West Metro Health Service Partnership COVID‑19 and influenza vaccination advice for people with low vaccination rates
Background
The West Metro Health Service Partnership (WMHSP) has launched a campaign urging GPs and other healthcare practitioners to encourage vaccination against COVID-19, Influenza and other recommended vaccines without delay, especially in groups where vaccination rates are historically low.
The united move is a response to a Population Health Needs Assessment conducted by the WMHSP in collaboration with the North Western Melbourne Primary Health Network and Western Public Health Unit, which noted an increase in hospitalisation of people with vaccine preventable diseases (VPD).
The campaign specifically targets:
- older people (65 years and over), with advice provided by the Royal Melbourne Hospital (RMH)
- people with cancer, with advice from the Peter MacCallum Cancer Centre (Peter Mac)
- children, particularly those with specific medical conditions, with advice provided by the Royal Children’s Hospital (RCH).
Advice for older people (65 years of age and over)
Older people, 65 years of age and over, are at higher risk of morbidity and mortality from COVID-19 and influenza infections, especially if they have underlying conditions such as cardiorespiratory, multiple complex co-morbidities, or have immunocompromise.
COVID-19 vaccination can provide protection against serious infection and its complications.
RMH has released a checklist of conditions that carry increased risk of severe COVID-19, particularly in those over 65 years:
- immunocompromise
- no prior infection with COVID-19
- chronic inflammatory conditions requiring disease modifying anti-rheumatic drugs (DMARDs), immune-suppressive or immunomodulatory therapies
- haematological diseases or cancers
- cancer within the past 5 years requiring chemotherapy, radiotherapy, immunotherapy, or targeted anti-cancer therapy (active or recently completed), or advanced disease, regardless of treatment
- chronic lung, liver, or cardiac disease
- severe chronic stage 4 or 5 kidney disease
- diabetes mellitus requiring medication
- multiple complex comorbidities
- complex multisystem disorders
- severe obesity with BMI at or above 40 kg/m2
- severe underweight with BMI below 16.5 kg/m2.
Recommendation
The COVID-19 vaccine is recommended for adults aged 75 years and over every 6 months. For adults aged 65 to 74, the COVID-19 vaccine is recommended every 12 months and can be considered every 6 months if they have a condition that has an increased risk of severe COVID. The influenza vaccine is recommended annually and is free for people aged 65 years and over. These vaccines can be safely administered together.
Timing
Older people (65 years of age and over) can be vaccinated for COVID-19 earlier than the recommended 6-month interval in exceptional circumstances, including before starting immunosuppressant therapy, before travelling overseas, or if someone can’t reschedule their vaccination easily. In patients with recent COVID-19 infection and prior vaccination, a subsequent dose of the vaccine can be considered six months post-infection.
Advice for people with cancer
People with cancer are at higher risk of contracting COVID-19 and influenza infections, especially if they have a haematological malignancy.
People receiving treatment for malignancy, may find their response to vaccination is impaired. This can be due to patient, disease or treatment-related factors.
The COVID-19 and influenza vaccines used in Australia do not contain live virus and are therefore safe for people receiving active treatment.
Recommendation
People with cancer who have never been immunised against COVID-19 should receive a primary course of vaccination (2 or 3 doses depending on circumstances) followed by a dose every 6 to 12 months depending on their age. Influenza vaccines should be administered annually to ensure protection against the strains of influenza that are circulating in the community. Most cancer patients can be safely vaccinated during active therapy. Other preventative measures, such as hand hygiene, social distancing and wearing masks, remain important, especially in patients who may have lower responses to vaccination due to specific treatment types.
| Vaccine | Patient group | Recommendation |
| Influenza * | People with cancer aged 65 years and over | Single dose, quadrivalent adjuvant dose influenza vaccine |
| People with cancer aged under 65 years | Single dose, quadrivalent standard dose influenza vaccine | |
| COVID-19 ** | People with cancer aged over 75 years | Strain matched dose every 6 months |
| People with cancer aged 18-74 years with severe immunocompromise | Strain matched dose every 12 months, consider dose every 6 months based on risk-benefit assessment |
* In their first year following stem cell transplantation or chimeric antigen receptor T-cell therapy, patients should get two doses of their influenza vaccine schedule (standard dose) separated by four weeks.
** Following stem cell transplantation or chimeric antigen T-cell therapy, patients should have their primary COVID-19 vaccination schedule (3 doses) repeated.
Timing
Where possible, vaccinations should be administered before starting any anti-cancer therapies. However, the Peter MacCallum Cancer Centre has issued a handy guide for health care providers to guide the timing of vaccination for patients undergoing cancer treatment.
| Types of therapy | Timing of COVID-19 and influenza vaccination |
| Conventional chemotherapy | If possible, vaccinate during ‘off’ week during cycle. If severe neutropenia (ANC <0.5 x109/L) present, wait until neutrophil recovery |
| Haematopoietic stem cell transplant (HSCT) | From 3 months following HSCT Can vaccinate earlier: • if only opportunity to do so • if rising cases in the community. NB: People with stable graft vs. host disease can be vaccinated |
| Chimeric antigen receptor T-cell therapy (CAR-T) | From 3 months following CAR-T Can vaccinate earlier: • if only opportunity to do so • if rising cases in the community. |
| Targeted therapies e.g. tyrosine kinase inhibitors, BCL-2 inhibitors | People can be vaccinated during active therapy |
| Immunomodulatory drugs | People can be vaccinated during active therapy |
| Immune checkpoint inhibitor therapy | Single immune checkpoint inhibitor: • people can be vaccinated during active therapy. NB: People on dual checkpoint inhibitor therapies should discuss with treating physician about optimal timing relative to therapy |
| Monoclonal antibody therapy | Patients can be vaccinated during active therapy |
| Radiotherapy | Patients can be vaccinated during active therapy |
| Hormonal therapy | Patients can be vaccinated during active therapy |
Special considerations
- Where possible, patients should avoid getting their vaccination on the same day as an intravenous immunoglobulin replacement, to minimise confusion around any adverse effects.
- Patients who have thrombocytopenia or are on oral anticoagulants may develop a haematoma at the injection site. To minimise the risk of this, please apply prolonged pressure at the injection site.
- Patients should avoid vaccination in a body area where the patient is receiving or has received radiation therapy.
- If patients are having a positron emission tomography (PET) scan, let the PET imaging team know about any recent COVID-19 or influenza vaccination.
Advice for children, especially those with immunosuppression
Protecting children through vaccination before they are exposed to infections is an important way to limit vaccine-preventable diseases (VPDs) and their significant complications.
Younger children, particularly those with underlying medical conditions can be especially vulnerable to more serious disease compared with other age groups. Staying up to date with the funded schedule, as well as receiving other additionally recommended vaccines is important.
Some children with immunosuppression can have a suboptimal response to routine vaccine schedules, so health practitioners are reminded that additional doses may be required to achieve adequate protection.
Recommendation
RCH is urging healthcare providers to encourage all children from 6 months to receive influenza vaccines. Children under 9 years of age should receive 2 doses of the influenza vaccine, administered at least 4 weeks apart, in the first year of being vaccinated against influenza.
Children with specified medical conditions or those taking certain therapies may also require additional vaccines or additional doses of vaccines. These children include:
- those waiting for a transplant or those who have previously received a transplant
- those undergoing treatment for cancer
- those taking immunosuppressive therapies, such as rituximab
- those without a functioning spleen.
Children over 6 months of age who are severely immunosuppressed may also be recommended to receive COVID-19 vaccines.
Parents and guardians should receive annual influenza vaccines, and stay up to date with COVID 19 vaccination and other vaccine recommendations.
Timing
Timeliness of vaccine administration is important to minimise the window in which children are not adequately protected from vaccine-preventable diseases (VPDs).
In the case of children with specified medical conditions or taking specific therapies, the timing of some vaccines may depend on where children are up to with their treatment. Their treating specialist should be consulted prior to vaccination in this instance.
Resources
- Australian Immunisaiton Handbook: COVID-19
- Australian Immunisation Handbook: Influenza
- Raising Children Australia
Author: West Metro Health Service Partnership
Reviewed by: Nigel Crawford (Director, MVEC), Benjamin Teh (Infectious Diseases Physician, Peter MacCallum Cancer Centre) and Irani Thevarajan (Infectious Diseases Physician, Royal Melbourne Hospital).
Date: April 2024
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information on this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.