Influenza vaccine information for health professionals

The 2022-2023 seasonal influenza vaccines protect against the following influenza strains:
Quadrivalent vaccines:
Egg-Based Vaccines (Fluzone® Quadrivalent, FluLaval® Tetra, Alfuria® Tetra, and Fluzone® High-Dose Quadrivalent):

• A/Victoria/2570/2019 (H1N1)pdm09-like virus; A/Darwin/9/2021(H3N2)-like virus; B/Austria/1359417/2021(B/Victoria lineage)-like virus; and
• B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.

Egg-Based Trivalent vaccine (Fluad®):

• A/Victoria/2570/2019 (H1N1)pdm09-like virus;
• A/Darwin/9/2021(H3N2)-like virus; and
• B/Austria/1359417/2021(B/Victoria lineage)-like virus

Who is recommended to be immunized against influenza?

NACI recommends that all individuals aged six months and older be immunized against influenza every year. 

As per Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2022-2023, influenza immunization is particularly recommended for the following groups:

• People at high risk of influenza-related complications or hospitalization:
• All children six to 59 months of age;
• Adults and children with the following chronic health conditions:
• cardiac or pulmonary disorders (includes bronchopulmonary dysplasia, cystic fibrosis, and asthma);
• diabetes mellitus and other metabolic diseases;
• cancer, immune compromising conditions (due to underlying disease, therapy, or both, such as solid organ transplant or hematopoietic stem cell transplant recipients);
• 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 (BMI of 40 and over); and
• children six months to 18 years of age undergoing treatment for long periods with acetylsalicylic acid, because of the potential increase of Reye’s syndrome associated with influenza.
• All pregnant women;
• People of any age who are residents of nursing homes and other chronic care facilities;
• Adults 65 years of age and older; and
• Indigenous peoples.
• People capable of transmitting influenza to those at high risk and to infants under six months of age:
• 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;
• Household contacts, both adults and children, of individuals at high risk, whether or not the individual at high risk has been vaccinated:
• household contacts of individuals at high risk;
• household contacts of infants less than six months of age, as these infants are at high risk but cannot receive influenza vaccine;
• members of a household expecting a newborn during the influenza season;
• Those providing regular child care to children 0 to 59 months of age, whether in or out of the home; and
• Those who provide services within closed or relatively closed settings to people at high risk (e.g., crew on a ship).

• Others:
• People who provide essential community services
• People who are in direct contact with poultry infected with avian influenza during culling operations

How many vaccine doses are required?

Two doses are recommended for children six months to under nine years of age receiving seasonal influenza vaccine for the first time in their life, 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, unless another cause was found for the GBS.
• 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. If an individual is found to have an anaphylactic reaction to a component in one influenza vaccine, consideration may be given to offering another influenza vaccine that does not contain the implicated component, in consultation with an allergy expert. Individuals who have an allergy to substances that are not components of the influenza vaccine are not at increased risk of allergy to influenza vaccine

For more information, please consult the product monographs:

• Contraindications and precautions concerning Fluzone® Quadrivalent
  
• Contraindications and precautions concerning FluLaval® Tetra
• Contraindication and precautions concerning Alfuria® Tetra 
• Contraindications and precautions concerning Fluzone® High-Dose Quadrivalent
• Contraindications and precautions concerning Fluad®

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

Detailed product recommendations from NACI are available at: 

Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2022-2023,

* Egg allergy is not a contraindication to receiving the influenza vaccine (see Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2022-2023)

**Thimerosal-free QIVs in pre-filled syringe format (Fluzone^® Quadrivalent and Afluria® Tetra are available for those with a thimerosal allergy. Please note that Afluria® Tetra is only indicated for those five years of age and older.

Important notes:

• Fluzone^® Quadrivalent and Fluzone^® High-Dose Quadrivalent are different products. Fluzone^® High-Dose Quadrivalent 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 standard dose (SD), QIV High Dose (HD) and TIV-Adj for patients 65 years of age and older:

Rather than delay vaccination for a particular product, the recommendation is to vaccinate older adults with either the QIV, QIV-HD or TIV-adj which all protect against the flu.

For individual-level decision making, NACI in Canada states that when available, high-dose is recommended over standard-dose inactivated influenza vaccine, given the burden of influenza A(H3N2) disease and the good evidence of better protection compared to standard-dose in adults 65 years of age and older.

However, NACI states that any of the available age-appropriate influenza vaccines can be used. There is no preferential recommendation for the use of QIV-HD versus TIV-adj vaccine for this age group.

To date, no studies have directly compared QIV-HD and TIV-adj formulations or TIV-adj and QIV formulations.

Please consider the following information when discussing vaccine options:

• There is insufficient evidence to make a preferential recommendation between QIV-HD and TIV-adj. There is good evidence of QIV-HD providing better protection compared to QIV standard dose.

• In considering use of TIV-adj and QIV standard dose, given the increased burden of disease associated with influenza A(H3N2) in older adults, better protection against influenza A(H3N2) afforded by the TIV-adj may be more important, especially in those with multiple co-morbid conditions and compromised health status.

For more information on high-dose QIV, TIV-Adj and QIV, please refer to the Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2022-2023.

More information for individuals 65 years of age and older can be found here Health Care Providers Q&A for individuals 65 years of age and older.

Vaccine Distribution Centre hours are Monday to Friday, 8 am to 4 pm.

NOTE: On all Statutory holidays, statutory holiday and The Vaccine Distribution Centre is closed.

1. To order vaccine, please use the Influenza Vaccine Order Form 2022/2023 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 to be shipped to vaccinate high-risk patients. Additional influenza orders can be placed on or after October 10. Please allow up to seven business days for your order to be processed.
3. OPH recommends reserving 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. Please 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. You will need to bring your own cooler and two ice packs per cooler.

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.

Find more information about what constitutes an AEFI, please see Public Health Ontario's Fact Sheet on AEFI Reporting for Health Care Providers or Public Health Ontario's webpage on Vaccine Safety. 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.

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 2022/2023 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 Quadrivalent ®High-Dose) 1-888-621-1146
    • GlaxoSmithKline, Inc. (FluLaval^® Tetra) 1-800-387-7374
    • Seqirus (Alfuria® Tetra, and Fluad^®) 1-855-358-8966
  • To receive information about local health issues and direction during health emergencies, please subscribe to receive Ottawa Public Health Alerts for Health Care professionals. You may also select to receive the Physicians’ Update electronic newsletter.
• Patient Resources
  • Patient information: OPH’s web page for Influenza (Flu)
  • For the latest public health information, your patients can contact Ottawa Public Health Information Centre at 613-580-6744 (TTY: 613-580-9656) or on Facebook and Twitter (@ottawahealth). To reach Telehealth Ontario, call 1-866-797-0000.