Influenza vaccine recommendations

MVEC influenza recommendations 2019

In Victoria, the influenza vaccine is funded on the Immunisation Schedule for the following groups:

• Children aged 6-months to < 5-years without medical risk factors (Victorian state funded program)
• ≥ 6 months of age with certain medical risk factors (Commonwealth funded program)
• All adults ≥ 65 years of age
• Pregnant women (at any stage of pregnancy)
• All Aboriginal & Torres Strait Islander people ≥ 6-months of age

For people who do not meet this criteria, the influenza vaccine is still strongly encouraged and is available for private purchase.

The influenza vaccine can be administered in primary care settings as well as hospital immunisation clinics.

The key messages for the 2019 season:

• There are 2 strain changes for the influenza vaccine in 2019, with the A(H3N2) strain changing to Switzerland/2017 and a B strain changing to Colorado/2017
• Victoria are already seeing some ‘out of season’ influenza hospital admissions in 2019, these have predominantly been the Influenza A H1N1 strain, which is in all of the available seasonal influenza vaccines as per below

The quadrivalent inactivated influenza vaccine (QIV) in 2019 will contain:

• A H1N1 pandemic09 (A/Michigan/2015)
• A (H3N2) (A/Switzerland/2017)
• B /Colorado/2017
• B/Phuket/2013

The higher-immunogenicity trivalent influenza vaccine (TIV) available for ≥ 65-years in 2019 will contain:

• A H1N1 pandemic09 (A/Michigan/2015)
• A (H3N2) (A/Switzerland/2017)
• B/Phuket/2013

Special Considerations

• Quadrivalent influenza vaccines (QIV) are on the National Immunisation Program (NIP) for those aged 6-months to ≤ 64-years (funding is criteria dependent)
• The seasonal influenza vaccine is now NIP funded for all children and adults of Aboriginal and Torres Strait Islander background
• For those aged ≥ 65-years, we preferentially recommend the NIP funded higher- immunogenicity trivalent influenza vaccine (TIV), Fluad®
• One of the influenza vaccine brands available for children ≥ 6-months to < 5-years (Fluarix-tetra®) is a full dose (0.5 ml). The other product for this age group (FluQuadri Junior®), is a half dose (0.25ml) for children ≥ 6-months to < 3-years; and a full dose (FluQuadri® 0.5ml) for children 3-years to < 5-years
• Two doses of the QIV (1-month apart) are recommended for children 6-months to < 9-years, the very 1^st year they receive the QIV

Dosing guidelines by age

Table 1: Influenza brand and dosing guidelines for children aged < 5-years

Age group	Brand and dose
	FluQuadri Junior®	Fluarix-tetra®	FluQuadri®
< 6-months	Too young to receive vaccine [N/A]
≥ 6-months to < 3-years*¥	0.25ml	0.5ml	**Please see update below
3-years to < 5-years*¥	N/A	0.5ml	0.5ml

*2 doses, minimum of 4 weeks apart should be given to children in this age group in the first year of receiving the influenza vaccine
¥For all children < 9-years, a single dose is recommended in subsequent years
N/A not registered for use in this age group
**FluQuadri Junior (0.25 mL) 2019 stock has now expired and will not be supplied in 2020.
FluQuadri (0.5 mL) can now be administered to infants and children from 6 months of age, as per TGA approval of an age indication update to FluQuadri Product Information (see references). As per the updated PI, FluQuadri is indicated for use in adults and children 6 months and older. This change in age indication was based on immunogenicity and safety data of FluQuadri in children aged 6 months to less than 3 years.

Table 2: Influenza brand and dosing guidelines for 5-years to ≤ 64-years

Age group	Brand and dose
	Fluarix-tetra®	FluQuadri®	Afluria Quad®	Influvac tetra®
5-years to < 9-years*¥	0.5ml	0.5ml	0.5ml	N/A
9-years to < 18-years	0.5ml	0.5ml	0.5ml	N/A
18-years to ≤ 64-years	0.5ml	0.5ml	0.5ml	0.5ml

*2 doses, minimum of 4 weeks apart should be given to children in this age group in the first year of receiving the influenza vaccine
¥For all children < 9-years, a single dose is recommended in subsequent years
N/A not registered for use in this age group

Table 3: Influenza brand and dosing guidelines for ≥ 65-years

Age	Brand and dose
	Fluad® [TIV]^	Fluzone High-dose® [TIV]	Fluarix-tetra®*	FluQuadri®*	Afluria Quad®*	Influvac tetra®*
≥ 65-years	0.5ml	0.5ml	0.5ml	0.5ml	0.5ml	0.5ml

^Fluad® is the preferred influenza vaccine brand for this patient group and is funded on the NIP for those aged ≥ 65-years
*Trivalent influenza vaccines (TIV) are the preferentially recommended vaccine types for adults aged ≥ 65-years. Fluarix tetra®/FluQuadri®/Afluria Quad®/Influvac tetra® are all quadrivalent influenza vaccines (QIV). They are licensed in this age group but are not the preferred vaccine of choice.

Influenza vaccine in the ≥ 65 year age group

In order to provide better protection against hospitalisation with influenza and pneumonia, higher-immunogenicity trivalent influenza vaccines (TIV) continue to be the preferred influenza vaccination for the older population [refer to Table 3 above for dosing information]. 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. [NB: standard TIVs are no longer available in Australia]

The higher-immunogenicity TIV is safe but can cause mild side effects such as injection site reactions and fever. This may occur slightly more commonly than the standard QIV formulations.

Latex allergies

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

Influenza vaccine and egg allergy

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 [refer to ASCIA guideline].

Co-administration of Influenza vaccine

Influenza vaccines may be safely co-administered with any other vaccines on the same day. This includes live-attenuated vaccines (e.g. measles and varicella), as well meningococcal and pneumococcal vaccines.

Influenza vaccine and pregnancy

Pregnant women are more at risk of serious illness due to influenza compared to non-pregnant women. Influenza inflections whilst pregnant, can lead to serious illness such as pneumonia and can cause miscarriage or premature labour. Pregnant women are more likely to be hospitalised than non-pregnant women due to the flu.

The influenza vaccination will protect the mother and baby from the risk of serious illness and hospitalisation. We recommend the QIV for all pregnant women. It is Free, and it can be received safely at any time during pregnancy [see Resources].

Vaccine safety

SAEFVIC (Surveillance of Adverse Events Following Vaccination In the Community) would be happy to discuss any vaccine safety queries and we encourage online reporting of AEFI via our website.

Telephone: 1300 882 924 (option 1)
Email: saefvic@mcri.edu.au
Website: www.aefican.org.au/Home/Info/VIC

Resources

• Statement from the Chief Medical Officer: 2019 Influenza vaccines
• ATAGI advice on seasonal influenza vaccines in 2019
• Victorian DHHS: Seasonal influenza vaccine
• The Conversation: High-dose, immune boosting or four-strain? A guide to flu vaccines for over-65’s
• Australian Immunisation Handbook: Influenza
• Australasian Society of Clinical Immunology and Allergy: Vaccination of the egg allergic individual
• MVEC: Vaccines in pregnancy
• MVEC: Influenza vaccine: Frequently asked questions
• The Conversation: Thinking about getting your child’s flu vaccine? Here’s what you need to know
• FluQuadri Product Information Update 2019

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