MVEC’s influenza vaccine FAQ’s provide answers to commonly asked questions on the use of the influenza vaccine in 2022. It has been designed to be used in conjunction with the MVEC influenza reference page.

General influenza vaccine questions

  • When is the ideal time to be immunised against the flu?

    Annual vaccination before the onset of influenza season is recommended for all individuals ≥ 6 months of age. The peak period of circulating influenza disease is typically June to September, however out of season cases do occur. The influenza season may be atypical in 2022 following the reopening of international borders in the context of COVID-19.  Optimal protection against influenza occurs within the first 3-4 months following vaccination. It is never too late in the season to vaccinate.

  • Should we have a dose of the 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 a person’s medical risk factors, risk of disease exposure and the current circulating virus strains.

  • Why is the influenza vaccine recommended annually?

    The circulating strains of influenza virus varies each year and therefore influenza vaccines are modified annually to provide protection against those more commonly circulating strains. Optimal influenza disease protection occurs in the first 3-4 months following immunisation before it begins to wane. Annual influenza immunisation is therefore strongly recommended to have the best possible protection against influenza disease and its complications.

  • Do healthy people need to be immunised against influenza?

    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.

    Globally, incidences of “flurona”, a co-infection of influenza and COVID-19, have been recorded which places people at higher risks of severe disease or poorer health outcomes. To reduce the risk of co-infection, it is recommended individuals receive the seasonal influenza vaccine annually as well as remaining up to date with COVID-19 vaccination as per current recommendations.

  • How quickly is immunity developed 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 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.

  • If an individual has had confirmed influenza disease this year, are they still recommended to receive an influenza vaccine and when should they receive 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.

  • What is the difference between egg-based and cell-based influenza vaccines?

    Traditional influenza vaccines are made by cultivating influenza viruses in chicken eggs. Cell-based influenza vaccines are made by growing influenza viruses in animal cells lines (canine kidney). By using a cell-based platform, influenza vaccines have the potential to provide protection against influenza strains that are more closely matched to the circulating influenza strains in the community.

    Cell-based influenza vaccines have been used internationally since 2012 and in 2021 a cell-based influenza was registered for use within Australia for the first time. Flucelvax quad® is available for private purchase for immunisation of those aged ≥ 2 years.

    Expected side effects from cell-based influenza vaccines are consistent to the side effects expected from traditional egg-based influenza vaccines. The most commonly reported symptoms are local injection site reactions, including pain and redness.

  • Why are the strains included in the egg-based influenza vaccines different to the strains included in the cell-based influenza vaccines?

    The method of manufacture differs for egg-based influenza vaccines and cell-based influenza vaccines. This can impact the ability to produce the same strains of virus for both platforms. In cases where it is not possible to produce the same strains, strains with similar properties are selected.

    The recommendation for which strains should be included in influenza vaccines is made by the World Health Organization’s Global Influenza Surveillance and Response System (GISRS) based on epidemiological data, genetic characteristics of the virus, antiviral resistance, vaccine effectiveness and the availability of candidate vaccine viruses.

  • Can I give my patient < 60 years of age either of the adjuvanted influenza vaccines available in 2022 to produce a greater immune response?

    No, individuals < 60 years are recommended to receive standard formulation influenza vaccines. Fluad® Quad is only registered for use in peopled aged ≥ 65 years of age and is NIP funded. Fluzone High-Dose Quad is only registered for use in people aged ≥ 60 years of age but is not NIP funded.

  • If a standard QIV formulation has been given to my patient aged ≥ 60 years, do I need to re-vaccinate with an adjuvanted vaccine?

    If a patient aged ≥ 60 years old (including those aged ≥ 65 years) has already received a dose of a 2022 standard QIV vaccine they do not need re-vaccination or booster dosing with an adjuvanted influenza vaccine.

  • Why are adjuvanted formulations of influenza vaccine the preferred vaccine for older people?

    A gradual decline of the immune system occurs as people age (known as immunosenescence), impacting how the immune system responds to immunisation. For older adults the higher-immunogenecity influenza vaccines are preferentially recommended over standard QIVs as the antibody response is increased in comparison to non-adjuvanted QIV influenza vaccines.

    Whilst there is no preference between either of the higher-immunogenicity vaccines available in 2022, they are the preferred choice compared with standard formulations for individuals ≥ 65 years. Fluad® Quad is funded on the NIP for people aged ≥ 65 years of age. FluZone High-Dose Quad is available for private purchase for individuals from ≥ 60 years.

Administration of influenza vaccines

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

    Generally speaking, yes, influenza vaccines may be co-administered with most other vaccines on the same day. This includes live-attenuated vaccines (eg. measles and varicella) and the pertussis vaccine in pregnancy.

    COVID-19 vaccines can safely be co-administered with influenza vaccines however in children aged 6 months – 5 years of age an interval of 7-14 days is preferred to minimise adverse events such as fever.

    Whilst co-administration of Fluad®Quad and Shingrix is acceptable, there is limited safety data on this and therefore it is preferred to separate their administration by several days.

  • What is the process when a patient requires both influenza and COVID-19 vaccines?

    Influenza vaccines can be administered on the same day as COVID-19 vaccines in most individuals. In children aged 6 months – 5 years it is preferable that there is an interval of 7-14 days between administering COVID-19 vaccines and other vaccines to minimise adverse events such as fever.

  • If an individual has had a reaction to a COVID-19 vaccine, can they safely receive an influenza vaccine?

    There are only two absolute contraindications to an influenza vaccine, anaphylaxis to a previous dose of any influenza vaccine or a component of any influenza vaccine.

    Adverse events following a COVID-19 vaccine should be reported to SAEFVIC and referred to VicSIS for specialist advice and follow up if indicated.

    A previous reaction to a COVID-19 vaccine is not a contraindication to receiving an influenza vaccine.

  • Can Fluad®Quad and Shingrix be administered on the same day?

    The safety of co-administering Fluad®Quad and Shingrix has not been studied. Whilst co-administration of these vaccines is acceptable, it is preferred to separate their administration by several days.

  • Can influenza vaccines be given to someone who has had Guillain-Barre Syndrome (GBS)?

    Influenza vaccination has been identified as a possible cause of GBS following H1N1 containing vaccines, but the evidence is variable and at a very low rate, lower than the rate of GBS caused by ‘wild type’ influenza. As per the AusVaxSafety clinical resources flow chart, 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.

  • In children < 9 years who received the influenza vaccine for the first time last year but only received 1 dose, how many doses are required this year?

    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.

  • Children < 9 years need 2 doses of the influenza vaccine in their first year of being immunised. Do they need to receive the same brand for both doses?

    Influenza vaccine brands are interchangeable. Always ensure that the age-appropriate brands are administered.

  • What is the recommended site for injection when giving multiple vaccines in the same visit?

    The preferred injection site for adults and children ≥ 12 months of age is the deltoid. For infants < 12 months of age the recommended injection site is the middle third of the vastus lateralis (anterolateral thigh). More than 1 vaccine can be given into each site for injection ensuring a 2.5cm spacing between each vaccine. In some circumstances in children ≥ 12 months of age, the anterolateral aspect of the thigh may also be considered as an alternate site if required. For more information please refer to MVEC: Administration of injected vaccines-correct technique.

Safety of influenza vaccines

  • How do we 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. Online reporting of adverse events following immunisation can be reported online to SAEFVIC.

  • What are the expected side effects of the flu vaccine?

    Common side effects following the influenza vaccine 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. Cell-based influenza vaccines have a similar side-effect profile to traditional egg-based influenza vaccines. Side effects may occur slightly more commonly following immunisation with adjuvanted quadrivalent formulations than with standard QIV formulations.

  • 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.

  • Is it safe to receive the influenza vaccine whilst breastfeeding?

    Annual influenza immunisation is safe and recommended for breastfeeding mothers. Babies less than 6 months of age are at greatest risk from disease yet cannot receive influenza vaccines until they are 6 months of age. Maternal immunisation will provide protection for mothers as well as providing some passive protection for babies through the secretion of antibodies until they are old enough to receive their own influenza vaccine.

  • Cell-based influenza vaccines have only been available in Australia since 2021. How do we know they are safe?

    All vaccines must pass through strict safety and efficacy criteria before the Therapeutic Goods Administration (TGA) will grant approval for use within Australia. To read more about the vaccine development process please refer to MVEC: Development of vaccines.

    Cell-based influenza vaccines have been used internationally since 2012. Expected side effects from cell-based influenza vaccines are consistent to the side effects expected from traditional egg-based influenza vaccines. The most commonly reported symptoms are local injection site reactions, including pain and redness.

Pregnancy, breastfeeding and influenza vaccines

  • My pregnant patient received last year’s influenza vaccine when in early pregnancy in 2021, should they also receive a dose of 2022 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.

  • 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.

  • Is it safe to receive an influenza vaccine with other vaccines when pregnant?

    Influenza vaccines can be safely co-administered with pertussis and COVID-19 vaccines to pregnant individuals.

  • 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.

  • Is it safe to receive the influenza vaccine whilst breastfeeding?

    Annual influenza immunisation is safe and recommended for breastfeeding mothers. Babies less than 6 months of age are at greatest risk from disease yet cannot receive influenza vaccines until they are 6 months of age. Maternal immunisation will provide protection for mothers as well as providing some passive protection for babies through the secretion of antibodies until they are old enough to receive their own influenza vaccine.

  • Why is influenza vaccination recommended in pregnancy?

    Pregnant women are at greater risk of morbidity and mortality from influenza disease than non-pregnant women. They are more than twice as likely to be hospitalised with influenza disease as other people with influenza. Babies less than 6 months of age are at greatest risk of disease and death from influenza. Vaccinating pregnant women will also provide protection to babies for the first few months of life until they can be immunised against influenza from 6 months of age.

Special risk patients

  • 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 patients receiving high-immunogenicity vaccines where only 1 dose is recommended (refer to immunisation specialist for individual advice in this patient group).

  • Should my older immunosuppressed patient receive 2 doses of an adjuvanted quadrivalent influenza vaccine this year?

    Only one dose of an adjuvanted influenza vaccine is recommended per year, regardless of medical conditions.

Vaccine components

  • 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. Egg-based influenza vaccines 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. It is not necessary to preferentially administer cell-based influenza vaccines in this patient group. For further information refer to MVEC: Allergy and immunisation.

  • Can patients with latex allergies receive the influenza vaccine?

    All influenza vaccines available under the NIP in 2022 are latex free. People with a latex allergy can safely be vaccinated with influenza vaccines that are available under the NIP.

  • What are cell-based influenza vaccines?

    Cell-based influenza vaccines are made by growing influenza viruses in animal cell lines (canine kidney). This is a different method of manufacture compared with traditional influenza vaccines which are created by cultivating influenza viruses in chicken eggs.

If you have any further queries or your question has not been answered above, please contact MVEC.

Authors: Georgina Lewis (Clinical Manager, SAEFVIC, Murdoch Children’s Research Institute), Rachael McGuire (MVEC Education Nurse Coordinator), Francesca Machingaifa (MVEC Education Nurse Coordinator) and Daryl Cheng (MVEC Medical Lead, Murdoch Children’s Research Institute)

Reviewed by: Francesca Machingaifa (MVEC Education Nurse Coordinator) and Rachael McGuire (MVEC Education Nurse Coordinator)

Date: August 18, 2022

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.