Flu vaccination programme 2025-2026

There is no concern about you putting your mum at risk because you had the BCG vaccine, she cannot catch TB from it. Take a look at this  link  for more information. 

There are two Shingles vaccine, and one of these (Zostavax) is a live vaccine. Transmission to susceptible household contacts has been reported but is rare. The vaccine is however recommended for healthy susceptible contacts of immunocompromised patients where continuing close contact is unavoidable (e.g. siblings of a leukaemic child, or a child whose parent is undergoing chemotherapy). If in doubt check with your centre if they would be happy for you to be vaccinated, if the answer is yes, you need not worry about household contact transmission. 

Please discuss with your health team whether the vaccine is suitable or not, as this depends on different factors such as your T cell function as well as whether or not you are on immunosuppressive therapy. You can find information on the shingles vaccine at Shingles vaccine overview – NHS (www.nhs.uk) 

All girls aged 12 to 13 are offered HPV vaccination as part of the NHS childhood vaccination programme. The vaccine protects against cervical cancer. It’s usually given to girls in year eight at schools in England. 

The vaccines available are recombinant protein vaccines – virus-like particles, with no live virus potential so they are safe for girls who have a PID. 

Both the meningitis and septicaemia vaccines are killed vaccines so PID patients should definitely have the vaccination. PID patients may not make the most effective response to the vaccine but it’s better to have some protection. 

Many but not all patients are suitable for pneumococcal vaccine.  Patients on immunoglobulin (Ig) replacement therapy would not normally receive it but may do if their Ig is stopped.  Other patients may have specific contraindications and this would be best discussed with their specialist health team. 

Pneumococcal vaccine is not usually given whilst on Ig therapy.  This is because there is a good spread of anti-pneumococcal antibodies in Ig, and this is part of its value.  Pneumococcal vaccine can be “neutralised” by the antibodies present in the Ig.  There is a limited useful T-cell response that would help provide further protection to these organisms, so there is no great utility in vaccinating. This is unlike the killed flu vaccine, which can provide useful T-cell protection even if there is no antibody response. 

It is very difficult to give blanket advice on vaccination for people with immunodeficiency.  We advise that you discuss this with your specialist team as they can provide advice specific to you and your condition.   Some patients will be given pneumococcal vaccine as part of their work up, patients on immunoglobulin therapy would not normally be offered it since they get the protection from this treatment.  

There are two types of vaccines for the ‘pneumonia jab’ Streptococcus Pneumoniae (pneumococcus).  Pneumovax is a vaccine prepared from a mixture of 23 bacterial polysaccharide (sugar) components which is effective in older children and adults. This is used to protect those that have sickle cell disease or have had their spleen removed, to prevent chest and sinus infections. This safe vaccine may be used to test for antibody production as part of the investigation of a suspected immunodeficiency. 

Children under the age of two do not respond to the polysaccharide vaccines. To protect this group of high-risk individuals, conjugated pneumococcal vaccines were introduced universally in the UK in 2006. These vaccines are also composed of bacterial components and contain no live organisms; they are safe in immunodeficient patients and may be used to investigate suspected immunodeficiency. 

You may also find this IPOPI booklet on vaccines useful. 

To date no cases of transmission have been reported. Children well enough to attend mainstream school do not need to avoid other children who have received the vaccine, but PID patients should not receive the live virus as a direct inoculation. Children undergoing or recovering from bone marrow transplant or with SCID (untreated) are advised that household contacts should have killed, not live, vaccines.

Although vaccinated children are known to shed virus a few days after vaccination, the vaccine virus that is shed is less able to spread from person to person than the natural infection. The amount of virus shed is normally below the levels needed to pass on infection (transmit) to others and the virus does not survive for long outside of the body. This is in contrast to natural flu infection, which spreads easily during the flu season. 

It is more likely that you had naturally acquired flu and that you will hopefully have had less severe infection than if you were not vaccinated. 

Although vaccinated children are known to shed the virus a few days after vaccination, the vaccine virus that is shed is less able to spread from person to person than the natural infection. The amount of virus shed is normally below the levels needed to pass on infection (transmit) to others and the virus does not survive for long outside of the body. This contrasts with a natural flu infection, which spreads easily during the flu season. In schools using vaccines, therefore, the overall risk of influenza transmission is massively reduced by having a large number of children vaccinated. In the US, where there has been extensive use of the nasal spray flu vaccine (live attenuated influenza vaccine; LAIV) for many years, serious illness amongst immunocompromised contacts who are inadvertently exposed to the vaccine virus has never been observed. Expert doctors at Great Ormond Street Hospital, who deal with many children with very serious immune problems, do not recommend keeping such children off school purely because of vaccination. 

All pregnant women are advised to have flu vaccine to protect them and their newborn child. If you have a PID then live vaccine should not be used (but these are not licensed for adults so should not be an issue). 

Vaccines reduce the likelihood of getting an infection and often reduce how badly a person will be affected if infection still occurs.  Some people with immunodeficiency will be able to be vaccinated, but their responses may not be as good as individuals with fully functioning immune systems.  Vaccinating family members or close household contacts with the injectable killed flu vaccine is recommended to help reduce the likelihood that someone brings influenza into the house and will therefore help protect the individual indirectly. 

There is a theoretical potential for transmission of live attenuated influenza virus in Fluenz Tetra® to immunocompromised contacts for one to two weeks following vaccination. In the US, where there has been extensive use of the Live Attenuated Influenza Vaccine, there have been no reported instances of illness or infections from the vaccine virus among immunocompromised patients inadvertently exposed. Where close contact with very severely immunocompromised patients (e.g. bone marrow transplant patients requiring isolation) is likely or unavoidable (for example, household members), however, appropriate alternative inactivated influenza vaccines should be considered.   For the majority of PID patients this means that household contact with a live vaccine is fine, but if in doubt check with your immunologist. 

No Fluenz is a live nasal vaccine and should not be given to children with a PID.  Other killed; injectable flu vaccines may be recommended. You should speak to your immunology team for advice. 

In general, there is no contraindication between having immunoglobulin therapy and killed vaccines, but if the two are given close together and there are high levels of antibody in the Ig to the vaccine then the efficacy is likely to be impaired. Please check with your immunology team about the appropriate timing.