Previous changes

August 2025 — minor update. Influenza vaccines have been updated in line with those available in the UK for the 2025 to 2026 season.

June 2025 — reviewed. The management section has been updated to align with the NHS immunisation programme 2025 to 2026.

November 2024 — minor update. Minor typographical error corrected in the summary section. 

September 2024 — minor update. Topic has been updated to reflect August updates made in the UKHSA publication National protocol for inactivated influenza vaccine. 

July 2024 — minor update. The vaccines available and the age brackets in the vaccine choice section have been updated to reflect updates made in the UKHSA publication National protocol for inactivated influenza vaccine.

May 2024 — minor update. The management section has been updated to align with the NHS immunisation programme 2024 to 2025. 

June 2023 — reviewed. The management section has been updated to align with the NHS immunisation programme 2023 to 2024.

September 2022 — minor update. The summary page has been updated. Additionally new information to be aware that administration of Novavax COVID-19 vaccine should be separated from administration of influenza vaccine by at least 7 days. This is based on an update to the green book, chapter 19. 

August 2022 — minor update. The management section has been updated to align with the NHS immunisation programme 2022 to 2023. 

October 2021 — reviewed. A literature search was conducted in October 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. A recommendation that children aged over 2 years with a history of severe anaphylaxis to egg who have previously required intensive care management in hospital can be offered the egg-free cell-based quadrivalent influenza vaccine (QIVc) as an alternative to referral to a specialist for immunization in hospital has been added to this topic. A section has been added summarising the preferred vaccines by age range and other relevant characteristics.

July 2021 — minor update. Information added to update the eligibility criteria for the immunization which has been extended to those children in secondary school from years 7–11.

December 2020 — minor update. Information added to reflect the authorization of the use of the recombinant quadrivalent vaccine (QIVr) in the 2020/2021 immunization programme.

August 2020 — minor update. Eligibility for seasonal influenza immunizations updated in line with the updated 2020/2021 immunization programme. Details of available vaccines have also been updated in line with the World Health Organization recommendations and Public Health England information.  

July 2020 — minor update. Eligibility for seasonal influenza immunizations updated in line with the 2020/2021 immunization programme.

January 2020 — minor update. Quality standards added.

September 2019 — minor update. Information added to reflect the 2019/2020 immunization programme including eligibility, vaccination availability and suitability.

September 2018 — minor update. Information added to reflect the 2018/2019 immunization programme regarding eligibility. 

May 2018 — reviewed. A literature search was conducted in May 2018 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic has undergone restructuring. No major changes to the recommendations have been made.

August 2017 — minor update. Information added to reflect the 2017/18 immunization programme regarding eligibility. 

January 2017 — minor update. Information added on contraindication to Fluenz Tetra^® nasal spray for anyone with severe allergic reaction to egg as per the manufacturer's summary of product characteristics.

November 2016 — minor update. Information from the Public Health England (PHE) document Immunisation against infectious disease — The Green Book has been added to clarify the benefits of quadrivalent vaccines. 

September 2016 — reviewed. A literature search was conducted in September 2016 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials since the last revision of this topic. The recommendations on the clinical risk groups eligible for annual influenza immunization have been updated to include people with morbid obesity; the information on the extension of the national childhood influenza immunization programme has been updated to include children of appropriate age for school years 1, 2, and 3; and the information on the management of children and adults with egg allergy have all been updated in line with the chapter on Influenza in the Public Health England (PHE) document Immunisation against infectious disease — 'The Green Book' for the 2016/2017 influenza season. The information on available vaccines has been updated in line with PHE. The topic has also undergone minor restructuring.

February 2015 — minor update. Addition of people with learning disabilities to the table in at risk groups list.

December 2014 — minor update. Citation updated regarding administration of influenza vaccines and porcine gelatine in multi-faith groups.

September 2014 — revised to include updated guidance from the Department of Health's Immunization against infectious disease — 'The Green Book' chapter 19, Influenza for the 2014/2015 seasonal influenza vaccination programme.

August 2014 — minor update. Minor typographical error corrected in the evidence section on the use of influenza vaccines in healthy adults.

October 2013 — revised to include updated guidance from the Department of Health's Immunization against infectious disease — 'The Green Book' chapter 19, Influenza (updated in September 2013) for the 2013/2014 seasonal influenza vaccination programme.

August 2013 — minor update. The text has been updated to reflect new recommendations from Public Health England regarding seasonal vaccine for children aged two to three years old.

June 2013 — minor update. The 2013 QOF options for local implementation have been added to this topic.

September 2012 — revised to include updated guidance from the Department of Health's Immunization against infectious disease — 'The Green Book' chapter 19, Influenza (updated in August 2012) for the 2012/2013 seasonal influenza vaccination programme.

April 2012 — minor update. The 2012/2013 QOF indicators have been added to this topic. 

March 2012 — minor update to include further information about excipients in currently available vaccines. 

October 2011 — minor update to reflect the updated guidance on egg allergy from the Department of Health's Immunization against infectious disease — 'The Green Book' chapter 19, Influenza (updated in July 2011) for the 2011/2012 seasonal influenza vaccination programme. 

September 2011 — revised to include updated guidance from the Department of Health's Immunization against infectious disease — 'The Green Book' chapter 19, Influenza (updated in July 2011) for the 2011/2012 seasonal influenza vaccination programme, and new recommendations from the Chief Medical Officer (2011). This CKS topic gives recommendations for the 2011/2012 influenza season only. 

June 2011 — minor update. The 2011/2012 QOF indicators have been added to this topic in line with the BMA and NHS Employers document (2011). 

February 2011 — minor update. The Chief Medical Officer has clarified that seasonal influenza vaccine should be offered to all pregnant women, regardless of whether they have received a previous dose of H1N1 swine influenza vaccine. 

November 2010 — minor update. The Ministry of Health of Saudi Arabia now recommends that pilgrims for the Hajj and Umrah season of 1431 (2010) receive seasonal influenza vaccine, in line with the NaTHNaC (2010) publication. 

September 2010 — updated to include the new recommendations from the Department of Health for the 2010/11 seasonal influenza vaccination programme. 

August 2010 — minor update. The Department of Health (2010) has advised that Enzira^®and CSL Biotherapies generic influenza vaccine should not be used to vaccinate children under the age of 5 years. An alternative vaccine should be used in this age group. 

April to July 2009 — converted from CKS guidance to CKS topic structure. The evidence-base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence. A new recommendation to offer influenza immunization to poultry workers has been included.

June 2009 — minor update. Additional swine flu links added. Links to information sources regarding 'swine flu' have been added to Have I got the right topic? section. 

January 2008 — minor update. Influenza split virion vaccine is no longer a black triangle product. Prescription updated. 

April to June 2006 — written. Validated in September 2006 and issued in October 2006. This is a new guidance and replaces the relevant sections that used to be in the CKS topic on Influenza. The information and recommendations have been updated following a full literature review. A more detailed evidence section to support the recommendations has been included.

New evidence

Evidence-based guidelines

No new evidence-based guidelines since 1 June 2026.

HTAs (Health Technology Assessments)

No new HTAs since 1 June 2026.

Economic appraisals

No new economic appraisals relevant to England since 1 June 2026.

Systematic reviews and meta-analyses

No new systematic reviews or meta-analysis which reach the CKS threshold for inclusion since 1 June 2026.

Primary evidence

No new primary evidence which reaches the CKS threshold for inclusion published since 1 June 2026.

New policies

No new national policies or guidelines since 1 June 2026.

New safety alerts

No new safety alerts published since 1 June 2026.

Changes in product availability

• New adjuvanted trivalent influenza vaccine licensed for prophylaxis of influenza in adults aged 50 and over. See more here.

Who should be offered the seasonal influenza immunization?

• Note: influenza vaccination should be given as soon as possible to provide protection before flu starts to circulate and should ideally be completed by the end of November, but can also take place up until the following 31 March.
• The following groups of people are eligible for a flu vaccine from 1 September 2026 as part of the NHS flu immunization programme: 
  • Pregnant women at any stage of pregnancy (including those who become pregnant during the influenza season).
  • All children aged 2 or 3 years on 31 August 2026. 
  • All primary school-aged children (from reception to year 6). 
  • Secondary school-aged children (from year 7 to year 11).
  • All children in clinical risk groups aged from 6 months to less than 18 years.
  • Note: from 1 October 2026, community pharmacies can also offer flu vaccination to children aged 2 to 3 years and to children in clinical risk groups aged 2 years to under 18 years. From 1 December 2026, community pharmacies can offer flu vaccination to school-aged children who missed vaccination through their school immunisation service. Children in clinical risk groups aged 6 months to under 2 years cannot be vaccinated in a community pharmacy.
• The following groups of people are eligible for a flu vaccine from 1 October 2026 as part of the NHS flu immunization programme: 
  
  • People aged 65 years and over (including those who are 64 but will be 65 on or before March 2027). 
  • People aged 18 years to under 65 years in clinical risk groups (see Table 1).
  • People living in long-stay residential care homes or other long-stay care facilities (not including prisons, young offender institutions, or university halls of residence).
  • People in receipt of a carer's allowance or those who are the primary carer of an elderly or disabled person. 
  • Close contacts of immunocompromised people.  
  • People experiencing homelessness aged 16 years and over (defined as rough sleepers and those using homeless hostels or night shelters).
  • All frontline social care staff without an employer-led occupational scheme, including those employed by:
    • A registered residential care or nursing home.
    • A registered domiciliary care provider.
    • A voluntary managed hospice provider.
    • Direct Payment (personal budgets) and/or Personal Health Budgets, such as personal assistants.

Table 1. Clinical risk groups in people aged 6 months and older.

Which influenza vaccines are available?

• See Table 2 for a list of influenza vaccines available for the 2026/2027 influenza season. For more detailed information about individual influenza vaccines, see the manufacturers' Summary of Product Characteristics on the electronic Medicines Compendium website. 
  • None of the vaccines listed contain thiomersal as an added preservative. Most of the viruses are grown in embryonated hens' eggs and are then chemically inactivated before being further treated and purified.
  • In the 2026/2026 influenza season in the northern hemisphere, it is recommended that egg-based trivalent vaccines include: 
    • An A/Missouri/11/2025 (H1N1)pdm09-like virus;
    • An A/Darwin/1454/2025 (H3N2)-like virus; and
    • A B/Tokyo/EIS13-175/2025 (B/Victoria lineage)-like virus. 
  • In the 2026/2027 influenza season in the northern hemisphere, it is recommended that cell- or recombinant-based trivalent vaccines include: 
    • An A/Missouri/11/2025 (H1N1)pdm09-like virus;
    • An A/Darwin/1415/2025 (H3N2)-like virus; and
    • A B/Pennsylvania/14/2025 (B/Victoria lineage)-like virus. 

Table 2. Influenza vaccines available for the 2026/2027 influenza season.

Which vaccine should I administer?

• In the 2026/2027 influenza season, it is recommended that:
  • First-line vaccine choice for people aged 65 years or over includes the adjuvanted inactivated vaccine (aIIV/aTIV), the high-dose influenza vaccine (IIV-HD/TIV-HD), the recombinant influenza vaccine (IIVr/TIVr), or the cell-cultured influenza vaccine (IIVc/TIVc).
    
    • If these are not available, offer the cell-based trivalent influenza vaccine (TIVc).  
  • First-line vaccine choice for people aged 18 to 64 years in eligible groups should be either the cell-culture influenza vaccine (TIVc) or the recombinant influenza vaccine (TIVr/QIVr). First-line vaccines also include the adjuvanted influenza vaccine (aTIV) for people aged 50 years and over, and the high-dose influenza vaccine (TIV-HD/QIV-HD) for those aged 60 years and over, in line with their licenses.
    • If these are not available, offer the egg-culture influenza vaccine (TIVe/QIVe). 
    • Note: the high-dose influenza vaccine (IIV-HD/TIV-HD) can be used off-label for people aged 50 to 59 years in a clinical risk group.
  • For Children aged 6 months to under 2 years in a clinical risk group, the first line choice is a suitable TIVc. Children who have not received influenza vaccine previously should be offered a second dose at least 4 weeks later. 
    • If this is not available, give TIVe/QIVe. 
    • Note: inactivated influenza vaccines are interchangeable, so the second dose does not have to be the same vaccine as the first dose.  
  • Children aged 2 to under 18 years should receive the quadrivalent live attenuated influenza vaccine (LAIV) given as a nasal spray (Fluenz).
    • If LAIV is contraindicated or otherwise unsuitable, offer a TIVc. 
    • Children aged under 9 years in a clinical risk group, who have never previously received influenza vaccine, should be offered a second dose of influenza vaccine at least 4 weeks later. If the LAIV vaccine is unavailable for the second dose a suitable inactivated injectable flu vaccine should be offered as an alternative. If an inactivated vaccine was used for the first dose and is not available, an alternative suitable inactivated vaccine should be offered. The inactivated flu vaccines are interchangeable, so the second dose does not have to be the same vaccine as given for the first dose. 
    • An inactivated vaccine should be considered in children who are household contacts of very severely immunocompromised people rather than a live flu vaccine.
    • Note: Fluenz contains a highly-processed form of porcine gelatine, which may not be acceptable to some faith groups.
• See Table 3 for a summary of preferred influenza vaccines and alternatives (if the preferred vaccine is unavailable or unsuitable).

Table 3: Preferred influenza vaccines and alternatives for 2026 to 2027.

What contraindications and cautions are associated with influenza vaccines?

• Do not give influenza vaccine to people with a confirmed anaphylactic reaction to either:  
  • A previous dose of the vaccine. 
  • Any component of the vaccine (except ovalbumin — see the section on How should I manage a person with egg allergy? for more information). 
    • If there is any uncertainty about the appropriate management of a person with a suspected or confirmed history of anaphylaxis, seek specialist advice from the local immunization coordinator, consultant in communicable disease control, or a consultant paediatrician, to minimize the time period that the person is left unvaccinated.
    • For more information on the diagnosis of anaphylaxis, see the CKS topic on Angio-oedema and anaphylaxis.
• For people with a suspected or confirmed anaphylactic reaction to one or more excipients:
  • Ensure that the vaccine formulation used is free of the identified excipients (for example, neomycin or other aminoglycosides). For further information, see the manufacturers' Summary of Product Characteristics for the individual influenza vaccines on the electronic Medicines Compendium website.
• For people who are allergic to egg or have had a confirmed anaphylactic reaction to egg, see the section on How should I manage a person with egg allergy?.
• Do not give the influenza immunization to people who are acutely unwell (with a febrile illness or acute infection) — postpone immunization until they have fully recovered. 
  • Note: minor illnesses without fever or systemic upset are not valid reasons to postpone immunization. 
• Fluenz nasal spray is contraindicated in children or young people who:
  • Are severely immunocompromised due to conditions or immunosuppressive therapy such as acute and chronic leukaemias; lymphoma; cellular immune deficiencies; HIV infection not suppressed by antiretroviral therapy; and high dose corticosteroids (prednisolone at least 2 mg/kg/day for a week or 1 mg/kg/day for a month or equivalent). 
  • Have a history of severe anaphylaxis to egg that has previously required intensive care management in hospital. See the section on How should I manage a person with egg allergy?
  • Are taking systemic salicylate therapy.  
•  Fluenz nasal spray is not recommended in children or young people:
  • Who have heavy nasal congestion — consider postponing until symptoms have resolved (or using an alternative vaccine by an alternative route). 
  • Are experiencing an acute exacerbation of asthma (increased wheeze or use of additional bronchodilator treatment in the previous 72 hours). 
  • Where close contact with a severely immunocompromised person is likely or unavoidable (for example where a person with a bone marrow transplant requiring isolation is a household contact) — consider offering an alternative inactivated influenza vaccine. 
  • Until 48 hours after stopping treatment with an influenza antiviral agent. For more information on antiviral agents, see the CKS topic on Influenza - seasonal. 

How should I manage a person with egg allergy?

• Determine if the person has a true egg allergy — see the CKS topic on Angio-oedema and anaphylaxis for more information. The following are not considered to be a true egg allergy:
  • A family history of a reaction to an influenza vaccine or any other vaccine.
  • A family history of egg allergy.
• For children with a history of severe anaphylaxis to egg who have previously required intensive care management in hospital, arrange referral to a specialist for immunization with LAIV in hospital, or if aged 2 years or over, give the egg-free cell-based quadrivalent influenza vaccine (QIVc). This can be administered in any setting.  
  • Fluenz nasal spray is contraindicated in anyone who has had a severe allergic reaction (for example, anaphylaxis) to egg or to egg proteins.
• For all other children with a history of egg allergy:
  • Fluenz can be given to most children with egg allergy in any setting, including primary care.
    • Egg-allergic children with asthma can receive Fluenz provided their asthma is well-controlled. See the section on contraindications and cautions for more information.
  • If children with egg allergy also have another clinical contraindication to Fluenz (for example, immunosuppression), give an inactivated influenza vaccine with a very low ovalbumin content (less than 0.06 micrograms per 0.5 mL dose), or for children aged over 2 years, give the egg-free QIVc. See the section on available influenza vaccines for details of the ovalbumin content.
• For adults with:
  • A history of severe anaphylaxis which has previously required intensive care management in hospital, arrange referral to a specialist for assessment for immunization in hospital, or offer the egg-free QIVc. 
  • Less severe egg allergy — an inactivated influenza vaccine with a very low ovalbumin content (less than 0.06 micrograms per 0.5 mL dose), or an egg-free quadrivalent vaccine can be given in any setting. See the section on available influenza vaccines for details of the ovalbumin content.

How should I administer influenza vaccines?

• Seasonal influenza vaccine should be given annually, ideally between early October and late November for most adults. For children and pregnant women, this should start from 1 September.
  • For school-aged cohorts, vaccination in schools should be completed by the second Friday in December (11 December 2026), with further catch-up opportunities provided via community clinics or additional school visits as appropriate. 
  • Following clinical assessment, there may be a small number of other adults who would benefit from vaccination from 1 September, for example, those who are due to commence immunosuppressive treatment (such as chemotherapy). GPs should use clinical judgement to bring forward vaccination only in these exceptional circumstances.
• Obtain written or verbal consent at the time of vaccination for people aged over 16 years. For younger people, it is usual to get consent from a person with parental responsibility.
• For Fluenz intranasal spray, give a single application of 0.1 mL in each nostril. The dose does not need to be repeated if the child or young person blows their nose or sneezes after administration. 
• Administer the other influenza vaccines by intramuscular injection (people taking anticoagulants and people with bleeding disorders may also be vaccinated intramuscularly). 
  • For adults and children aged 1 year and older, use the deltoid area of the upper arm or the anterolateral aspect of the thigh.
  • For infants younger than 1 year of age, use the anterolateral aspect of the thigh.
  • Do not give immunizations in the buttock area.
  • Note: Some of the summaries of product characteristics (SPCs) for intramuscular inactivated influenza vaccines indicate that young children can be given either a 0.25 ml or a 0.5 ml dose. JCVI has advised that where these alternative doses are indicated, the 0.5 ml dose of intramuscular inactivated influenza vaccine should be given to infants and children aged 6 months or older. 
• Ensure that the brand of vaccine, batch number, and administration site are accurately recorded in the person's records. 
• Influenza vaccines can be given at the same time as other live or inactivated vaccines. 
  • Administer the vaccines at separate sites, preferably in a different limb (if appropriate).
    • If the vaccines need to be given in the same limb, use vaccination sites at least 2.5 cm apart.
• If there is inadvertent administration of Fluenz to a person with a clinical contraindication: 
  • If the person is severely immunocompromised, consider the use of influenza antiviral prophylaxis. For more information, see the CKS topic on Influenza - seasonal. If antiviral prophylaxis is used, offer inactivated influenza vaccine immediately to provide ongoing protection for the current influenza season. If there is any uncertainty about management, seek specialist advice.
  • For all other people, advise them to seek medical advice if they develop influenza-like symptoms in the 4 days following administration of Fluenz. For more information on typical symptoms of influenza, see the CKS topic on Influenza - seasonal.
• Be aware that very severely immunocompromised healthcare professionals should not administer Fluenz intranasal spray, due to a theoretical risk of acquiring vaccine virus due to exposure to the live attenuated vaccine. 
• Be aware that administration of Novavax COVID-19 vaccine should be separated from administration of influenza vaccine by at least 7 days.

What are the adverse effects of influenza vaccines?

• Advise that the following adverse effects are common after influenza immunization and usually disappear within 1–2 days without needing treatment:
  • Pain, swelling, or redness at the injection site.
  • A small painless nodule (induration) at the injection site.
  • Low-grade fever, malaise, shivering, or fatigue.
  • Headache, myalgia, or arthralgia.
  • Nasal congestion, rhinorrhoea, reduced appetite, and headache following administration of Fluenz nasal spray.
• Be aware that rare adverse effects may include:
  • Neuralgia, paraesthesia, convulsions, and transient thrombocytopenia.
  • Vasculitis with transient renal involvement (very rare).
  • Neurological disorders, such as encephalomyelitis (very rare).
• Report all serious suspected adverse reactions to influenza vaccines using the Yellow Card scheme (website available at https://yellowcard.mhra.gov.uk).
  • Report any suspected adverse reactions to vaccines, which are black triangle drugs, as they are subject to intensive surveillance by the Medicines and Healthcare products Regulatory Agency (MHRA). 

What information and advice should I give?

• Advise the person or family/carers that:
  • The protection provided by the influenza vaccine lasts for about one year and so they need to be vaccinated annually (usually before late November).
  • After vaccination, protective antibody levels may be achieved within 14 days.
  • The influenza vaccine will not protect the person from other micro-organisms that can cause similar respiratory infections, such as the common cold and respiratory syncytial virus.
  • People who have received the Fluenz nasal spray should avoid close contact with severely immunocompromised people for 1–2 weeks following vaccination, if possible.
  • Adverse effects are generally minor and usually disappear within 1–2 days without the need for treatment.
• Provide sources of information and advice on the influenza vaccine and national influenza immunization programme, including patient information leaflets published by the UK Health Security Agency (UKHSA). UKHSA and the UK Teratology Information Service have also produced patient leaflets on influenza vaccination in pregnancy.