Influenza vaccine

Brands: Fluad^® Quad, Afluria^® Quad, Influvac^® Tetra, Afluria^® Quad Junior

Vaccine types: Inactivated virus vaccines that contain viral surface antigens (haemagglutinin proteins) or split viruses with disrupted haemagglutinin proteins from the surface of the virus

Schedule and administration

Schedule vaccines

The four funded quadrivalent influenza vaccines for 2021 are:

Fluad Quad

• Only approved for use in adults aged 65 years or older.
• Funded for eligible adults aged 65 years or older.

Afluria Quad

• Funded for eligible children aged 5 years or older and adults.
• Afluria Quad is funded for eligible adults aged 65 years or older when Fluad Quad is no longer available.

Influvac Tetra

• Funded for eligible children aged 3–4 years.
• Only for use in children aged 3–4 years.

Afluria Quad Junior

• Funded for eligible children aged under 3 years, i.e. 6–35 months.

These vaccines are also available for those who do not meet the funded eligibility criteria through private immunisation providers (general practitioners or pharmacists or occupational health) at a cost.

Detailed health professional information and resources about the 2021 Influenza Immunisation Programme for health professionals are available on the Influenza information for health professionals website, www.influenza.org.nz.

The Fight Flu website, www.fightflu.co.nz, provides information about influenza immunisaton in 2021 for people who are not health professionals.

The influenza vaccine is recommended for:

• Children aged 6 months and over.≠
• Healthy adults.
• Pregnant women.*†
• Adults 65 years of age and over.*
• Children aged 6 months to under 5 years who have been hospitalised for respiratory illness or have a history of significant respiratory illness.*
• Anyone aged 6 months to under 65 years with a medical condition that increases their risk of acquiring influenza or developing complications from influenza:*
  • Cardiovascular disease (ischaemic heart disease, congestive heart disease, rheumatic heart disease, congenital heart disease, cerebrovascular disease).
  • Chronic respiratory disease (asthma if on regular preventive therapy; other chronic respiratory disease with impaired lung function).
  • Diabetes.
  • Chronic renal disease.
  • Cancer (patient currently has cancer), excluding basal and squamous skin cancer if not invasive.
  • Other conditions (such as autoimmune disease, immune suppression, immune deficiency, human immunodeficiency virus (HIV), transplant recipients, neuromuscular and central nervous system diseases, cochlear implant, error of metabolism at risk of major metabolic decompensation, pre- or post-splenectomy, Down syndrome, haemoglobinopathies and children on long term aspirin).

The following conditions are excluded from funding:

• Asthma not requiring regular preventive therapy.
• Hypertension (high blood pressure) and/or dyslipidaemia (high cholesterol) without evidence of end-organ (brain, eye, heart, kidney) disease.
• Occupational recommendations for this vaccine: early childhood services staff; health care assistants and long term facility carers; laboratory staff; medical, nursing, other health professional staff and students in training for these occupations; police.

*Eligible for funded influenza vaccine.

≠Recommendations for influenza vaccine for children vary between countries. The Advisory Committee on Immunization Practices within the Centres for Disease Control and Prevention in the U.S. recommends annual vaccination for all children aged 6 months to 18 years. Influenza infection rates are generally higher in children. The greatest benefits are seen in vaccinating children at high risk of influenza or its complications. However, healthy children are the major cause of the spread of influenza in the community and vaccination of this population can substantially reduce the spread of influenza and related costs. The Ministry of Health in New Zealand offers free influenza vaccination to children from six months of age who have certain chronic medical conditions.

†The seasonal influenza vaccine is strongly recommended for women who will be pregnant or are pregnant during the influenza season. In 2009 pregnant and post-partum women in Australian and New Zealand were seven times more likely to be admitted to intensive care with 2009 H1N1 influenza than non-pregnant women of child bearing age. This risk increased to 20 times more likely from 20 weeks gestation. Studies have demonstrated that when the influenza vaccine is given to a woman in the late stages of pregnancy the incidence of laboratory confirmed influenza is reduced during the first 6 months of life and hospital admissions for laboratory confirmed influenza are significantly reduced.

Administration

• Fluad Quad, Afluria Quad, Influvac Tetra, Afluria Quad Junior can be given to people with a known history of egg anaphylaxis.
• Influenza vaccine can be administered to women planning pregnancy and pregnant women in any trimester. 
• Women who are breast feeding can safely have the influenza vaccine. No adverse consequences for a breast feeding infant have been observed following vaccination of lactating women.
• The ideal time to immunise a person having chemotherapy or radiation therapy is prior to onset of treatment. When this is not possible for the current season, influenza vaccination is recommended for children and adults undergoing cancer chemotherapy as soon as the vaccine becomes available. Following cessation of treatment normal immune responses return after about 30 days.
• Specialist advice should be sought regarding influenza vaccination after bone marrow transplantation. Typically these patients commence annual influenza vaccinations from 6 months post-transplant.
• Where a person has a history of Guillain-Barré Syndrome (GBS) occurring within 6 weeks of a previous influenza vaccination the decision to administer the influenza vaccine must be made on an individual basis after careful consideration of the risks and benefits.
  • Epidemiological studies have suggested either no increased risk or a possible slight increase in risk of around one case per million adult influenza vaccinations.
  • A study in the United Kingdom compared the incidence of GBS following influenza vaccination and following influenza-like illness. The relative incidence of GBS after vaccination was not increased however the risk after influenza-like illness was seven times higher.
• Travellers should consider immunisation or re-immunisation prior to travel to the Northern Hemisphere during their influenza season when the influenza vaccine available in New Zealand provides protection against influenza viruses circulating in the Northern Hemisphere.

The following dosage schedule for is recommended:

• Children aged 6–35 months
  • Afluria Quad Junior
    • Age 6–35 months 0.25ml 1 or 2* doses
• Children aged 3–4 years
  • Influvac Tetra
    • Age 3–4 years 0.5ml 1 or 2* doses
• Children aged 5 years or older and adults
  • Afluria Quad
    • Age 5–8 years 0.5ml 1 or 2* doses
    • ≥ 9 years 0.5ml 1 dose
• Adults aged 65 years or older
  • Fluad Quad
    • 0.5mL 1 dose

* Children aged 6 months to under 9 years who have never received an influenza vaccine before should receive two doses four weeks apart, to help improve their immune response. Children in this age group who have received one or more influenza vaccine doses in the past only need one influenza vaccine dose each year.

Waiting after receiving an influenza vaccination

The 20-minute waiting period continues to be the best option when the waiting area is adequate and safe.

Adolescents aged 13 years or older and adults receiving only an influenza vaccination:

• If the risk of exposure to infectious disease in a crowded waiting rooms is higher than the low risk of anaphylactic events; adolescents and adults who meet ALL the following criteria may not need to wait for 20 minutes post-vaccination:

1. do not have a history of severe allergic reactions,
2. have been assessed for any immediate post vaccination adverse reactions (5 minutes),
3. are aware of when they need to and how to seek post-vaccination advice,
4. will have another adolescent or adult with them for the first 20 minutes post vaccination, and
5. have the ability to contact emergency services if required.

Adolescents aged 13 years or older and adults receiving any other vaccination, and all children aged under 13 years need to remain under observation for the 20-minutes post-vaccination.

Administration of influenza vaccine and other vaccines

Spacing of influenza vaccination and the COVID-19 vaccine (COMIRNATY™)

In view of the absence of data on concomitant delivery, and to minimise confusion with any associated reactions, a gap of two weeks is generally recommended between giving mRNA-CV after any other vaccine. However, based on first principles of how these vaccines work, adverse impacts on immunogenicity or safety are unlikely with a shorter gap, so if it is clinically important to deliver in a shorter time, do not delay.

• If it is not practicable to keep a two-week gap between vaccines, then do not delay.
• If a live vaccine has been administered, wait four weeks before giving a COVID-19 vaccine but if not practicable, then do not delay.
• If a COVID-19 vaccine is administered first, then maintain a two-week gap before any other vaccines.

Note: the second mRNA-CV dose is given at least 21 days after the first dose.

Spacing of influenza vaccination and non-COVID-19 vaccines

The influenza vaccine can be administered concurrently with all non-COVID-19 vaccines, including the herpes zoster (shingles) vaccine, pneumococcal vaccines and Tdap, and the National Immunisation Schedule vaccines. Separate syringes and different injection sites should be used.

Zostavax^® and annual influenza vaccination

• Annual influenza immunisation is recommended and funded for adults aged 65 years or over.
• One Zostavax is recommended for adults aged 65 years to under 80 years. This dose is also funded.
  • Zostavax and influenza vaccine can be administered at the same visit. 
  • Zostavax is only given as a single dose – it IS NOT administered every year that an eligible adult receives their influenza vaccination.
• PMS systems have been updated to enable dual claiming of Zostavax and influenza vaccination.

Storage and preparation

Store as per the cold chain, between +2°C to +8°C. Protect from light. The expiry date of the vaccine is the last day of the month in the year indicated on the packaging.

Vaccine safety

For all vaccines, similar to most medications, an extremely rare allergic reaction called ‘anaphylaxis’ can occur. Anaphylaxis after immunisation occurs about 1–3 times in every one million vaccine doses. All vaccinators will have training and equipment to deal with this situation in the unlikely event of it occurring. No other serious responses to the vaccine have been identified.

Influenza vaccine should not be given to:

• Anyone with severe allergy (anaphylaxis) to a previous dose of this vaccine or a component of the vaccine (except egg anaphylaxis).

Influenza immunisation should be postponed for:

• Individuals suffering from a fever over 38°C.
  • The presence of a minor infection is not a reason to delay immunisation.

Vaccine effectiveness

• Influenza immunisation protects around 7–8 pregnant women out of 10 from serious influenza related illness requiring hospital treatment. Around half of infants whose mother had an influenza immunisation during pregnancy are also protected from influenza for up to 6 months after birth.
• Very little information on how effective the influenza vaccine in infants under 2 years of age has been collected. The information collected suggests about 6–7 in 10 infants in this age group will be protected from influenza.
• Influenza immunisation will protect around 6–7 in 10 healthy children under 3 years of age, around 6–7 in 10 healthy children under 16 years of age, and 4–6 in 10 healthy adults from influenza. The influenza vaccine only has a modest reduction in the time healthy adults take off work due to influenza.
• The influenza vaccines have a modest effect, around up to 60%, in preventing confirmed influenza in those aged 65 years and over living in the community, and can reduce the number of older people needing to be hospitalised with influenza-related pneumonia and complications. Influenza vaccine has also been shown to reduce the risk of influenza-related pneumonia in older people living in long term care facilities who develop complications related to influenza.