.2 |
Local authority
Overall, vaccine uptake for children in school years Reception to Year 11 combined by local authority varied across England, ranging from 22.6% in Brent to 72.5% in Herefordshire. This is seen in Table 4 of the supplementary data.
The following local authorities report collectively:
- City of London and Hackney
- Cornwall and Isles of Scilly
- Leicestershire and Rutland
Therefore, the total local authority count in this section is 151 in contrast to the 154 referenced in the report.
For all school-aged children (Reception to Year 11), 9 out of 151 LAs (6.0%) had uptake in the range of 0% to 29%. A further 28 (18.5%) had uptake in the range of 30% to 39%, with 46 (30.5%) in the range of 40% to 49%, 44 (29.1%) in the range of 50% to 59%, 23 (15.2%) in the range of 60% to 69%, and 1 (0.7%) in the range of 70% to 79%. None had uptake of over 80%. See Figure 3a.
For primary school-aged children (Reception to Year 6), 4 out of 151 LAs (2.6%) had uptake in the range of 0% to 29%. A further 12 (7.9%) had uptake in the range of 30% to 39%, 34 (22.5%) were in the range of 40% to 49%, 51 (33.8%) were in the range of 50% to 59%, 41 (27.2%) were in the range of 60% to 69%, and 8 (5.3%) were in the range of 70% to 79%, with 1 (0.7%) achieving uptake of over 80%. See Figure 3b.
For secondary school-aged children (Year 7 to Year 11), 37 out of 151 LAs (24.5%) had uptake in the range of 0% to 29%, while 38 (25.1%) had uptake in the range of 30% to 39%, 37 (24.5%) were in the range of 40% to 49%, 32 (21.2%) were in the range of 50% to 59%, 6 (4.0%) were in the range of 60% to 69%, and 1 (0.7%) was in the range of 70% to 79%. None had uptake of over 80%. See Figure 3c.
Figure 3a. Histogram for all school-aged children, showing the number of local authorities that achieved cumulative influenza vaccine uptake within each category, in England for the 2023 to 2024 season
Figure 3b. Histogram for all primary school-aged children showing the number of local authorities that achieved cumulative influenza vaccine uptake within each category, in England for the 2023 to 2024 season
Figure 3c: Histogram for all secondary school-aged children showing the number of local authorities that achieved cumulative influenza vaccine uptake within each category, in England for the 2023 to 2024 season
Vaccine uptake by school year group and LA ranged from:
- 25.0% to 94.9% in Reception
- 25.9% to 86.5% in Year 1
- 24.7% to 91.6% in Year 2
- 25.2% to 77.5% in Year 3
- 23.2% to 79.5% in Year 4
- 23.3% to 74.9% in Year 5
- 22.5% to 74.4% in Year 6
- 22.3% to 90.6% in Year 7
- 17.0% to 79.6% in Year 8
- 13.8% to 84.8% in Year 9
- 13.2% to 79.4% in Year 10
- 10.9% to 65.4% in Year 11
For the first time since the school-aged programme was introduced, influenza vaccine uptake in excess of 90% was achieved in a school year group at LA level. This was seen once in 3 year groups: Reception, Year 2 and Year 7).
Glossary
At-risk
At-risk patients with clinical risk groups as listed in the Green Book.
Green Book
The Green Book, or Immunisation against infectious disease has the latest information on vaccines and vaccination procedures, for vaccine preventable infectious diseases in the UK. Chapter 19 refers to influenza.
ImmForm
A website that provides a secure online platform for vaccine uptake data collection for several immunisation surveys, including the seasonal influenza vaccine uptake collection.
School-age year
The school-age year is determined by the child’s age on the 31 August. This will be correct for the majority of children.
Data sources and methodology
UKHSA provides screening and immunisation teams in England a standard protocol describing the inclusion criteria and method of collecting the data. Data providers must use a suitable data source to identify eligible school cohorts in the local area. These sources are decided upon locally, usually by the screening and immunisation team or the school-aged immunisation service (SAIS). Most children are offered a single dose of vaccine. Eligible children in clinical at-risk groups without prior vaccination history aged under 9 years are recommended 2 doses of vaccine and are counted as one vaccination in the numerator. More information about this can be found in chapter 19 of the Green Book.
Cumulative data on seasonal influenza vaccine uptake was collected for all 153 local authorities between 1 September 2022 to 28 February 2023 using the ImmForm website managed by UKHSA. ImmForm provides a secure online platform for vaccine uptake data collection for nearly all the national immunisation programmes, including the seasonal influenza vaccine uptake collections. UKHSA co-ordinated and managed the data collection and produced monthly provisional data on vaccinations. This allowed the NHS and Department of Health and Social Care (DHSC) to track the progress of the programme during the 2023 to 2024 influenza season. This collection received approval as a mandatory collection from the Data Alliance Partnership Board (DAPB) under the reference ‘DAPB2195 Amd 50/2022 Childhood Influenza Vaccination Programme: Primary School Age Children’.
End-of-season programme vaccine uptake was calculated based on the number of children in the target population reported as having received the influenza vaccine (either LAIV or inactivated influenza vaccine during the campaign period). Therefore, vaccine coverage reflects all children in school years Reception to Year 11 (aged 4 years rising to aged 16 years old, based on age on 31 August 2023) that received an influenza vaccine between 1 September 2022 and 31 January 2024.
Data in this report covers all reported vaccinations given during the 2022 to 2023 season and is compared with data from the season before where this is available. Additional tables also compare uptake data from 2022 to 2023 season with all previous seasons where school-aged delivery has taken place.
Target population
In 2022 to 2023, primary school-aged children in Reception to Year 6 and secondary school-aged children focusing in Years 7 to 11 were included for the national school-aged childhood influenza vaccination programme. Any remaining vaccine was offered to Years 10 and 11, subject to vaccine availability. Vaccination of younger cohorts and at-risk children was prioritised first with vaccination of secondary school-aged children continuing into the new year. The target population is defined by school age cohorts born between 1 September 2007 and 31 August 2019, as defined by the child’s age on 31 August 2023 (Table 8). This season all children in Reception to Year 11 (aged 4 years rising to 16 years old) were offered the vaccine.
Table 8: year group cohort definitions
| Academic year group | Age range on 31 August 2023 | Born from date | Born to date |
|---|---|---|---|
| Reception | Aged 4 to 5 years | 1 September 2018 | 31 August 2019 |
| 1 | Aged 5 to 6 years | 1 September 2017 | 31 August 2018 |
| 2 | Aged 6 to 7 years | 1 September 2016 | 31 August 2017 |
| 3 | Aged 7 to 8 years | 1 September 2015 | 31 August 2016 |
| 4 | Aged 8 to 9 years | 1 September 2014 | 31 August 2015 |
| 5 | Aged 9 to 10 years | 1 September 2013 | 31 August 2014 |
| 6 | Aged 10 to 11 years | 1 September 2012 | 31 August 2013 |
| 7 | Aged 11 to 12 years | 1 September 2011 | 31 August 2012 |
| 8 | Aged 12 to 13 years | 1 September 2010 | 31 August 2011 |
| 9 | Aged 13 to 14 years | 1 September 2009 | 31 August 2010 |
| 10 | Aged 14 to 15 years | 1 September 2008 | 31 August 2009 |
| 11 | Aged 15 to 16 years | 1 September 2007 | 31 August 2008 |
Data in this report is a school-aged collection, predominantly delivered in schools and also a GP-based delivery model for some local areas and cohorts (such as the Isles of Scilly, and those aged 2 and 3 years). Children who reside in one locality attending schools in neighbouring localities would be captured by the schools in the neighbouring locality to avoid double counting. Data providers can use single or multiple sources as appropriate to identify their eligible population.
For the 154 local authorities where the programme was delivered through a school model, the denominator was based on all the eligible children in schools (all state-funded primary schools, special schools, academies, faith schools, free schools, pupil referral units, and independent schools) in the local authority geography. The denominator was also based on those children who were educated out of school in the local authority geography. This was defined by child age on 31 August 2023 using routine data sources such as the local education authority school registers. Data was submitted by data providers and/or screening and immunisation coordinators at the local authority level. Data was submitted on the ImmForm reporting website via manual upload.
For the Kernow local authority (which comprises Cornwall and the Isles of Scilly), most children were offered the vaccine through school delivery programmes, except for the Isles of Scilly, where the programme was delivered through GPs. The denominators for the Isles of Scilly were derived from GP systems that are based on the number of patients registered with a GP practice located within the local authority’s geographical boundary, as defined by a child’s age on 31 August 2023. Data was submitted on the ImmForm reporting website either via an automated extraction (XML bulk upload or a web service) or provided by GP IT software suppliers who extract data directly from GP computer systems as described in full in the GP flu vaccination annual report. Data was submitted at GP practice level and then aggregated at local authority level by GP postcode for reporting purposes.
Data limitations
The identification of the school-aged population may differ between localities depending on the data sources consulted. Depending on the characteristics of the local school-age population, it may be necessary that providers use multiple data sources to identify eligible school-aged cohorts. These include the school roll call and the local Child Health Information Services (CHIS) system.
Where the denominators (total number of children for the influenza vaccine) were not amended, denominators from the school census survey from January 2023 were used. This survey was provided to data providers at the start of the data collection as not all will have a complete school roll call while consent forms are still being collected. Some of the school data providers will only be indicating those children that have returned information on their vaccination status in consent forms (those who have already received the vaccine at the GP).
Although every effort is made to capture vaccinations delivered in other settings within this data collection, where data providers have indicated that they have included additional children that were vaccinated in other settings, it should be noted that the completeness of these figures may vary. It is important to note that not all data providers may be able to access information on children vaccinated through other settings such as GP practices. Most of the children vaccinated in GP practices are at-risk children that have been called in by their GP to receive the vaccination.
Healthy children in school years Reception to Year 11 who are not in a clinical risk group should not ordinarily be offered vaccination by their GP practice unless commissioned to vaccinate these children.
For these reasons, some caution is advised when making direct comparisons of vaccine coverage between localities and historic data as delivery models and timing of vaccine supply will affect any comparisons.
Throughout the 2023 to 2024 season, provisional uptake data by school year cohort was published on UKHSA’s website on a cumulative monthly basis.
Background information
This is the ninth report evaluating uptake in the national childhood influenza school-aged vaccination programme across England.
The appendix outlines the changes in the school-aged programme for each season since the schools’ programme was introduced.
In summary, between 2014 to 2015 and the 2020 to 2021 seasons, the school-aged immunisation programme has seen a consistent expansion with the addition of one year group each season. In contrast both this season (2022 to 2023) and the previous season (2021 to 2022) have seen the addition of multiple additional year groups within one season. Implementation of the secondary school programme began in 2020 to 2021 season with an addition of 1 school year group (Year 7). In contrast to previous seasons, the 3 subsequent seasons (2021 to 2022, 2022 to 2023 and 2023 to 2024) have seen the addition of multiple secondary school-aged year groups within one season. An additional challenge to all of these seasons was that the announcements of the expansion into secondary schools were made later in the programme planning cycle than usual (in July 2021, July 2022 and July 2023, respectively), just weeks prior to schools closing for the summer term. This meant that the time to plan the secondary school age programme was reduced. See the appendix for links to the annual flu letters with more details for each season.
Further challenges to note were in the 2021 to 2022 season, (the second year that implementation of the secondary school programme took place), the influenza immunisation programme was also affected by pupil and immunisation staff absences as a result of COVID-19. Last season (2022 to 2023) saw a change in policy for secondary school age children between April and July 2022, and therefore the time to implement the secondary school-aged programme was extended into the new year. For the first time, the annual report for last season (2022 to 2023) described influenza vaccine uptake for children of school age up to 28 February (rather than 31 January). Comparability between seasons for secondary school-aged vaccine uptake is therefore limited.
It is important to continue to monitor uptake in all current groups and build on the uptake in future seasons. It is important to improve the uptake in the school-aged national influenza vaccination programme to provide both direct protection for those immunised and indirect protection to the wider population by reducing transmission.
Intended audience
This report is aimed at professionals directly involved in the delivery of the influenza vaccine to children such as GPs, pharmacy leads, screening and immunisation teams, local commissioners involved in the planning and financing of local health services, the wider public health community, governmental organisations and researchers with an interest in the influenza vaccination programme in England.
Aim of the report
This report provides an evaluation of the national childhood influenza vaccination programme in school-aged children (from school years Reception to Year 9) at national and sub-national levels.
Childhood influenza programme roll-out timeline
Following the recommendation of the Joint Committee on Vaccination and Immunisation (JCVI) (PDF, 91 KB) in 2012 and accompanying statement (PDF, 111 KB), the Department of Health and Social Care (DHSC) (formerly the Department of Health) in partnership with UK Health Security Agency (UKHSA, formerly Public Health England) and the National Health Service (NHS) England began the phased roll-out of the national influenza vaccination programme to ultimately cover all those aged 2 to 16 years (inclusive) in the UK. This programme uses the licensed live attenuated influenza vaccine (LAIV), with the aim of providing direct protection for those immunised, as well as indirectly protecting the remaining population by reducing transmission. Children in clinical risk groups who are contraindicated for LAIV would most likely be offered the injectable vaccine through their GP.
Feedback and acknowledgements
You are welcome to contact us directly by emailing childfluvac@ukhsa.gov.uk with any feedback you may have about this report and data.
The authors would like to thank everyone who contributed to the data collection, specifically:
- all NHS school-age vaccination providers who participated in, delivered and supported the childhood influenza vaccination programme uptake collection for 2023 to 2024
- all data providers, the child influenza taskforce and NHS England public health commissioning team colleagues (including screening and immunisation influenza coordinators and others)
- the ImmForm helpdesk and development team who provided and supported the online survey
References
- Joint Committee on Vaccination and Immunisation: Minutes of meeting 5 October 2011 (PDF, 91 KB).
- Influenza: the green book, chapter 19.
- Seasonal flu vaccine uptake in GP patients: winter 2019 to 2020 June 2020.
- Schools, pupils and their characteristics: January 2020.
- Seasonal flu vaccine uptake in children of school age: monthly data, 2021 to 2022.
- National flu immunisation programme 2022 to 2023 letter July 2022.
- Seasonal flu vaccine uptake in children of school age: winter 2020 to 2021 June 2021.
- [JCVI statement on the annual influenza vaccination programme – extension of the programme to school-aged children 25 July 2012].(https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/224775/JCVI-statement-on-the-annual-influenza-vaccination-programme-25-July-2012.pdf) (PDF, 111 KB).
Appendix
Childhood influenza vaccination programme roll-out timeline
2013 to 2014
The children’s programme began in the 2013 to 2014 season with all 2- and 3-year-olds being offered vaccination with LAIV through general practice and a school pilot programme was rolled out in geographically distinct areas in England, targeting all primary school-age children (aged 4 to 10 years, rising to 11 years old).
2014 to 2015
In the 2014 to 2015 season, the national programme was extended to 4-year olds through general practice in England. In addition, the school pilot programme was extended to a total of 14 pilot areas (including 6 pilots that participated in 2013 to 2014 season), targeting both primary school-age children (aged 4 to 10 years, rising to 11 years old) and secondary school- age children (12 years rising to 13 years old).
2015 to 2016
In the 2015 to 2016 season, the national programme was extended to include children of appropriate age in school years 1 and 2. For most children, this was offered via a school-based programme, although in a few areas of England vaccinations were delivered through alternative schemes such as community pharmacies and general practices. The 2014 to 2015 pilot areas continued to offer vaccination to all primary school-age children (aged 5 to 10 years, rising to 11 years old) in 2015 to 2016.
2016 to 2017
In the 2016 to 2017 season, the national programme was extended to include children in school year 3, offering LAIV vaccination to all children in school years 1, 2 and 3. Most children were offered the influenza vaccine via a school-based programme. However, in a few areas vaccinations were delivered through alternative schemes such as community pharmacies and general practice. Children aged 2, 3 and 4 years (but not 5 years or older) continued to be vaccinated by GPs. Vaccination continued to be offered to primary school-aged children (aged 5 to 10 years, rising to 11 years old) in the areas that had participated previously as pilot areas in England.
2017 to 2018
In the 2017 to 2018 season, the national programme was extended to include children in Reception (aged 4 years, rising to 5 years old) to children in Year 4 (aged 8 years rising to 9 years old) and all children of primary school age (aged 4 to 10 years, rising to 11 years old) in areas that participated previously as pilot areas. The mode of vaccination remained primarily through school delivery models with children aged 2 and 3 years offered the vaccine in GP practices, the only exception being the Isles of Scilly who delivered the vaccines through GP practices.
2018 to 2019
In the 2018 to 2019 season, the national programme was extended to include children in Year 5 (aged 9 years rising to 10 years old). For most children, the LAIV vaccine was offered via school-based programmes (with additional mop-up clinics where required), with the Isles of Scilly operating via a GP model. Children aged 2 and 3 years (but not 4 years or older on 31 August 2018) were still offered the vaccine through general practices.
Vaccination continued to be offered to primary school-aged children in reception to Year 6 (aged 4 to 10 years rising to 11 years old) in those areas that previously participated in primary school pilots in England.
2019 to 2020
During the 2019 to 2020 season, the national programme was extended to include children of Year 6 (aged 10 years rising to 11 years old) and thus included all children of primary school age for the first time and no additional age cohorts were added to the previous pilot areas. It is important to note that there were supply issues for the LAIV vaccine in this season that may have affected the programme (more information about this can be found in the 2020 to 2021 edition of this release). The mode of vaccination remained primarily through school delivery, with eligible children in the Isles of Scilly (and all children aged 2 and 3 years) offered the vaccine in GP practices.
2020 to 2021
During the 2020 to 2021 season, the national programme was extended to include children of Year 7 (aged 11 years rising to 12 years old), with no pilot areas. The mode of vaccination remained primarily through school delivery, with eligible children in the Isles of Scilly and all children aged 2 and 3 years offered the vaccine in GP practices. Please note that the programme will have been affected by the second and third national COVID-19 restrictions (‘lockdowns’) in England that began on the 31 October 2020 and 6 January 2021. The third lockdown included school closures except for vulnerable children and children of key workers.
2021 to 2022
During the 2021 to 2022 season, the national programme was extended as a temporary measure to include children of Year 8 (aged 12 rising to 13 years), Year 9 (aged 13 rising to 14 years), Year 10 (aged 14 rising to 15 years) and Year 11 (aged 15 rising to 16 years) with no pilot areas. This was the first season where all children aged 2 through to 16 years old had been offered the vaccine. This was an expansion of 4 additional year groups (whereas previous seasons have seen an expansion of one additional year group) and was announced later in the programme planning cycle than usual (July 2021). The mode of vaccination remained primarily through school delivery, with eligible children in the Isles of Scilly (and all children aged 2 and 3 years) offered the vaccine in GP practices. Note that the programme will have been affected by the COVID-19 related pupil and immunisation staff absences.
2022 to 2023
For the 2022 to 2023 season, between April 2022 and July 2022 there was a change in policy for school-aged children, with an expansion from the original policy of primary school-aged children (Reception to Year 6), to also include secondary school-aged children focusing on Years 7, 8 and 9, with any remaining vaccine offered to Years 10 and 11, subject to vaccine availability. More details about this can be found in the National flu immunisation programme plan 2022 to 2023 and Statement of amendments to annual flu letter 2022 to 2023. Vaccination of younger cohorts and at-risk children was therefore prioritised first with vaccination of secondary school-aged children continuing into the new year. Therefore, for the first-time data for the 2022 to 2023 season included data submitted up until 28 February.
During the 2022 to 2023 season, the national programme included all primary school-aged children and secondary school-aged children in Year 7 to Year 9 (aged 13 years rising to 14 years), with no pilot areas. The mode of vaccination remained primarily through school delivery, with eligible children in the Isles of Scilly and all children aged 2 and 3 years offered the vaccine in GP practices.
2023 to 2024
For the 2023 to 2024 season, the national programme included all primary school-aged children and secondary school-aged children in Year 7 to Year 11 (aged 15 years rising to 16 years), with no pilot areas. The inclusion of primary school-aged children (Reception to Year 6) in the national programme was announced in May 2023, with confirmation of the inclusion of secondary school-aged children (Year 7 to Year 11) announced in July 2023. The mode of vaccination remained primarily through school delivery, with eligible children in the Isles of Scilly (and all children aged 2 and 3 years) offered the vaccine in GP practices.