Influenza vaccine information for health professionals

Immunization is the most effective strategy to prevent and reduce the impact of influenza in our community. Influenza vaccine has been shown to reduce influenza-related complications, hospitalizations, and deaths. Ottawa Public Health supports your efforts to increase influenza vaccine uptake in your practice through vaccine delivery, and by providing you and your patients with information and resources.

Influenza strains covered by the vaccine

The 2018-2019 seasonal influenza vaccines protect against the following influenza strains:

Quadrivalent vaccines:

  • A/Michigan/45/2015 (H1N1)pdm09-like virus;
  • A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus;
  • B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage); and
  • B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage).

Trivalent vaccine:

  • A/Michigan/45/2015 (H1N1)pdm09-like virus;
  • A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus; and
  • B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage)
Populations recommended to be immunized

National Advisory Committee on Immunization (NACI) statement for 2018-2019

Who is recommended to be immunized against influenza?

NACI recommends that all individuals aged 6 months and older be immunized against influenza. As per the 2018-2019 NACI statement, influenza immunization is particularly recommended for the following groups:

  • People at high risk of influenza-related complications or hospitalization:
    • All pregnant women.
    • Adults and children with the following chronic health conditions:
      • cardiac or pulmonary disorders (including bronchopulmonary dysplasia, cystic fibrosis and asthma);
      • diabetes mellitus and other metabolic diseases;
      • cancer, immune compromising conditions (due to underlying disease, therapy or both);
      • renal disease;
      • anemia or hemoglobinopathy;
      • neurologic or neurodevelopment conditions;
      • morbid obesity (body mass index [BMI] of 40 and over);
      • children and adolescents (age 6 months to 18 years) undergoing treatment for long periods with acetylsalicylic acid, because of the potential increase of Reye’s syndrome associated with influenza.
    • People of any age who are residents of nursing homes and other chronic care facilities.
    • People 65 years of age and older.
    • All children 6 to 59 months of age.
    • Indigenous peoples. 
  • People capable of transmitting influenza to those at high risk:
    • Health care and other care providers in facilities and community settings who, through their activities, are capable of transmitting influenza to those at high risk of influenza complications.
    • Household contacts (adults and children) of individuals at high risk of influenza-related complications (whether or not the individual at high risk has been immunized):
      • household contacts of individuals at high risk, as listed in the section above;
      • household contacts of infants under 6 months of age as these infants are at high risk of complications from influenza but cannot receive influenza vaccine;
      • members of a household expecting a newborn during the influenza season.
    • Those providing regular child care to children 59 months of age and under, whether in or out of the home.
    • Those who provide services within closed or relatively closed settings to persons at high risk (e.g., crew on a ship). 
  • Others:
    • People who provide essential community services.
    • People in direct contact during culling operations with poultry infected with avian influenza. 

How many vaccine doses are required?

Children 6 months to under 9 years of age receiving seasonal influenza vaccine for the first time in their life should be given two doses, with a minimum interval of four weeks between doses. All others require only one dose annually.

Contraindications to influenza immunization

Contraindications to influenza immunization:

Influenza vaccine is contraindicated in:

  • Persons who have developed Guillain-Barré Syndrome (GBS) within six weeks of influenza vaccination.
  • Persons who have developed an anaphylactic reaction to a previous dose of influenza vaccine or to any of the vaccine’s components, with the exception of egg.
  • Egg-allergic individuals may be vaccinated against influenza without prior influenza vaccine skin test and with the full dose, irrespective of a past severe reaction to egg, and without any extraordinary precautions, but ensuring that, as with all vaccine administration, immunizers be prepared with the necessary equipment, knowledge and skills to respond to a vaccine emergency at all times.
  • In situations of suspected hypersensitivity or non-anaphylactic allergy to a vaccine or its components, investigation is indicated which may involve immunization in a controlled setting. Consultation with an allergist is advised. 

In addition, live-attenuated influenza vaccine (LAIV) (FluMist Quadrivalent®) is contraindicated in:

  • Children less than 24 months of age, due to increased risk of wheezing.
  • Individuals with severe asthma, as defined as currently on oral or high-dose inhaled glucocorticosteroids or active wheezing, or those with medically attended wheezing in the 7 days prior to the proposed date of immunization.
  • Children and adolescents 2 to 17 years of age currently receiving aspirin or aspirin-containing therapy because of the association of Reye’s syndrome with aspirin and wild-type influenza infection. It is recommended that aspirin-containing products in children less than 18 years of age be delayed for four weeks after receipt of live-attenuated influenza vaccine.
  • Pregnant women, because it is a live attenuated vaccine and there is a lack of safety data at this time. However, it is not contraindicated in breastfeeding mothers.
  • Persons with immune compromising conditions, due to underlying disease, therapy, or both, as the vaccine contains live attenuated virus. 

For more information, please consult the product monographs:

NACI vaccine product recommendations

National Advisory Committee on Immunization (NACI) statement for 2018-2019

Influenza vaccine is recommended for everyone 6 months of age and older who does not have contraindications to the vaccine.

Recipient by age group

Vaccine types available for use in Ontario

Recommendation

Children 6-23 months of age

  • Quadrivalent inactivated influenza vaccine (QIV)

NACI recommends that, given the burden of influenza B disease, QIV should be used.

Children 2-17 years of age

  • QIV
  • Quadrivalent live - attenuated influenza vaccine (Q-LAIV)

In children without contraindications to the vaccine, QIV or Q-LAIV can be used. Q-LAIV or QIV can be used in children with chronic health conditions and without contraindications. 

The current evidence does not support a recommendation for the preferential use of Q-LAIV in children and adolescents 2–17 years of age.

Q-LAIV is contraindicated for children with immune compromising conditions.

Adults 18-59 years of age

  • QIV
  • Q-LAIV

QIV is recommended for adults with chronic health conditions.

QIV, instead of Q-LAIV, is recommended for health care workers.

Q-LAIV is contraindicated for adults with immune compromising conditions.

Adults 60-64 years of age

  • QIV

QIV is authorized for use in this age group.

Adults 65 years of age and older

  • QIV
  • High-dose TIV 

Either QIV or high-dose TIV may be used in this age group.

See below for key considerations when choosing between QIV and high-dose TIV. 

Pregnant women

  • TIV
  • QIV

Q-LAIV is not recommended because of the theoretical risk to the fetus from administering a live virus vaccine.

Choosing between QIV and High-Dose TIV for patients 65 years of age and older

The National Advisory Committee on Immunization (NACI) does not recommend high-dose TIV over QIV for persons aged 65 years and older, because there are no studies directly comparing the effectiveness of one to the other. Public Health Ontario has produced a document (available upon request) highlighting key considerations when choosing between high-dose TIV and QIV; these key considerations are summarized below.

Key considerations for choosing between high-dose TIV and QIV for persons aged 65 years and older:

  • While
    high-dose TIV contains only one B strain (from the B/Victoria lineage for the
    2018-19 vaccine) compared to the QIV which contains B strains from both
    lineages, high-dose TIV contains four times as much antigen compared to QIV (60
    μg versus 15 μg per antigen) for the three strains the vaccines share in common.
  • Among persons aged 65 years and older, the immune response, efficacy and
    effectiveness has generally been found to be better for high-dose TIV compared
    to standard-dose TIV, but no direct comparisons have been published for
    high-dose TIV and standard-dose QIV. 

Influenza A coverage:

  • The burden of influenza A/H3N2 is higher in adults 65 years of age and over compared to other strains. The high-dose TIV provides better protection than standard-dose TIV, including against the A/H3N2 strain. 
  • The A/H3N2 strain is the same in the standard-dose TIV and the QIV vaccines, so similar enhanced protection against the A/H3N2 found for high-dose TIV is also expected when compared to the standard-dose QIV. 

Influenza B coverage:

  • Although the high-dose TIV contains one less B strain than in the QIV, B strains occur less frequently in adults 65 years of age and over than A strains.
  • There may be cross protection against B lineages, such that the TIV vaccine that contains B/Victoria may offer some protection against B/Yamagata and vice versa, although this may not always occur. Therefore, high-dose TIV may afford some protection against the B lineage not included in that vaccine.

Based on key considerations comparing the high dose TIV vs. the QIV put forth by Public Health Ontario, Ottawa Public Health expects the high-dose TIV to be more effective than QIV in persons ages 65 years of age and over; however, there is no available evidence directly comparing these two vaccines as of yet.

Vaccine products publicly funded in Ontario

Quadrivalent influenza vaccine (QIV) is publicly-funded for children and adults aged 6 months and older

For individuals aged six months and older, quadrivalent inactivated vaccines (QIV) are available: Fluzone Quadrivalent® and FluLaval Tetra® (subject to availability).

For children two years to 17 years, a live attenuated influenza vaccine (Q-LAIV) (FluMist Quadrivalent®) administered through the intranasal route is also available.

High-Dose Trivalent influenza vaccine (high-dose TIV) is publicly-funded for adults aged 65 years and older

For individuals aged 65 years and older, a high-dose trivalent vaccine (Fluzone® High-Dose) is available. Fluzone® High-Dose will be available through primary care providers (e.g. physicians and nurse practitioners), participating retirement homes, long-term care homes, hospitals and at Ottawa Public Health community flu clinics. Fluzone® High-Dose will not be available through pharmacies.

 Vaccine

FluLaval Tetra®

Fluzone Quadrivalent®

Flumist® Quadrivalent

Fluzone® High-Dose

Influenza Vaccine Formulation

Quadrivalent Inactivated Vaccine (QIV)

Quadrivalent Inactivated Vaccine (QIV)

Quadrivalent live attenuated vaccine (Q-LAIV)

High-Dose Trivalent Inactivated Vaccine (High-Dose TIV)

Dosage and Route of Administration

0.5mL IM

0.5mL IM

0.2mL (0.1mL in each nostril) Nasal Spray

0.5mL IM

 Format

Multi-dose vial 

Multi-dose vial (MDV)

Prefilled syringe (PFS)

Prefilled single use sprayer 

Prefilled syringe 

Eligibility for publicly funded vaccine

6 months and older

6 months and older

2-17 years

65 years and older

Potential Allergens

  • Egg Protein*
  • Thimerosal**
  • Egg Protein*
  • Thimerosal (multi-dose vial only)**
  • Egg Protein*
  • Arginine
  • Gelatin
  • Gentamicin
  • Egg Protein*

* Egg allergy is not a contraindication to receiving inactivated influenza vaccines or live attenuated influenza vaccine (see National Advisory Committee on Immunization Influenza Statement).

** Nominal supply of thimerosal free, single-dose prefilled syringe of Fluzone Quadrivalent vaccine is available for those 6 months of age and over who have known thimerosal allergies.

Important note: Fluzone® Quadrivalent and Fluzone® High-Dose are different products. Fluzone® High-Dose is only authorized for those 65 years of age and older. Please use caution when administering Fluzone® products to ensure that the right vaccine is being administered to the right person.

Vaccine ordering and pick up

Vaccine Distribution Room hours are Monday to Friday, 8 am to 4 pm. NOTE: November 12 is a statutory holiday and the Vaccine Distribution Room will be closed.

  1. Use the Influenza Vaccine Order Form 2018/2019 from Ottawa Public Health to order vaccine (not the MOHLTC form)
  2. Place your order using the number of doses required. Orders will be filled in the order in which they are received, with priority to high-risk groups. A small amount of vaccine will be shipped in October for high risk patients only. Regular flu orders can be made after October 22nd. Please allow up to 7 business days for your order to be processed.
  3. Always reserve some vaccine for persons age 65 years and older, and persons under 65 with medical conditions that put them at high risk for influenza-related complications.
  4. Your clinic/facility will be called when your order is ready. Arrange to pick up your order within 48 hours of notification at the Ottawa Public Health Vaccine Distribution Centre, on the ground floor of 100 Constellation Drive.
  5. Bring your own cooler and ice pack.

Vaccine that is not used by your clinic/facility cannot be redistributed. To reduce vaccine wastage, only order the quantity that you are sure to use. You can order more vaccine as needed. Return unused vaccine to the Ottawa Public Health Immunization Program once you are finished immunizing for the season using Ottawa Public Health Vaccine Return Form.

Report of adverse events following immunization (AEFI)

To report an adverse event following immunization (AEFI), visit our AEFI section.

Health care agencies and workplaces providing influenza vaccine clinics

Ottawa Public Health seeks to support you in your efforts to increase influenza vaccine uptake in your facility or workplace by offering information and resources.

In your cannot find the information you seek here, please call 613-580-6744 and select “1” for English then “2” for healthcare provider; your call will be prioritized for answer by the next available public health nurse.

Information from the MOHLTC on the 2018/2018 Seasonal Universal Influenza Immunization Program (UIIP) is also available.

Return unused vaccine to the Ottawa Public Health Immunization Program once you are finished immunizing for the season using Ottawa Public Health Vaccine Return Form.

More information
  • Ottawa Public Health
    • Information about influenza for healthcare providers
    • To order vaccine fax the influenza vaccine order form to 613-580-2783
    • For questions regarding a vaccine order email vaccine@ottawa.ca  or call 613-580-6744 and follow prompts for the Vaccine Distribution Centre.
    • Fax the Adverse Event Following Immunization (AEFI) reporting form to 613-580-9660
    • Hospitals, long-term care, retirement homes call the outbreak reporting line 613-580-6744 ext 26325 to report outbreaks
    • Workplaces call 613-580-6744 and select “1” for English then “2” for healthcare provider; your call will be prioritized for answer by the next available public health nurse.
  • Influenza vaccine manufacturers’ contact information:
    • Sanofi Pasteur (Fluzone®Quadrivalent and Fluzone®High-Dose ) 1-888-621-1146
    • GlaxoSmithKline, Inc. (FluLaval®Tetra) 1-800-387-7374
    • AstraZeneca Canada (Flumist®) 1-800-668-6000
  • Patient information poster for your office: Treat the Flu: Know when to stay home, know when to seek medical attention

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