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 2020. 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. Re-vaccination later in the same year is not routinely recommended, but may benefit some individuals due to circumstances such as travel or pregnancy. 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 adjuvanted quadrivalent formulations, side effects may occur slightly more commonly than with standard 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. Can I give my patient < 65-years of age the adjuvanted influenza vaccine Fluad® Quad to produce a greater immune response?
No. Adjuvanted 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 standard 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 2021.
8. Can the influenza vaccine be given at the same time as other vaccines?
People can safely receive inactivated influenza vaccines 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 2020 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.
11. Can influenza vaccine be given to someone who has had Guillain-Barre syndrome?
Guillain-Barre Syndrome (GBS) is a rare neurological disorder where the body’s immune system attacks the peripheral nervous system causing weakness and at times paralysis. It can occur at any age (although it is more frequent in adults and older people). Fortunately, most people recover from even the most severe cases of GBS although some people will continue to have some degree of weakness.
Influenza vaccination has been identified as a possible cause following H1N1 containing vaccines, but the evidence is variable and at a very low rate, definitely lower than the rate of GBS caused by ‘wild type’ influenza. As per the AusVaxSafety clinical resources flow chart [see resources], influenza immunisation is generally not recommended for people with a history of GBS occurring within 6 weeks of receiving a previous influenza vaccine. However specialist immunisation advice should be sought to discuss the potential benefit of vaccination and the risk for GBS recurrence post vaccination or GBS recurrence post influenza disease. There are no concerns administering influenza vaccines to patients who have a history of developing GBS more than 6 weeks following an influenza vaccine.
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. 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 to < 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. 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]
4. 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.
5. 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 2019, should they also receive a dose of 2020 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.
Adjuvanted QIV (Fluad® Quad) Influenza vaccines
1. Should my ≥ 65-year old immunosuppressed patient receive 2 doses of adjuvanted QIV this year?
Only 1 dose of Fluad® Quad vaccine is recommended per year.
2. Fluad® Quad is the QIV formulation funded in 2020 for those ≥ 65-years, however other QIV formulations are available. Is one better/preferred over the other?
For adults aged ≥ 65-years the adjuvanted QIV, Fluad® Quad is preferentially recommended over standard QIVs as the antibody response is increased in comparison to non-adjuvanted QIV influenza vaccines.
3. If a standard QIV formulation has been given to my patient aged ≥ 65-years, do I need to repeat the dose with the recommended adjuvanted vaccine (Fluad® Quad)?
If a patient aged ≥ 65-years old has already received a dose of a 2020 standard QIV vaccine they do not need to repeat the dose with Fluad® Quad.
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, a minimum of 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 QIV (refer to immunisation specialist for individual advice in this patient group).
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 vaccines available under the NIP in 2020 are latex free. People with a latex allergy can safely be vaccinated with influenza vaccines that are available under the NIP.
- MVEC: Influenza vaccine recommendations
- MVEC: Allergy and immunisation
- MVEC: SAEFVIC
- MVEC: AusVaxSafety
- MVEC: Maternal vaccination during pregnancy
- ATAGI advice on seasonal influenza vaccines in 2020
- Department of Health: 2020 Influenza vaccines: Clinical advice for vaccination providers
- AusVaxSafety Clinical Resources: Approach to influenza vaccination in patients with a history of Guillain-Barre Syndrome
Authors: Georgina 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)
Reviewed by: Georgina Lewis (Clinical Manager, SAEFVIC, Murdoch Children’s Research Institute), Francesca Machingaifa (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)
Date: July 2020
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.