MVEC influenza recommendations 2021

MVEC strongly supports annual influenza immunisation for anyone who wishes to be protected from influenza disease and its complications. The circulating strains of influenza disease change frequently and as such vaccination against the current strains are required each year.

Influenza vaccines are provided for free on the National Immunisation Program (NIP) for specific at-risk groups including:

  • Children aged 6 months to < 5-years
  • People aged ≥ 6 months of age with certain medical risk factors
  • 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 the criteria for funded doses, the influenza vaccine is still strongly encouraged and is available to purchase for a small fee. Influenza vaccines are available from a variety of providers, such as your GP, local council or local pharmacy (pharmacist immunisers are authorised to administer influenza vaccines to people aged 10-years and over in Victoria).

Key messages for the 2021 season

  • Annual influenza immunisation is strongly recommended for all people ≥ 6 months of age as the most important measure of preventing influenza disease and its complications.
  • COVID-19 vaccines and influenza vaccines should not be co-administered on the same day. A minimum interval of 14 days between vaccines is recommended.
  • Reporting of influenza vaccine administration to the Australian Immunisation Register (AIR) is now mandatory.
  • Fluad® Quad is the preferred vaccine brand for those aged ≥ 65 years
  • Flucelvax® Quad is a cell-based influenza vaccine registered for use in those aged ≥ 9 years and is available only for private purchase [refer to Table 1]

Table 1: The influenza strains included in the 2021 influenza vaccines for the Southern Hemisphere

Egg-based influenza vaccinesCell-based influenza vaccines
A/Victoria/2570/2019 (H1N1)pdm09-like virusA/Wisconsin/588/2019 (H1N1)pdm09-like virus
A/Hong Kong/2671/2019 (H3N2)-like virusA/Hong Kong/2671/2019 (H3N2)-like virus
B/Washington/02/2019-like (B/Victoria lineage) virusB/Washington/02/2019-like (B/Victoria lineage) virus
B/Phuket/3073/2013-like (B/Yamagata lineage) virusB/Phuket/3073/2013-like (B/Yamagata lineage) virus

Table 2: Influenza brand registered for each age group in 2021

Age groupVaccine brand and dose
Vaxigrip Tetra® (0.5 ml)Fluarix® Tetra (0.5ml)FluQuadri® (0.5ml)Influvac® Tetra (0.5ml)Afluria® Quad (0.5ml)Flucelvax® Quad (0.5ml)Fluad® Quad (0.5ml)
< 6 monthsNA
6-35 months (< 3 years)✓*✓*✓*NANANANA
3 - ≤ 4 years✓*✓*✓*✓*NANANA
5 years - ≤ 8 years✓*✓*✓*✓*✓*NANA
9 years - ≤ 64 yearsNA
≥ 65 years✓§

N/A not registered for use in this age group.
* 2 doses, minimum of 4-weeks apart should be given to children < 9 years of age in the first year of receiving the influenza vaccine. Only a single dose is recommended in subsequent years.
§
Fluad® Quad is the preferred influenza vaccine brand for this patient group and is funded on the NIP for those ≥ 65 years of age. Fluarix® Tetra/FluQuadri®/Afluria® Quad/Vaxigrip Tetra®/Influvac® Tetra/ Flucelvax® Quad are licensed for those ≥ 65 years of age but are not the preferred vaccine of choice.
Purple shaded boxes indicate the vaccine is funded under the NIP for eligible people.

Table 3: Number of influenza doses recommended for individuals in 2021

AgeNumber of doses of influenza vaccine
required in the first year of vaccination
Number of doses of influenza vaccine
required in subsequent years
6 months - < 9 years2 doses minimum of 4 weeks apart)*1
≥ 9 years11
People of any age who received a solid organ transplant (SOT) or haematopoietic stem cell transplant (HSCT) in the last 12 months2 doses (minimum of 4 weeks apart)^1

* If a patient inadvertently only received 1 dose of influenza vaccine in a previous year, then only 1 dose is required in future years.
^2 doses are recommended in the first year following SOT/HSCT regardless of history of influenza vaccination due to immunosuppression.

Co-administration of influenza vaccine with other vaccines

Due to a lack of safety and immunogenicity data on the co-administration of influenza vaccines and COVID-19 vaccines, it is currently recommended that these vaccines are not administered on the same day, but with a minimum interval of 14 days. There is no preference regarding the order of vaccine administration, noting that both the Oxford/AstraZeneca and Pfizer/BioNTech COVID-19 vaccines require a 2-dose schedule. If you have started with a Pfizer/BioNTech vaccine, it would be appropriate to first complete this course (following the recommended 21 day interval between doses), then waiting 14 days before receiving the seasonal influenza vaccine. The Oxford/AstraZeneca vaccine has a wider recommended interval between dose 1 and 2 (up to 12 weeks), so the influenza vaccine can be scheduled between these doses.

If influenza and COVID-19 vaccines are inadvertently administered on the same day or are administered within a shorter timeframe than 14 days, revaccination with either vaccine is not recommended.

Influenza vaccines may be 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, and pertussis vaccine in pregnancy.

Cell-based influenza vaccines vs egg-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 has been registered for use within Australia for the first time. Flucelvax® Quad is available for private purchase for immunisation of those aged ≥ 9 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.

Influenza vaccine in the ≥ 65 year age group

Due to a gradual decline in effectiveness of the immune system of older people (a process known as immunosenescence) immunity following vaccination with standard QIVs can be suboptimal. In addition, those aged ≥ 65 years have the highest rates of influenza disease burden and associated complications including pneumonia and death. Adjuvanted influenza vaccines continue to be the preferred vaccine type for the older population. Common side effects include injection site reactions and fever and these may occur slightly more frequently compared with standard QIV formulations.

Latex allergies

All influenza vaccines available in Australia in 2021 are latex free. People with a latex allergy can safely be vaccinated with influenza vaccines.

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.

Influenza vaccine and pregnancy, planning pregnancy and breastfeeding

Influenza vaccination is safe and strongly recommended for all pregnant women in every pregnancy at any stage of the 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.

For pregnant women who received an influenza vaccine during pregnancy in 2020, it is recommended to re-vaccinate if the 2021 influenza vaccine becomes available before the end of pregnancy.

For women who receive an influenza vaccine before becoming pregnant, it is recommended to re-vaccinate during pregnancy to protect the unborn infant.

It is safe for women who are planning a pregnancy and for those who are breastfeeding to receive an influenza vaccine.

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.saefvic.org.au

Authors: A/Prof Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute), Rachael McGuire (Research Nurse SAEFVIC, Murdoch Children’s Research Institute), Georgina Lewis (Clinical Manager SAEFVIC, Murdoch Children’s Research Institute) and Mel Addison (Research Nurse SAEFVIC, Murdoch Children’s Research Institute).

Reviewed by: A/Prof Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute), Dr Daryl Cheng (Paediatrician, the Royal Children’s Hospital, Parkville), Francesca Machingaifa (MVEC Education Nurse Coordinator) and Rachael McGuire (MVEC Education Nurse Coordinator).

Date: March 2021

Materials in this section are updated as new information becomes available. The Melbourne Vaccine Education Centre (MVEC) staff regularly review 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.