Flu Vaccination Elegibility

For the 2022/23 flu campaign there are some changes for the patients aged under 65 year who can have the flu vaccine.
Now the 50-64 age group (who are not in at risk category) can not have a free flu vaccine, it has reverted back to pre-covid categories (as highlighted in the table below).
Also the obesity category is for patients with a BMI of 40+, not 30-39.
Clinical risk categoryExamples (this list is not exhaustive and decisions should be based on clinical judgement)   
Chronic respiratory
disease
Asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission.

Chronic obstructive pulmonary disease (COP) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD).

Children who have previously been admitted to hospital for lower respiratory tract
disease.
Chronic heart
disease
Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease.
Chronic kidney
disease
Chronic kidney disease at stage 3, 4 or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation.
Chronic liver diseaseCirrhosis, biliary atresia, chronic hepatitis
Chronic neurological disease (included in the DES directions for Wales)Stroke, transient ischaemic attack (TIA). Conditions in which respiratory function may be compromised due to neurological disease (e.g. polio syndrome sufferers). Clinicians should offer immunisation, based on individual assessment, to clinically vulnerable individuals including those with cerebral palsy, learning disabilities, multiple sclerosis and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability.
DiabetesType 1 diabetes, type 2 diabetes requiring insulin or oral hypoglycaemic drugs, diet controlled diabetes.
ImmunosuppressionImmunosuppression due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression, bone marrow transplant, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement disorder)

Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day (any age), or for children under 20kg, a dose of 1mg or more per kg per day.

It is difficult to define at what level of immunosuppression a patient could be considered to be at a greater risk of the serious consequences of influenza and
should be offered influenza vaccination. This decision is best made on an individual basis and left to the patient's clinician.

Some immunocompromised patients may have a suboptimal immunological response to the vaccine.
Asplenia or dysfunction of the spleenThis also includes conditions such as homozygous sickle cell disease and coeliac syndrome that may lead to splenic dysfunction.
Pregnant womenPregnant women at any stage of pregnancy (first, second or third trimesters).
Morbid obesity (class Ill obesity)Adults with a Body Mass Index ≥40 kg/m?