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 2020-2021 seasonal influenza vaccines protect against the following influenza strains:

Quadrivalent vaccines:

Egg-Based Vaccines (Fluzone® Quad, FluLaval® Tetra):

  • A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus;
  • A/Hong Kong/2671/2019 (H3N2)-like virus;
  • B/Washington/02/2019 (B/Victoria lineage)-like virus; and
  • B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.

Egg-Based Vaccine (FluMist® Quadrivalent)

  • A/ Hawaii /66/2019 (A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus)
  • A/Hong Kong/2671/2019 (H3N2)
  • B/Phuket/3073/2013 (Yamagata lineage)
  • B/Washington/02/2019 (Victoria lineage)

Cell-based Vaccines (Flucelvax® Quad):

  • A/Hawaii/70/2019 (H1N1)pdm09-like virus;
  • A/Hong Kong/45/2019 (H3N2)-like virus;
  • B/Washington/02/2019 (B/Victoria lineage)-like virus; and
  • B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.

Trivalent vaccine (High-Dose Fluzone®):

  • A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus;
  • A/Hong Kong/2671/2019 (H3N2)-like virus; and
  • B/Washington/02/2019 (B/Victoria lineage)-like virus.
Populations recommended to be immunized and schedule
National Advisory Committee on Immunization (NACI) statement for 2020-2021

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 2020-2021 NACI statement, influenza immunization is particularly recommended for the following groups:

  • People at high risk of influenza-related complications or hospitalization:
    • All pregnant women
    • People who are residents of nursing homes or other chronic care facilities
    • People ≥65 years of age
    • All children 6-59 months of age
    • Indigenous peoples
    • Adults or children 6 months of age and over with the following chronic health conditions:
      • Cardiac or pulmonary disorders
      • Diabetes mellitus or other metabolic disease
      • Cancer
      • Conditions or medication which compromise the immune system
      • Renal disease
      • Anemia or hemoglobinopathy
      • Neurologic or neurodevelopmental conditions
      • Morbid obesity (body mass index of ≥40)
      • Children and adolescents (6 months to 18 years) undergoingtreatment with acetylsalicylic acid for long periods
  • People capable of transmitting influenza to those at high risk and to infants under 6 months of age:
    • Health care workers and other care providers in facilities and communitysettings
    • Household contacts (adults and children) of individuals at high risk ofinfluenza related complications
    • Persons who provide care to children ≤59 months of age
    • Members of a household expecting a newborn during the influenza season
    • Those who provide services within a closed or relatively closed setting topersons at high risk of influenza related complications (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

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.

In addition to the contraindications above, FluMist® is contraindicated for those who:

  • Have an allergy to gentamicin, gelatin or arginine hydrochloride;
  • Are under 2 years of age or over 59 years of age;
  • Have a weakened immune system due to an underlying medical condition, therapy or both;
  • Have severe asthma (defined as currently on oral or high dose glucocorticosteroids), active wheezing, or medically attended wheezing in the 7 days prior to vaccination;
  • Were treated with an influenza antiviral medication in the previous 48 hours. If these medications are used in the 2 weeks following immunization with LAIV, they are likely to kill the vaccine virus and they may not develop immunity;
  • Are less than 18 years of age and are on aspirin or aspirin containing therapy (Aspirin or aspirin containing medications should not be used to treat illness, pain, or fever in children, unless otherwise advised by a physician. Consuming Asprin or Aspirin containing medication should be delayed by 4 weeks after receiving FluMist® Quadrivalent vaccine (LAIV) in recipients who are less than 18 years of age);
  • Are pregnant.

For more information, please consult the product monographs:

Vaccine products publicly funded in Ontario

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

Detailed product recommendations from NACI are available at: National Advisory Committee on Immunization (NACI) statement for 2020-2021

Vaccine Age indication Influenza Vaccine Formulation Dosage and Route of Administration Format Most common allergens
FluLaval® Tetra 6 months of age and older Quadrivalent Inactivated Vaccine (QIV or IIV4-SD) 0.5mL IM
  • Multi-dose vial (MDV)
  • Egg Protein*
  • Thimerosal**
Fluzone® Quadrivalent 6 months of age and older Quadrivalent Inactivated Vaccine (QIV or IIV4-SD) 0.5mL IM
  • Multi-dose vial (MDV)
  • Pre-filled Syringes (PFS)
  • Egg Protein*
  • Thimerosal** (multi-dose vial only)
FluMist® Quadrivalent 2 years of age to 59 years of age

Quadrivalent Live Attenuated Intranasal Vaccine (Q-LAIV)

0.2mL Intranasal
  • Intranasal Spray

  • Gelatin
  • Gentamicin
  • Egg Protein*
  • Arginine hydrochloride
Flucelvax® Quadrivalent 9 years of age and older Quadrivalent Inactivated Vaccine (QIV or IIV4-cc) 0.5mL IM
  • Pre-filled Syringes (PFS)
  • Not applicable
Fluzone® High-Dose 65 years of age and older High-Dose Trivalent Inactivated Vaccine (High-Dose TIV or IIV3-HD) 0.5mL IM
  • Pre-filled Syringes (PFS)
  • Egg Protein*

* Egg allergy is not a contraindication to receiving the influenza vaccine (see National Advisory Committee on Immunization Influenza Statement). 

** Thimerosal-free Fluzone® Quadrivalent (pre-filled syringes) and FluMist® Quadrivalent (nasal spray) are available for those with an allergy.

Important notes:

  • 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.

Choosing between QIV (IIV4-SD) and High-Dose TIV (IIV3-HD) for patients 65 years of age and older

Do not delay vaccination to wait for a particular product. Both QIV and high-dose TIV protect against the flu, and the most important thing is for older adults to be vaccinated. When discussing the flu vaccine, the following should be considered for your discussion:

  • There is insufficient evidence to recommend the use of high-dose TIV over standard-dose QIV.
  • However, given the increased burden of disease associated with influenza A (H3N2) in older adults, better protection against influenza A (H3N2) may be more important than better protection against influenza B, especially in those with multiple co-morbid conditions and compromised health status.

For more information on high-dose TIV and QIV, please refer to the Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2020-2021.

Vaccine ordering and pick up
Vaccine Distribution Room hours are Monday to Friday, 8 am to 4 pm. NOTE: November 11 is a statutory holiday and the Vaccine Distribution Room will be closed.
  1. Use the Influenza Vaccine Order Form 2020/2021 from Ottawa Public Health to order vaccine (not the Ministry of Health form).
  2. Place your order by completing the number of doses required on the form. Orders will be filled in the order in which they are received, with priority to high-risk groups. The first auto-shipment will contain a predetermined amount of vaccine will be shipped to vaccinate high-risk patients. Additional influenza orders can be placed after October 19th. 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 2 ice packs per cooler.
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 within the month. 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)
All adverse events following administration of an influenza vaccine must be reported to Ottawa Public Health within 24 hours by fax to 613-580-9660 using the AEFI reporting form.

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.

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 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 2020-2021 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
  • Ministry of Health (MOH)
  • 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 (Flucelvax® Quadravalent) 1-855-358-8966
      • AstraZeneca (FluMist® Quadrivalent) 1-800-565-5877
 

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