Immunization and Vaccines

Quadrivalent vaccines:

• A/Brisbane/02/2018 (H1N1) pdm09-like virus;
• A/Kansas/14/2017 (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/Brisbane/02/2018 (H1N1) pdm09-like virus;
• A/Kansas/14/2017 (H3N2)-like virus; and
• B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage).

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 2019-2020 NACI statement, influenza immunization is particularly recommended for the following groups:

• People at high risk of influenza-related complications or hospitalization:
  • All pregnant people.
  • 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 (includes neuromuscular, neurovascular, neurodegenerative, neurodevelopmental conditions, and seizure disorders [and, for children, includes febrile seizures and isolated developmental delay], but excludes migraines and psychiatric conditions without neurological 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:
    • 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.

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, except for 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 always.
• 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.

For more information, please consult the product monographs:

• Contraindications and precautions concerning Fluzone® Quadrivalent
• Contraindications and precautions concerning FluLaval® Tetra
• Contraindications and precautions concerning Afluria® Tetra
• Contraindications and precautions concerning Fluzone® High-Dose

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

Choosing between QIV (IIV3-SD) and High-Dose TIV (IIV3-HD) for patients 65 years of age and older

The high-dose TIV (IIV3-HD) contains three influenza strains: two A strains (H1N1 and H3N2) and one B strain. Studies have shown that the high-dose TIV (IIV3-HD) provides better protection against the influenza A(H3N2) strain in individuals who are 65 years of age and older compared to the standard-dose TIV formulations. A(H3N2) is associated with greater disease burden in individuals 65 years of age and older.

The high-dose TIV (IIV3-HD) contains a higher amount of antigen per strain than standard-dose influenza vaccine formulations. The high-dose TIV (IIV3-HD) contains 60 μg of hemagglutinin (HA) protein for each of the three vaccine strains compared to 15 μg of HA per strain in a standard dose vaccine, such as QIV (IIV3-SD). Studies have shown that the higher antigen content improves the immune response and improves how well the vaccine works compared to standard dose TIV, which is important since older individuals may not respond as well to influenza vaccines compared to younger individuals.

The QIV (IIV4-SD) offers protection against the same strains contained in the high-dose TIV (IIV3-HD) formulation with additional protection against a second influenza B strain. Relative to A(H3N2), influenza B occurs much less commonly in individuals 65 years of age and older.

Currently, there is insufficient evidence to directly compare the high-dose TIV (IIV3-HD) and QIV (IIV4-SD) products.

Given the options available for vaccination for those 65 years of age and older, it is important to discuss the specifics of each available vaccine to assist the individual in their decision making. Delaying vaccination in order to wait for a specific product is not recommended. Both QIV (IIV4-SD) and high-dose TIV (IIV3-HD) protect against the flu, and the most important thing is for seniors to be vaccinated.

Quadrivalent influenza vaccine (QIV or IIV4-SD) is publicly-funded for children and adults aged 6 months and older

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

For individuals aged 5 years and older, a quadrivalent inactivated vaccine is available: Afluria® Tetra (subject to availability).

Flumist® Quadrivalent, a live attenuated quadrivalent influenza vaccine given as a nasal spray, will not be available in Canada for the 2019/2020 influenza season.

High-Dose Trivalent influenza vaccine (high-dose TIV or IIV3-HD) 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.

* Egg allergy is not a contraindication to receiving the 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.

1. Starting November 1, 2019, Ottawa Public Health will start accepting orders for additional quantities of influenza vaccine. Use the Influenza Vaccine Order Form 2019/2020 from Ottawa Public Health to order vaccine (not the Ministry of Health form). Please note: The Influenza Vaccine Order Form 2019/2020 will be available on our website as of November 1, 2019.
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 predetermined amount of vaccine will be shipped in October to vaccinate high- risk patients. Additional flu orders can be placed after Nov 1st. Please allow up to 5 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.

More information about what constitutes an AEFI can be found here. If you have any questions related to the reporting of adverse events following immunization, 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.

In you 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 Ministry of Health on the 2019/2020 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.

• Ministry of Health (MOH)
  • Ministry of Health Universal Influenza Immunization Program (UIIP)
    
• 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
    • Seqirus (Afluria®Tetra) 1-855-358-8966