‘The Green Book’ provides the evidence and rationale behind the UK vaccination schedule. The green book is an online resource which is constantly updated to reflect the latest evidence guidance and recommendations. It can be accessed via the PHE immunisation pages.
The book is divided into sections.
Part one, chapters 1 – 12; include information on principles of vaccination, policy, and practice procedures. This includes information on vaccine safety and how vaccines are continually monitored.
Part two has the disease specific information. Each chapter details the epidemiology of the disease and how the infection is contracted and then the vaccines used to prevent or minimise the impact of the illnesses.
Each chapter is fully referenced.
There are often reports on the vaccine effectiveness, the efficacy of the vaccine is not exact it varies year on year depending on the match of the vaccine to the circulating strains. The protection also varies for different age groups, and also against different strains of the virus. Overall the effectiveness of the vaccine is estimated to be 59% for adults aged between 18 – 65 years.
There is clear evidence that the immune responses to vaccination declines significantly as we get older and as such the vaccine effectiveness in older adults is much lower than in younger people. However, again it varies year on year.
The 2018 2019 season will see new vaccines which will hopefully improve the overall effectiveness and coverage.
Older adults over 65 will be offered an adjuvented vaccine. The evidence for this shows it to be far more effective in this age group.
Younger people will be offered a quadrivalent vaccine to provide coverage for an additional B strain of influenza vaccine.
How safe are vaccines?
People understandably want to know how safe vaccines are. The World Health Organization (WHO) vaccine safety initiative provides information and assurance on how vaccine safety is monitored and assured globally. The WHO also have some useful information about the safety of giving vaccines together.
The Green Book also has information on vaccine safety and how vaccines are continually monitored.
What is in the flu vaccine?
Each year the Influenza vaccine used across the Northern Hemisphere will contain the same strains of influenza vaccine. This is decided by the WHO based on surveillance data on the circulating strains of virus.
Each vaccine will list the other ingredients in the summary of product characteristics which will be in each box and can also be found on the electronic medicines compendium.
All flu vaccines currently are grown on hens eggs and have very small amounts of ovalbumin protein in the vaccine.
Most people even with egg allergy can safely have one of the low ovalbumin containing vaccines. See the green book influenza chapter under egg allergy: https://www.gov.uk/government/publications/influenza-the-green-book-chapter-19
The Oxford vaccine group has more detail under the ingredients section for the:
The Nasal vaccine given to children contains a gelatine stabilizer ‘Porcine’ which is pork based. This guidance from PHE developed in 2014 details information about this. The document includes advice from both the Jewish and Muslim religious leaders on the acceptability and use of the vaccine.
The guidance states that where children are in one of the clinical risk groups alternative inactivated vaccines can be offered.
NB: The Inactivated vaccines do not contain porcine.
What are the practical aspects for vaccine administration?
The Green Book - Immunisation against infectious diseases contains advice on all aspects of vaccine administration.
The RCN position in relation to the role of health care assistants / health care support workers (HCSW) and vaccine administration see:
HCSW and adult vaccination (Version: July 2015) (PDF 299KB)
HCSW and Live Attenuated Influenza Vaccination [LAIV] for children and young people (Version: July 2015)
Please ensure if you are using a hard copy of these documents that you are using the most recent version.
For more information on the administration of vaccines in relation to Patient Specific Directions (PSD) and Patient Group Directions (PGD) please visit the medicines optimisation resource.
RCN online advice provides additional information and advice, see: Immunisations.
- vaccine administration
- the employer's responsibility to ensure they have an immunisation programme in place for health care employees
- the involvement of HCAs/APs in the provision of medication and immunisations
- training for healthcare staff involved in immunisations to ensure they maintain skills and competence
- immunisation policy throughout the UK
- the prescription and administration of vaccines by independent prescribers, nurses and midwives who are not prescribers and HCAs
- guidance for health care practitioners involved in travel health vaccination.
The WHO have advised that gloves do not need to be worn when giving a vaccine.
For more information on when to wear and not wear gloves be see the RCN's Tools of the Trade: Guidance for Health Care Staff on Glove Use and the Prevention of Contact Dermatitis.