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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.
    • This eligibility criteria includes children aged 6–59 months (under 5 years) who were hospitalised for measles.

Influenza immunisation for children and adults who meet the eligibility criteria to receive the vaccine for free can receive the vaccine through their family doctor. Some pharmacies also offer free influenza immunisation to adolescents and adults aged 13 years or older* and pregnant women.*

Healthy children and non-pregnant healthy adults under the age of 65 years can purchase the influenza vaccine through their family doctor and some pharmacies (children must be aged 13 years or older).

Some employers fund influenza vaccinations for their employees.

*Adults aged 18 years or older must also be eligible to receive publicly funded health and disability services in New Zealand to receive funded influenza vaccination. 

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 2020 [Internet]. Wellington: Ministry of Health; 2020. Available from: https://www.influenza.org.nz/sites/default/files/2020/IMAC2000%20Flu%20Kit%20Book%202020%20-%20Web.pdf.

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

Ministry of Health. Influenza vaccine update [Internet]. Wellington: Ministry of Health; 2020 [updated 2020 May 21; accessed 2020 May 22]. Available from: https://www.health.govt.nz/news-media/news-items/influenza-vaccine-update-0

Pharmaceutical Management Agency (PHARMAC). Pharmaceutical schedule [Internet]. Wellington: PHARMAC; 2020. Available from: https://www.pharmac.govt.nz/tools-resources/pharmaceutical-schedule/community/.

In Depth

Brands: Influvac® Tetra (Saison 2019/2020), Afluria® Quad, Afluria® Quad Junior

Vaccine types: inactivated, subunit vaccines that contain viral surface antigens (haemagglutinin proteins) or inactivated, split virion vaccines that contain disrupted haemagglutinin proteins from the surface of the virus

Schedule and administration

Schedule vaccines

The two funded quadrivalent influenza vaccines for 2020 are:

Afluria® Quad

For eligible adults and children aged 3 years or older.

Afluria® Quad Junior

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

Non-schedule vaccine

Influvac® Tetra (Saison 2019/2020)

For children and adults aged 3–64 years inclusively who are not eligible to receive funded influenza vaccination.

Detailed health professional information and resources about the 2020 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 2020 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.*
    • This eligibility criteria includes children aged 6–59 months (under 5 years) who were hospitalised for measles.
  • 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

  • Afluria Quad can be given to a pregnant woman.

  • Influvac Tetra (Saison 2019/2020), Afluria Quad and Afluria Quad Junior 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. 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.
  • 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
    • Afluria Quad Junior
      • Age 6-35 months 0.25ml 1 or 2* doses
  • Adults and children aged 3 years or older
    • Influvac Tetra (Saison 2019/2020) or Afluria Quad
      • 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.
  • 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 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.

* Influvac Tetra (Saison 2019/2020)

The Ministry of Health and Pharmac have secured 360,000 doses of Influvac Tetra (Saison 2019/2020) from the Northern Hemisphere. The vaccine is approved for use among healthy people aged 3 to 64 and will be available to purchase through general practices, pharmacies and occupational health services. This vaccine contains two of the same strains of influenza vaccine as the usual vaccines used in New Zealand this year, and one that is closely related. The expert advice is clear that the protection provided by the Northern Hemisphere vaccine is still valuable and that is why we have purchased it so that even more New Zealanders can receive a flu vaccine this year.

Influenza levels are currently low in New Zealand and the circulating strains are the ones included in the Influvac Tetra (Saison 2019/2020) vaccine. The COVID-19 social distancing we are practicing and overseas travel restrictions are likely to reduce spread of influenza too.

Last updated: May 2020