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Novartis has warned practices to expect delays caused by packaging problems.

The company expects to be back on track by mid-October, but nationwide television and poster campaigns for flu jabs are expected to start this week.

A spokeswoman said: 'We had a minor hiccup, but essentially everyone will receive some vaccine.'

The latest setback follows the announcement by GSK in August that deliveries of flu vaccine would be late, due to delayed growth of one of the component strains. For the fourth year running, practices may face problems immunising at-risk groups.

Former Practice Nurse Association chair Sue Nutbrown said: 'Most practices have contingency plans in place because something has always gone wrong in the last few years.'

Ms Nutbrown said many had placed orders for flu vaccines with more than one supplier. Practices facing a shortage should prioritise vaccinations for over-65s, patients with long-term conditions and the immunosuppressed, she advised.

Any long delays would leave practices with a heavy workload to catch up on missed vaccinations once supplies did arrive, she added.

Meanwhile, US experts said last week that vaccinating the elderly against flu may be pointless.

A review article in the Lancet Infectious Diseases said there was little evidence that vaccinating over-70s against flu reduced mortality.

Dr Lone Simonsen, of George Washington University, said excess mortality studies had been unable to confirm a decline in flu deaths since 1980, despite vaccine uptake increasing from 15 to 65 per cent.

But Ms Nutbrown said that preventing deaths was not the only benefit of flu vaccinations.

'It's not just about cutting deaths from flu, but reducing the morbidity that flu would bring in patients with long-term conditions,' she said.

She pointed out that this cut the workload of clinicians managing patients with long-term conditions, and saved the NHS money.

rachel.liddle@haymarket.com and nick.bostock@haymarket.com

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