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Influenza vaccines

Common name:

Flu vaccines

Protect against influenza.

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Overview

Annual influenza immunisation is recommended to provide protection from the predominant circulating influenza strains. The vaccine should be given before the influenza season in New Zealand.

The World Health Organization monitors influenza illness throughout the year and make recommendations on which three influenza types are likely to cause the most illness in the northern and in the southern hemisphere during their respective influenza seasons. Vaccine ingredients are specific to the brand of influenza vaccine they are associated with and may vary to year. Specific information on ingredients in the vaccines use each season can be found on the individual vaccine datasheets.

Influenza immunisation is recommended and offered free to:

  • Pregnant women (any trimester)
  • People aged 65 years or older
  • People aged under 65 years with a medical condition that increases their risk of developing complications from influenza, and the condition is specified in the Influenza Immunisation Programme eligibility criteria.
  • Children aged 4 years or under who have been hospitalised for respiratory illness or who have a history of significant respiratory illness.
  • Please note: From 1 April 2019, PHARMAC removed the influenza vaccine eligibility criteria for people under 18 years of age living in Seddon, Kaikoura and Hurunui areas.
    The standard eligibility criteria for people aged 6 months to under 18 years continues to apply in these regions.

Healthy children and non-pregnant healthy adults under the age of 65 years can purchase the influenza vaccine through their family doctor.

Some employers fund influenza vaccinations for their employees.

Responses to vaccine

Influenza vaccines

Common Responses

Responses are more common in children not previously exposed to the vaccine or virus than in adults.

  • Mild pain, redness and swelling around injection site
  • Unwell or tired
  • Fever
  • Muscle pain

Rare Responses

 

As with any medicine, very rarely a severe allergic reaction (anaphylaxis) can occur following immunisation.

References

Ministry of Health. Everything you need to know about flu 2019 [Internet]. Wellington: Ministry of Health; 2019. Available from: https://www.influenza.org.nz/sites/default/files/9095IMAC%202019%20Flu%20Kit%20Book%20FA.pdf.

Ministry of Health. Immunisation Handbook 2017 2nd Edition. Ministry of Health: Wellington. Available from: http://www.health.govt.nz/publication/immunisation-handbook-2017.

Pharmaceutical Management Agency (PHARMAC). Pharmaceutical schedule [Internet]. Wellington: PHARMAC; 2019. Available from: https://www.pharmac.govt.nz/tools-resources/pharmaceutical-schedule/.

In Depth

Brands: Afluria Quad™, Fluarix® Tetra, Influvac® Tetra

Vaccine types: inactivated, split virion (split virus) or influenza surface antigen vaccine

Schedule and administration

Schedule

The funded two funded quadrivalent influenza vaccines for 2019 are:

Influvac® Tetra

For adults and children aged 3 years or older.

Fluarix® Tetra

For children aged under 3 years, i.e. 6-35 months.

Detailed health professional information and resources about the 2019 Influenza Immunisation Programme for health professionals are available on the Influenza information for health professionals website.

The Fight Flu website, www.fightflu.co.nz, provides information about influenza immunisaton in 2019 for people who are not health professionals.

The influenza vaccine is available each year from 1 April, subject to influenza vaccine being available for distribution from then, 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).
  • People who are obese (this group of people are not eligible to receive a free influenza vaccine unless they also have an 'eligible' medical condition).
  • Please note: From 1 April 2019, PHARMAC removed the influenza vaccine eligibility criteria for people under 18 years of age living in Seddon, Kaikoura and Hurunui areas. 
    The standard eligibility criteria for people aged 6 months to under 18 years continues to apply in these regions.

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

  • Afluria Quad and Influvac Tetra can be given to a pregnant woman.

    • However, Influvac Tetra is the only funded influenza vaccine brand for women who are pregnant, i.e. the other vaccine brands can be used for pregnant women but the vaccine and administration costs cannot be claimed.

  • Afluria Quad, Fluarix Tetra and Influvac Tetra can be given to people with a known history of egg anaphylaxis.

  • Influenza vaccine is administered by intramuscular or deep subcutaneous injection.
    • The subcutaneous administration is recommended for people with thrombocytopenia or a bleeding disorder since bleeding may occur following an intramuscular administration.
  • 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.
  • Influenza vaccine can be administered to women planning pregnancy and pregnant women in any trimester. Traditionally, the influenza vaccine was offered in the second or third trimester to avoid coincidental association with spontaneous miscarriage or congenital abnormalities. 
  • 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. 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.
    • 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.
  • The influenza vaccine can be administered concurrently with other 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.
  • The influenza vaccine is packaged in a single-use syringe. Any vaccine contents remaining should be discarded immediately.

The following dosage schedule for is recommended:

  • Children aged 6-35 months
    • Fluarix Tetra is funded for eligible children and also available for purchase for children ineligible for funded influenza vaccination
      • Age 6-35 months 0.5ml 1 or 2* doses
  • Adults and children aged 3 years or older
    • Influvac Tetra is funded for eligibile individuals. Influvac Tetra or Afluria Quad¥ are available for purchase by individuls ineligible for funded influenza vaccination
      ¥ Note: Afluria Quad is licensed for individuals aged 5 years or older
      • Age 3-8 years 0.5ml 1 or 2* doses
      • ≥ 9 years 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.

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.

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 vaccine has a modest effect, around 30–50%, in preventing 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 illness and complications. Influenza vaccine has also been shown to reduce the risk of influenza-realted pneumonia in older people living in long term care facilities who develop complications related to influenza.

Last updated: Apr 2019