nMRCGP Exam Update - Influenza vaccination

Dr Louise Newson is a GP in the West Midlands and author of 'Hot Topics for MRCGP and General Practitioners', PasTest, 2006

Current situation

  • During the winter months there is usually an outbreak of influenza, caused by influenza A or B virus, which results in an increased workload for both primary care teams and hospitals.
  • Influenza causes between 10,500 and 25,000 deaths a year in England and Wales and is responsible for about 800,000 visits to GPs a year.
  • There is plenty of evidence to support the effectiveness of the vaccine; it reduces mortality and morbidity in high-risk groups.

What is the evidence?

  • There is not sufficient evid-ence to recommend universal vaccination against influenza in healthy adults. A review found that vaccinating healthy adults reduced their chances of developing flu-like illness by only a quarter and the number of working days lost by less than half a day (Cochrane Database Syst Rev 2007 2: CD001269).
  • One study has demonstrated that adults with diabetes, like other high-risk groups, benefit from receiving the influenza vaccine each year, regardless of age (Diabetes Care 2006; 29: 1,771-6).
  • A recent observational study found that influenza vaccination was associated with a 27 per cent reduction in the risk of hospitalisation for pneumonia or influenza and a 48 per cent reduction in the risk of death (N Engl J Med 2007; 357: 1,373-81).
  • A study has shown that many older people do not believe themselves to be at risk from influenza (Br J Gen Pract 2007; 57: 352-8). Individual prompts, especially from GPs, seem to be the most significant motivators to attend for immunisation.
  • One study found that the influenza vaccine reduced mortality by about a third when patients were admitted to hospital with community-acquired pneumonia (Arch Intern Med 2007; 167: 53-9).
  • Although there is little evidence to support the cost-effectiveness of the flu vaccination programme, there is still evidence that immunisation reduces pneu-monia, hospital admissions and mortality (BMJ 2006; 333: 1,241).

Implications for practice

  • A systematic review has shown that neuraminidase inhibitors have low effec-tiveness and should not be used in seasonal influenza control.

The authors of the review recommend that these drugs should only be used in a serious epidemic or pandemic, alongside other public health measures (Lancet 2006; 367: 303-13).

  • The possible emergence of resistance further limits the routine use of neuraminidase inhibitors.
  • Although amantadine is licensed for treatment of influenza A, it is no longer recommended (see NICE guidance).

Summary Points

  • Influenza still leads to many deaths in the UK.
  • Vaccine use leads to a reduction in pneumonia and death.
  • Many elderly people underestimate their risk of influenza.
  • Cost-effectiveness of antivirals is still unproven.


  • NICE guidance: Influenza (prophylaxis), amantadine, oseltamivir and zanamivir (September 2008).
  • Community-based virological surveillance schemes, including those run by the Health Protection Agency.

Useful websites

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins


Already registered?

Sign in

Just published

GP consultation

GP practices delivering 150,000 extra appointments per day compared with 2019

GP practices in England delivered 150,000 more appointments per working day in the...

Surgeon looking at a monitor in an operating theatre

NICE recommends non-invasive surgical procedure to target obesity

NICE has said that a non-invasive weight loss procedure should be used by the NHS...

GP trainee

Two training posts deliver one full-time GP on average, report warns

Two training posts are needed on average to deliver a single fully-qualified, full-time...

Dr Fiona Day

How to flourish as a GP by learning from the good and the difficult

Leadership and career coach Dr Fiona Day explains how GPs can grow and develop from...

Unhappy older woman sitting at home alone

Low mood – red flag symptoms

Low mood is a common presentation in primary care and can be a sign of a mental health...


PCN to take on GMS practice contract in landmark move for general practice

A GP practice in Hertfordshire could become the first to be run directly by a PCN...