MVEC’s Influenza vaccine FAQ reference page provides answers to commonly asked questions on the use of the Influenza vaccine for all age groups in 2019. It can be used in conjunction with existing resources on Influenza.

General influenza vaccine questions

1. When is the ideal time to be immunised against the flu?

Annual vaccination before the onset of influenza season is recommended. The peak period of circulating influenza disease is typically June to September, however out of season cases do occur. Optimal protection against influenza occurs within the first 3-4 months following vaccination. It is never too late in the season to vaccinate.

2. Should we have a dose of vaccine early in the season and a second dose later in the season?

For healthy individuals, the recommendation is to receive one dose of influenza vaccine annually, although a second dose is not a contraindication. A booster immunisation may be considered for those traveling in late 2019, who were vaccinated earlier in 2019. The decision to recommend a second dose should take into account personal risk factors, risk of disease and currently circulating virus strains.

3. What are the expected side effects of the flu vaccine?

Common side effects following the influenza vaccination include pain, redness and swelling at the injection site as well as fever, malaise and myalgia. Symptoms usually occur within the first 24-48 hours. Following immunisation with TIV formulations, side effects may occur slightly more commonly than with QIV formulations.

4. Why do I need an influenza vaccine every year?

The circulating strains of influenza virus causing disease change each year and therefore a new vaccine needs to be administered for protection. Immunity wanes over time with optimal influenza disease protection occurring for the first 3-4 months following immunisation.

5. Should someone <65 years of age have a Trivalent Influenza Vaccine (TIV) because they produce a greater immune response?

No. TIV formulations are currently only registered for use in those ≥ 65-years of age. They are designed to illicit a better immune response in the older population where response to the traditional QIV formulations have been found to be less effective. Standard QIV formulations are recommended for those aged < 65-years.

6. I am a healthy person, do I need a flu vaccine?

Influenza can be a very serious disease resulting in hospitalisation and death. Even in cases where disease and its complications are not severe, it can cause a great inconvenience for the individual, including the cost of GP visits and medications as well as time off work for themselves or to care for their sick child.

In some cases, a person may not get severe disease however infection can be spread to other people. This can be significant when it is spread to those who are too young to be immunised or are at higher risk of complications of disease.

7. When is it too late in the season to get the influenza vaccine?

It is never too late in the season to be immunised as disease can circulate all year round. Immunisation should still be offered while vaccine expiry date remains valid. Some brands have an expiry date of February 2020.

8. Can the influenza vaccine be given at the same time as other vaccines?

People can safely receive inactivated influenza vaccines (TIV and QIV) at the same time as any other vaccines including pneumococcal, meningococcal and live vaccines. This includes concurrently administering a Boostrix vaccine (diphtheria-tetanus-pertussis) to pregnant women.

9. How quickly will I develop immunity after receiving the influenza vaccine?

Most people will develop immunity within two to three weeks of vaccination providing optimal protection for the first 3-4 months thereafter. As influenza disease usually occurs from June, with the peak around August, vaccinating from mid-April 2019 will allow people to develop immunity before influenza transmission is at its peak. You can also speak with your doctor for advice on the best time to receive your vaccine, based on your individual circumstances.

10. I have already had confirmed influenza disease this year. Do I still need the influenza vaccine and when should I have it?

The influenza vaccine would still be recommended for someone with a history of confirmed influenza infection as the vaccine protects against multiple strains of influenza disease. The influenza vaccine can be administered as soon as the patient has recovered from their illness.

Children and influenza vaccines

1. My child (< 9-years) had the flu vaccine for the first time last year but only received 1 dose. Should they have 2 doses this year?

No, only 1 dose is required in this instance. 2 doses of the influenza vaccine are recommended for children < 9 years of age in the first year of receiving the vaccine, however if the second dose was inadvertently missed, it does not require catch up and only 1 dose is required in future years.

2. My child needs 2 doses of the influenza vaccine this year, do they need to receive the same brand each time?

Influenza vaccine brands are interchangeable as long as the age-appropriate brands are administered.

3. Given Fluarix-tetra® is now a full dose (0.5ml) from 6-months of age, does this mean that only 1 dose of influenza vaccine is required for those < 9-years receiving this brand as their influenza vaccine in their first year? 

No, 2 doses of age-appropriate influenza vaccines are still required for all children under 9 years of age in the first year of receiving the influenza vaccine.

4. How do I know that influenza immunisation is safe in children?

Surveillance of influenza vaccine safety continues to occur via AusVaxSafety which monitors post influenza immunisation outcomes. In children 6-months – < 5-years of age, it has been found that children in this age group experience only low rates of fevers (2%) and medical attendance (1%) post influenza immunisation [see Resources: NCIRS influenza]. SAEFVIC (Surveillance of Adverse Events Following Vaccination In the Community) would be happy to discuss any vaccine safety queries and online reporting of AEFI via the website is encouraged [www.aefican.org.au]

5. What do I do if a child ≥ 3-years of age is inadvertently given a FluQuadri Junior® (0.25ml)?

An extra dose of FluQuadri Junior® (0.25ml) should be given immediately. If the child has already left the immunisation venue, they should receive a full age-appropriate dose (0.5ml) as soon as they can return. It is not recommended to wait 4 weeks before giving the appropriate dose.

6. How soon can I protect my baby from the influenza vaccine?

All infants and children aged 6-months to < 5-years are strongly recommended and funded in Victoria to receive annual influenza vaccination.Children aged 6-months to < 5-years who are receiving influenza vaccine for the first time are recommended to receive 2 doses  4 weeks apart for optimal protection. Only 1 dose of influenza vaccine is required annually thereafter. Infants and children aged under 5-years have a higher risk of hospitalisation and increased morbidity after influenza disease. This is true for all children, not just those with pre-existing medical conditions.

7. Given that there are 3 vaccines already scheduled for the 12-month and 18-month time points, what is the recommended site for injection when also giving an influenza injection at the same visit?

The preferred injection site in children ≥ 12-months of age is the deltoid. More than 1 vaccine can be given into each deltoid muscle ensuring a 2.5cm spacing between each vaccine. In some circumstances the anterolateral aspect of the thigh may also be considered as an alternate site if unable to ensure correct spacing. For more information please refer to MVEC: Administration of injected vaccines-correct technique

Pregnancy and influenza vaccines

1. My pregnant patient received last year’s influenza vaccine when in early pregnancy in 2018, should they also receive a dose of 2019 influenza vaccine now during the same pregnancy?

Yes, women who received the previous year’s seasonal influenza vaccine early in their pregnancy are also recommended to receive the current year’s seasonal influenza vaccine to ensure protection against the current circulating strains.  

2. When is the ideal time to receive a flu vaccine in pregnancy?

Pregnant women can receive influenza vaccine during any stage of pregnancy. Timing is often dependent on seasonality and availability of the vaccine.

3. Is it safe to receive the influenza vaccine during pregnancy?

It is safe and recommended to receive the influenza vaccine during pregnancy. Immunisation not only provides protection for the mother against disease, but maternal antibodies are also transmitted to the baby, which will provide protection against disease for the first few months of life. Influenza immunisation is funded on the National Immunisation Program (NIP) for all pregnant women.

Trivalent Influenza Vaccines (TIV)

1. Patients over 65-years of age are funded to receive Fluad® (TIV). Should they also purchase a dose of the quadrivalent influenza vaccine (QIV) to ensure they receive protection against the missing B strain?

No, in order to provide better protection against hospitalisation with influenza and pneumonia, higher-immunogenicity TIV continue to be the preferred influenza vaccination for the older population. Whilst there is one less B strain in the TIV compared to the QIV, the important benefit will be increased protection from the three TIV strains. In most seasons, few infections are caused by the missing fourth strain.

2. Should my ≥ 65-year old immunosuppressed patient receive 2 TIV doses this year?

Only 1 dose of TIV immunisation is recommended per year.

3. Fluad® is the TIV formulation funded in 2019 for those ≥ 65-years, however Fluzone High-dose®, another TIV brand, is also available for private purchase. Is one better/preferred over the other?

There is not sufficient data to indicate that either of the higher-immunogenicity vaccines is superior to the other. Both vaccines are safe and effective in protecting against influenza related hospitalisations. Fluad® is the funded TIV brand provided on the NIP for this age group.

Special risk patients

1. Do immunosuppressed people require 2 doses of influenza vaccines?

People with certain immunocompromising conditions (ie: solid organ transplant, stem cell transplant etc) should receive 2 doses, 4 weeks apart, of QIV formulation of influenza vaccine in the first year of being immunosuppressed. Only 1 dose is required annually thereafter. An exception to this is in patients ≥ 65-years, as they are recommended to only receive 1 dose of the higher-immunogenicity TIV (refer to immunisation specialist for individual advice in this patient group).

Vaccine components

1. My patient is allergic to egg, how can they receive a flu vaccine safely?

Based on prospective and retrospective studies of influenza vaccination in those with and without egg allergy (including egg anaphylaxis), the presence of egg allergy does not increase the risk of allergic reactions to the influenza vaccine. The influenza vaccine can be administered in community vaccination clinics (which may or may not have direct medical practitioner supervision), General Practitioner surgeries or Immunisation clinics, as a single dose followed by the recommended 15 minute observation period. For further information refer to MVEC: Allergy and immunisation

2. Can patients with Latex allergies receive the influenza vaccine?

All influenza vaccine brands available for use in 2019 are latex free and therefore are safe to administer to those with latex allergies [see Resources: ATAGI advice].

Resources

Reviewed by: Georgie Lewis (Clinical Manager, SAEFVIC, Murdoch Children’s Research Institute), Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute) and Daryl Cheng (Senior Research Fellow, Murdoch Children’s Research Institute)

Date: April 2019

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 in 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.