Everything you need to know about - influenza.org.nz

 
Everything you need to know about - influenza.org.nz
Everything you
 need to know about

2020                  Key reference material   B
Everything you need to know about - influenza.org.nz
Four out of five people infected
show no symptoms of influenza
The Southern Hemisphere Influenza and Vaccine                          When the results were applied to the New Zealand
Effectiveness Research and Surveillance                                population in 2015, around 1.1 million people (26%)
(SHIVERS) Serosurvey, in 2015, provided                                would have been infected with influenza. Around
information about the immunity that people in                          880,000 (80%) of these people were asymptomatic
the community have against influenza.                                  carriers who could have spread the virus among their
                                                                       family, co-workers, classmates and patients without
                                                                       ever realising it.1

                                                                            31,850 sought help from their GP

Help prevent the potentially devastating effects of influenza
in your community

Recommend annual influenza vaccination

Please make sure you get vaccinated every year

     The SHIVERS Serosurvey
     The purpose of this study was to contribute to knowledge about influenza infection in the community and identify
     if participants:
     •	developed immunity to influenza by the end of the winter and
     •   had influenza during the winter

 C        Key reference material
Everything you need to know about - influenza.org.nz
Contents                                          NEW for 2020
                                                   	 Additional
                                                                copies of this resource can be
                                                      ordered online at influenza.org.nz/resources
                                                      from late March

Key reference material
Important information for 2020                                                                       1
Key messages                                                                                         1
Influenza disease                                                                                    3
Should healthcare workers be vaccinated?                                                             4
New Zealand immunisation strategy                                                                    5
Eligibility for funded influenza vaccine                                                             5
Eligible conditions for funded influenza vaccine                                                     6
Vaccine ordering, delivery and storage                                                               7
2020 funded influenza vaccine order form                                                             8
Recording influenza vaccinations on the National Immunisation Register                               9
Influenza vaccination consent form                                                                   10
Useful contact information                                                                           11

Clinical information
Summary of 2020 funded influenza vaccines                                                            12
Questions and answers about the 2020 funded influenza vaccines                                       13
Safety of inactivated influenza vaccines                                                             15
Effectiveness of inactivated influenza vaccines                                                      16

Influenza and special groups
Influenza and older people                                                                           18
Influenza and pregnancy                                                                              21
Influenza and children                                                                               25
Influenza and other special groups                                                                   26

The list of references is available in a separate document in the Resources section on the
influenza.org.nz website.
Everything you need to know about - influenza.org.nz
Important information for 2020
This resource is for use by healthcare professionals supporting and/or providing influenza vaccinations in a
variety of settings.

Start date                                                         Influenza Immunisation Programme goals
The annual Influenza Immunisation Programme (the                   •	Vaccinate 75% of the population aged 65 years or older
Programme) starts from 1 April each year, subject to                   against influenza annually
influenza vaccine being available for distribution.
                                                                   •	Improve influenza immunisation coverage for people
New Zealand influenza surveillance data shows that in recent           aged under 65 years with certain medical conditions, and
years the peak of influenza activity has been in August.2              pregnant women
A start date from 1 April for influenza vaccination provides
                                                                   •	Improve influenza immunisation uptake for healthcare
better protection for our vulnerable populations during the
                                                                       workers
expected peak of influenza activity.
                                                                   •	Vaccinate at least 80% of healthcare workers against
For consistency, the Ministry of Health recommends that
                                                                       influenza annually
providers of non-funded influenza immunisation, such as
workplace vaccinators, also consider commencing their
service on 1 April.                                                Eligibility for funded influenza vaccination
                                                                   Funded influenza vaccinations are available for those who
More information is available in the Ministry’s Policy statement
                                                                   meet PHARMAC’s eligibility criteria:
– Annual Influenza Immunisation Programme start date,
available at health.govt.nz/our-work/preventative-health-          •   Pregnant women (any trimester)
wellness/immunisation/influenza.
                                                                   •   People aged 65 years or older
                                                                   •	People aged under 65 years with certain medical
                                                                       conditions, refer to page 6
                                                                   •	Children aged 4 years or under who have been
                                                                       hospitalised for respiratory illness or have a history of
                                                                       significant respiratory illness

Key messages
     Your regular use and support of the following messages will play an essential role in increasing influenza
     vaccination and lowering infection rates.

        	 I mmunisation is the best protection against influenza. Even if you still catch influenza
            after immunisation, your symptoms are less likely to be severe.

        	Get immunised to stop the spread of influenza around your community. Even if you
          don't feel sick, you could still be infected with influenza and pass it on to others.
       -      If you are sick, staying away from others, regular handwashing or use of hand sanitisers and covering your
     		       mouth and nose when sneezing or coughing also help reduce the spread of influenza

        	Influenza immunisation is recommended and FREE for people who are most likely
          to get very sick, be hospitalised or even die if they catch influenza:
         -    pregnant women,
         -    people aged 65 years or older,
         -	people aged under 65 years with diabetes, most heart or lung conditions and some other illnesses, and
         -	children aged 4 years or under who have had a stay in hospital for asthma or other breathing problems

        	Having an influenza immunisation every year can keep older people healthy and active
          for longer.

        	Influenza immunisation during pregnancy helps protect the mother and her baby
          against influenza.

1         Key reference material
Everything you need to know about - influenza.org.nz
Two funded quadrivalent influenza vaccines for 2020
     1.	
        AFLURIA         ®
                            QUAD                                 2.	
                                                                    AFLURIA        ®
                                                                                       QUAD JUNIOR
            For adults and children aged 3 years or older.            For children aged under 3 years, i.e. 6–35 months.

Influenza vaccination precaution                                  Online ordering for other Influenza Immunisation Programme
                                                                  resources is available through the Resources page on
Influenza vaccination may be contraindicated or need to be
                                                                  influenza.org.nz.
delayed for people receiving some newer cancer treatments.
The immune-stimulant actions of atezolizumab (TECENTRIQ®),
ipilimumab (YERVOY®), nivolumab (OPDIVO®) and                     Pharmacist vaccinators
pembrolizumab (KEYTRUDA®) on the immune system increase           Many community pharmacies provide influenza vaccination
a person’s risk of developing autoimmune conditions.              to adults and children aged 13 years or older. Some
It is not known whether receipt of an influenza vaccine           community pharmacies also provide funded influenza
whilst receiving these treatments or for up to 6 months           vaccination to:
after treatment increases a theoretical risk of triggering the    •	pregnant women, and
occurrence of these side effects. Please contact the person’s
oncologist or 0800 IMMUNE (0800 466 863) for current              •	people aged 65 years or older
advice about influenza vaccination for these people BEFORE
administering the vaccine.3                                       Recording influenza vaccination on the
                                                                  National Immunisation Register (NIR)
AFLURIA® QUAD and AFLURIA® QUAD                                   All influenza vaccinations given in general practice and by
JUNIOR can be given to people with egg                            community pharmacists should be recorded on the NIR. This
allergy or anaphylaxis                                            provides invaluable information for planning the programme
AFLURIA® QUAD and AFLURIA® QUAD JUNIOR can be                     to protect our population. For more information, please refer
administered to people with a history of egg allergy or           to page 9.
egg anaphylaxis at general practices, pharmacies or at            Pharmacist vaccinators use the NIR web application
the workplace, although the data sheet advises caution            ImmuniseNow to check the vaccinees’ immunisation history
in people with a history of egg anaphylaxis. 4 Studies have       and record influenza vaccinations on the NIR. If the person
shown that influenza vaccines containing one microgram            is already registered on the NIR, a notification will be sent to
or less of ovalbumin do not trigger anaphylaxis in sensitive      their general practice advising that an influenza vaccination
individuals.3 The residual ovalbumin in one dose of AFLURIA®
                                                                  has been given by a pharmacist.
QUAD or AFLURIA® QUAD JUNIOR is below this limit.5
                                                                  Influenza coverage reports by District Health Board, Primary
Ordering influenza vaccine                                        Health Organisation, age, ethnicity and deprivation are
                                                                  available for providers, including general practice, with
Online ordering is preferred at hcl.co.nz. The online order
                                                                  access to the Business Objects NIR Datamart.
process is less susceptible to error, has an audit trail and
is faster than faxing or emailing orders. Faxed or emailed
orders incur a manual order processing fee of $10 per order.      Go to influenza.org.nz for additional
The fax order form is on page 8.                                  associated content
                                                                  •	Southern Hemisphere Influenza and Vaccine Effectiveness,
Ordering printed influenza resources                                  Research and Surveillance (SHIVERS) Serosurvey
The following three resources are ordered from HealthEd           •	Related diseases (pneumococcal, meningococcal and
(healthed.govt.nz). They replace the After your flu
                                                                      pertussis)
immunisation leaflet and Avoid flu during pregnancy
brochure used prior to 2019.                                      •	Flu kit booklet references

•	After your child is immunised (HE1504),                        •	Claiming funded vaccine

•	After your immunisation (HE2505) for teenagers and             •	Use of antivirals for influenza treatment and/or
    adults, and                                                       prevention
•   Immunise during pregnancy (HE2503) also available            •	Data sheets for AFLURIA® QUAD and AFLURIA® QUAD JUNIOR
    in Chinese Simplified, Chinese Traditional, Hindi,
    Māori, Samoan and Tongan

         The Ministry of Health and the Immunisation Advisory Centre
          appreciate all your hard work, and thank you for your role in
            ensuring New Zealanders are protected from influenza.

                                                                                        Key reference material                2
Influenza disease
Influenza is caused by different strains of influenza viruses. Symptoms may vary with age, immune status and
health of the individual, and include fever, sore throat, muscle aches, headache, cough and severe fatigue. The
fever and body aches can last 3–5 days and the cough and fatigue may last for 2 or more weeks.6

During seasonal increases, most influenza diagnoses are          Not everyone with influenza has symptoms or feels unwell.
based on symptoms. The definitive diagnosis of influenza         However, asymptomatic individuals can still transmit the
can only be made in the laboratory, usually from PCR testing     virus to others.6,10-12
of secretions from a nasopharyngeal swab. Samples should
                                                                 The Southern Hemisphere Influenza and Vaccine
be collected within the first 4 days of illness.7
                                                                 Effectiveness Research and Surveillance (SHIVERS) study,
                                                                 based in Auckland, identified around one in four people were
                                                                 infected with influenza during the 2015 influenza season.
                                                                 Data showed that four out of five children and adults (80%)
                                                                 with influenza did not have symptoms.1
     Influenza can be difficult to diagnose                      In an earlier study following the 2009 New Zealand influenza
     based on clinical symptoms alone because                    season, almost one quarter of adults who reported that they
                                                                 had not had influenza in 2009 had serological evidence of
     influenza symptoms can be similar to
                                                                 prior infection (21% [95% confidence interval 13–30%]).
     those caused by other infectious agents                     Conversely, almost one quarter of adults who reported having
     including Neisseria meningitidis,8*                         had influenza during 2009 had no serological evidence of
                                                                 prior infection (23% [95% confidence interval 12–35%]).13
     respiratory syncytial virus (RSV),
     rhinovirus and parainfluenza viruses.6                      Hospital-based surveillance for severe acute respiratory
                                                                 infections in Auckland during 2019 identified that infants aged
     * For more information go to                               under 1 year had the highest severe acute influenza respiratory
                                                                 infection hospitalisation rate of all age groups. There were
        influenza.org.nz/meningococcal-disease
                                                                 326 cases per 100,000 people in infants aged under 1 year
                                                                 compared with 216 cases/100,000 for adults aged 80 years or
                                                                 older, 98 cases/100,000 for children aged 1–4 years, and 77
                                                                 cases/100,000 for adults aged 65–79 years.14
                                                                 Māori and Pacific peoples had higher hospitalisation rates
A meta-analysis of influenza disease found that approximately
                                                                 for severe acute influenza respiratory infection than Asian,
20% of children and 10% of adults who did not receive an
                                                                 European and other ethnicities at 46 cases and 88 cases per
influenza vaccination were infected annually; around half of
                                                                 100,000 people respectively.14
those infected were asymptomatic.9

Transmission
The influenza virus is transmitted among people by direct
contact, touching contaminated objects or by the inhalation
of aerosols containing the virus. Influenza virus can be
aerosolised without sneezing or coughing. Sneezing is more            To reduce the spread
likely to contribute to contaminated surfaces and objects.10
                                                                      of influenza:
Symptomatic and asymptomatic influenza cases can transmit
the virus and infect others at home, in the community, at
work and in healthcare institutions. Healthy adults with                 	Cover your mouth and nose when you
influenza are infectious for up to 5 days, and children for up             sneeze or cough
to 2 weeks.6

                                                                         	Wash and dry your hands often

                                                                         	Stay away from others if you are sick

3         Key reference material
Should healthcare workers be vaccinated?
Yes. The World Health Organization strongly recommends healthcare workers as a priority group for influenza
vaccination, not only for their own protection and ability to maintain services but also to reduce the spread of
influenza to vulnerable patients including pregnant women.15
The Ministry of Health recommends annual influenza vaccination of healthcare workers because influenza is a
significant public health issue in New Zealand. Healthcare workers are twice as likely to acquire influenza than
non-healthcare workers, and healthcare workers can transmit influenza without knowing they are infected.16

A meta-analysis of studies of influenza A (H1N1) infection in       Healthcare workers have a duty of care to protect vulnerable
2009 showed that healthcare workers were twice as likely            patients from the serious health threat of influenza illness.
to have influenza than non-healthcare workers.17 In general,        Studies demonstrate that annual influenza vaccination
around 10% of adults who do not receive an influenza                for healthcare workers is likely to reduce illness among
vaccination catch influenza annually and approximately half         the patients they care for.18-20 Relying on patients being
of these cases are asymptomatic.                                    vaccinated is not enough as vulnerable people may have a
                                                                    poor immune response to their vaccination or may not have
Influenza does not always cause symptoms or make a
                                                                    been vaccinated this year.
person feel unwell.6,10-12 Data from the Southern Hemisphere
Influenza and Vaccine Effectiveness Research and                    Influenza vaccination coverage rates for District Health Board
Surveillance (SHIVERS) study, based in Auckland, suggest            (DHB) based healthcare workers increased to 73% in 2019,
that four out of five children and adults (80%) with influenza      the highest coverage to date.21 The Ministry of Health goal
did not have symptoms.1 In an earlier study following the           is at least 80% of all healthcare workers vaccinated against
2009 influenza season in New Zealand, almost one quarter            influenza annually. The 2019 Workforce Influenza Immunisation
of the adults who reported that they had not had influenza in       Coverage Rates by District Health Boards report is available
2009 had serological evidence of prior infection (21% [95%          on the Ministry of Health website health.govt.nz/our-work/
confidence interval 13–30%]).13                                     preventative-health-wellness/immunisation/influenza.

When should people be vaccinated?
It is possible to come in contact with influenza viruses all year   It is recommended that women who become pregnant
round. However, the likelihood of influenza viruses circulating     after winter and have not received the current influenza
in the community significantly increases during winter.             vaccination, are offered influenza vaccination up to and
                                                                    including 31 December.
For most people, the best time to be vaccinated against
influenza is before the start of the winter season. It can          From 1 April through 31 December 2020:
take up to 2 weeks for the vaccine to provide the best
                                                                    •       AFLURIA® QUAD is the funded vaccine for eligible adults
influenza protection. However, influenza vaccinations can
                                                                            and children aged 3 years or older
be given when influenza virus activity has been identified as
protective antibody levels have been observed to develop            •       AFLURIA® QUAD JUNIOR is the funded vaccine for eligible
rapidly from 4 days after vaccination.22,23                                 children aged under 3 years, i.e. aged 6–35 months

                                                                    Recommend annual influenza vaccination.

Why is influenza vaccination needed
every year?                                                             For 2020, of the four influenza strains included in
                                                                        the funded vaccines, the first three listed below
                                                                        are new.24
Annual influenza vaccination is required for two important
reasons:                                                                •     A/Brisbane/02/2018 (H1N1)pdm09-like virus

•   Protection from the previous vaccination lessens over time         •     A/South Australia/34/2019 (H3N2)-like virus

•	The circulating influenza viruses can change and the strains         •     B/Washington/02/2019-like virus
    in the vaccine usually change each year in response to the          •     B/Phuket/3073/2013-like virus
    changing virus pattern

                                                                                            Key reference material             4
New Zealand immunisation strategy

Who should be vaccinated?                                        Eligibility for funded influenza vaccine
Influenza continues to be a major threat to public health        All children aged under 18 years who meet the influenza
worldwide because of its ability to spread rapidly through       vaccination eligibility criteria can receive funded influenza
populations. Influenza vaccination can be offered to             vaccination regardless of their immigration and citizenship
individuals aged 6 months or older.                              status, and providers can claim the immunisation benefit for
                                                                 administering the vaccine.25
Influenza vaccination is funded for certain groups of people
who are considered to be at greater risk of complications from   Adults aged 18 years or older who meet PHARMAC’s
influenza. Additional preventative strategies are important      influenza vaccination eligibility criteria must also be eligible
to reduce their risk of exposure to influenza. The vaccination   to receive publicly funded health and disability services in
is also recommended, although not funded, for those who          New Zealand to receive funded influenza vaccination.25 For
are in close contact with individuals who are more vulnerable    more information, please refer to the Health and Disability
or at high risk of complications and who may also be less able   Services Eligibility Direction 2011 for eligibility criteria
to mount a strong immune response to vaccination. Front-         (available at health.govt.nz/new-zealand-health-system/
line healthcare workers are usually funded by their employer.    eligibilit y-publicly-funded-health-ser vices/eligibilit y-
                                                                 direction).
Funded vaccines for 2020                                         Women aged 18 years or older who are pregnant and not
AFLURIA® QUAD                                                    eligible to receive publicly funded health and disability
                                                                 services in New Zealand are recommended to receive
AFLURIA® QUAD is funded if administered to eligible adults
                                                                 influenza vaccination. However, they are not eligible to
and children aged 3 years or older, from 1 April through
                                                                 receive funded vaccination, even if they are receiving funded
31 December 2020.
                                                                 primary maternity services under the Section 88 Primary
AFLURIA® QUAD JUNIOR                                             Maternity Services Notice 200726 (available at health.govt.
                                                                 nz/publication/section-88-primary-maternity-ser vices-
AFLURIA® QUAD JUNIOR is funded if administered to
                                                                 notice-2007).
eligible children aged under 3 years, i.e. 6–35 months, from
1 April through 31 December 2020.
                                                                 For vaccination eligibility queries contact:
Note: Both AFLURIA® QUAD and AFLURIA® QUAD JUNIOR
                                                                 The Immunisation Advisory Centre (IMAC)
are prescription medicines. For full prescribing information,
please refer to the data sheets at medsafe.govt.nz or            The University of Auckland
influenza.org.nz.
                                                                 Phone: 0800 IMMUNE (0800 466 863)
                                                                 Email: 0800immune@auckland.ac.nz
                                                                 Also refer to page 6 or the New Zealand Pharmaceutical
                                                                 Schedule on the PHARMAC website (pharmac.govt.nz/tools-
                                                                 resources/pharmaceutical-schedule).

                                                                     Influenza vaccination
                                                                     before winter offers the
                                                                     best protection.

5         Key reference material
Eligible conditions for
funded influenza vaccination

     Funded influenza vaccine is available each year for people who
     meet the following criteria set by PHARMAC:*

                                                                 		 - HIV, or
1.   	People 65 years of age or older; or
                                                                 		 - transplant recipient, or

2.     People under 65 years of age who:
       • have any of the following cardiovascular diseases:
                                                                 		 - neuromuscular or CNS disease/disorder,c or
                                                                 		 - haemoglobinopathy,d or
                                                                 		 - children on long-term aspirin, or
		 - ischaemic heart disease, or
                                                                 		 - a cochlear implant, or
		 - congestive heart failure, or
                                                                 		 - error of metabolism at risk of major metabolic
		 - rheumatic heart disease, or
                                                                       decompensation, or
		 - congenital heart disease, or
                                                                 		 - pre- or post-splenectomy, or
		 - cerebrovascular disease; or
                                                                 		 - Down syndrome, or
       •	have either of the following chronic
                                                                       •	pregnant women (any trimester); or
          respiratory diseases:
		 - asthma, if on a regular preventative therapy, or
		 - other chronic respiratory disease with impaired
                                                                 3.  	Children aged 4 years or under who have been
                                                                       hospitalised for respiratory illness or have a history
      lung function;a or                                               of significant respiratory illness.
       •	have diabetes; or                                      	
       •	have chronic renal disease; or
       •	have any cancer, refer to the vaccine precaution       Unless meeting the criteria set out above, the following
          below#, excluding basal and squamous skin              conditions are excluded from funding:
          cancers if not invasive; or
                                                                       •	asthma not requiring regular preventative therapy
       •	have any of the following other conditions:
                                                                       •	hypertension and/or dyslipidaemia without
		 - autoimmune disease,b or                                            evidence of end-organ disease
		 - immune suppression or immune deficiency, or

                                                                                     *New Zealand Pharmaceutical Schedule.27

#
    Influenza vaccination precaution for some cancer treatments
Influenza vaccination may be contraindicated or need to be delayed for people receiving some newer cancer treatments. Please
read the information under Contraindications and precautions to receiving influenza vaccine on page 16 for people receiving
atezolizumab (TECENTRIQ ®), ipilimumab (YERVOY®), nivolumab (OPDIVO ®) and pembrolizumab (KEYTRUDA®) and contact the
person’s oncologist or 0800 IMMUNE (0800 466 863) for current advice about influenza vaccination for these people BEFORE
administering the vaccine.3

a.	Chronic respiratory diseases include: chronic bronchitis,    c.	Neuromuscular and CNS diseases/disorders include:
    chronic obstructive pulmonary disease, cystic fibrosis,          cerebral palsy, congenital myopathy, epilepsy,
    emphysema.                                                       hydrocephaly, motor neurone disease, multiple sclerosis,
                                                                     muscular dystrophy, myasthenia gravis, Parkinson’s
b.	Autoimmune diseases may include: coeliac disease,
                                                                     disease, spinal cord injury.
    Crohn’s disease, Grave’s disease, Hashimoto’s
    thyroiditis, lupus, rheumatoid arthritis. Immune             d. 	Haemoglobinopathies include: sickle cell anaemia,
    suppression or immune deficiency includes disease                 thalassemia.
    modifying anti-rheumatic drugs (DMARDS) or targeted
                                                                 For vaccination eligibility queries call 0800 IMMUNE
    biologic therapies.
                                                                 (0800 466 863)

                                                                                      Key reference material                6
Vaccine ordering, delivery and storage
Ordering vaccine                                                   bin holds up to 80 doses, a large bin holds up to 180 doses,
                                                                   and the extra-large bin holds up to 300 doses.
Influenza vaccine ordering is handled by Healthcare Logistics
(HCL). Online ordering via hcl.co.nz is the preferred option       Chilly bins can be reused:
and does not incur a manual order processing fee.
                                                                   • 	In Auckland and Christchurch, bins and fill can be collected
Send fax orders to 0508 408 358. The fax order form is                 by HCL couriers when they are dropping off the next delivery
available on page 8 and through the Resources section on
                                                                   • 	In Whangarei, Hamilton, Palmerston North, Wellington,
influenza.org.nz. For enquiries phone 0508 425 358.
                                                                       Nelson and Dunedin, providers can either drop the bin off
                                                                       or courier it to ProPharma for recycling. If bins are sent
Cost of the influenza vaccines                                         by courier, providers will need to arrange and pay for the
The vaccine costs $9.00 (excl. GST) per dose. For people               courier. It is not necessary to phone ProPharma in advance
eligible for funded influenza vaccine, refer to page 6, the
vaccine is free (i.e. no vaccine cost and no administration        Vaccine availability at the start of the season
service cost to the person). General practices can claim for
the cost of the vaccine and the immunisation benefit for           Pre-orders for influenza vaccines can be placed from 1
administration of a funded influenza vaccine to an eligible        March. Orders will be dispatched when stock is available and
individual via the usual Sector Services process.                  released by the Ministry of Health.

Note: Claims can only be made when the vaccine is given            Please do not organise clinics before your vaccine stock has
during the funded Influenza Immunisation Programme, from           arrived. The funded Influenza Immunisation Programme
1 April through 31 December.                                       starts from 1 April.

How much is the immunisation subsidy                               Influenza vaccine stock damaged in transit
General practices: $21.37 (excl. GST)                              Influenza vaccine damaged in transit may be returned
Community pharmacies: $19.57 (excl. GST)                           to Healthcare Logistics for destruction. Please contact
                                                                   Healthcare Logistics on 0508 425 358 before returning.
Order and delivery charges
• 	Faxed or emailed orders incur a manual order processing fee
                                                                   Refund for unused/expired funded
    of $10 per order. This fee can be avoided by ordering online   influenza vaccine
                                                                   Please ensure you continue to have influenza vaccine stock
• 	Orders for AFLURIA® QUAD that are less than the
                                                                   available until 31 December for those who are eligible for
    minimum quantity of described in the table below will
                                                                   influenza vaccination.
    incur a $25 small order delivery fee
                                                                   One refund will be available for a total of 10 doses of unused
• 	Orders for AFLURIA® QUAD JUNIOR will incur a $25 small
                                                                   AFLURIA® QUAD and/or one dose of unused AFLURIA® QUAD
    order delivery fee if they are not added to an AFLURIA®
                                                                   JUNIOR from any one account. To be eligible for a refund, the
    QUAD order that meets the minimum quantity
                                                                   unused stock must be returned prior to 31 January 2021.
                                                                   Contact Healthcare Logistics on 0508 425 358 to request a
Minimum order requirements                                         Return Authorisation.
for AFLURIA® QUAD
The AFLURIA® QUAD minimum order quantities for 2020 are            The shelf life of funded influenza vaccines
as follows:                                                        All influenza vaccines are marked with an expiry date that
                                                                   should be checked before vaccine administration.
        MARCH–MAY                          60 doses
         JUNE–JULY                         30 doses                Cold chain
           AUGUST                          20 doses                The vaccines must be stored between +2°C and +8°C at all
                                                                   times. They must not be frozen.
  SEPTEMBER ONWARDS                        10 doses
                                                                   Temperature-monitored chilly bins must be used if vaccines
AFLURIA® QUAD JUNIOR does not have minimum order                   are temporarily stored outside the vaccine refrigerator or
quantities. However, a $25 small order fee will apply if they      being transported. For more information, please refer to the
are not included with an AFLURIA® QUAD order that meets            National Standards for Vaccine Storage and Transportation
the minimum quantity.                                              for Immunisation Providers 2017 (2nd Edition), available at
                                                                   health. govt.nz/coldchain.
Maximum order quantity for
                                                                   If vaccines have been stored outside the required
AFLURIA® QUAD JUNIOR
                                                                   temperature range, quarantine the vaccines and contact your
AFLURIA® QUAD JUNIOR has a maximum order quantity of 20            Immunisation/Cold Chain Coordinator.
doses. If you have high demand and require more than 20
doses at the start of the season, please contact HCL.              Temperature logging devices
                                                                   A temperature logging device and instructions may be
Polystyrene chilly bins
                                                                   included with your order.
To reduce wastage when ordering, please consider your
expected usage. A small bin holds 60 doses, a medium chilly

7         Key reference material
2020 funded influenza vaccine order form
(Failing to complete in full may delay the processing of your order)

TO: Healthcare Logistics
ONLINE: hcl.co.nz (preferred option, registration required) or
TOLL-FREE FAX: 0508 408 358*
*Faxed or emailed orders incur a manual order processing fee of $10 per order. This fee can be avoided by ordering online.

Date: 										                                 Healthcare Logistics customer number:

Provider name:

Contact name:

Delivery address:

Contact phone:

Email address for invoice:

(Email address for invoicing only needs to be provided once)

Customer purchase order number (if applicable):

    I would like to order:

             AFLURIA® QUAD DOSES [1153792], funded influenza vaccine (only available in multiples of 10).

              FLURIA® QUAD JUNIOR DOSES [1153793], funded influenza vaccine
             A
             (only available in single dose packs).

    You will be supplied the doses that you commit to in your online or faxed order. Boxes cannot be split.

Notes for providers:
•    Due to demand, please allow up to 48 hours for dispatch. Please do not book your clinics before the stock has arrived
•    AFLURIA® QUAD minimum order quantities are as follows:

              MARCH–MAY                                      60 doses

               JUNE–JULY                                      30 doses

                 AUGUST                                       20 doses

        SEPTEMBER ONWARDS                                     10 doses

• 	AFLURIA® QUAD JUNIOR has a maximum order quantity of 20 doses. If you have high demand and require more than 20 doses
    at the start of the season, please contact HCL
•    T o reduce wastage when ordering, please consider your expected usage. A small bin holds 60 doses, a medium chilly bin holds
      up to 80 doses, a large bin holds up to 180 doses, and the extra-large bin holds up to 300 doses
• 	Some orders may have a temperature logging device included with the shipment. Do not be concerned if your shipment does
    not contain a temperature logging device
Refund for unused/expired funded influenza vaccine
Please ensure you continue to have influenza vaccine stock available until 31 December for those who are eligible for influenza vaccination.
One refund will be available for a total of 10 doses of unused AFLURIA® QUAD and/or one dose of unused AFLURIA® QUAD JUNIOR from any one
account. To be eligible for a refund, the unused stock must be returned prior to 31 January 2021. Contact Healthcare Logistics on 0508 425 358 to
request a Return Authorisation.

This form is also available on influenza.org.nz in the Resources section.

                                                                                                      Key reference material                   8
Recording influenza vaccinations on
the National Immunisation Register
The National Immunisation Register (NIR) is a national database, held by the Ministry of Health (the Ministry).
The NIR records National Immunisation Schedule vaccinations given to children and some Schedule vaccines
given to adults, such as influenza vaccinations. The Ministry and District Health Boards use the NIR to help
monitor vaccination coverage, including vaccination of those aged 65 years or older and pregnant women,
assess protection against diseases such as influenza, and plan future population health programmes.

The following points are useful for                               •	The provider should be noted as the “GP” and the nurse
                                                                     or “GP” who administers the vaccine as the “vaccinator”
informing your patients about the NIR
•   T he NIR provides an accurate record of a person’s           •	All influenza vaccinations should be recorded on the NIR
     vaccination history, to help with their ongoing heath        Note: The NIR does not schedule influenza vaccinations or
     care even if they change doctors, and to help the            identify overdue influenza vaccinations in the Overdue Tasks
     Ministry measure vaccination coverage across the             report as it does for the childhood vaccinations.
     whole population
•	The NIR records a person’s NHI number, name, gender,           Pharmacy
   address, date of birth and vaccination information             Pharmacist vaccinators use the NIR web application
•	Only authorised professionals will see, use or change          ImmuniseNow to check vaccinees’ immunisation history and
   the information                                                record influenza vaccinations on the NIR.

•	Information that does not identify individuals may be          If the person is already registered on the NIR, a notification
   used for research or planning                                  will be sent to their general practice advising that an influenza
                                                                  vaccination has been given by a pharmacist.
The NIR leaflet (HE2423) informs adults about the NIR. Leaflet
pads can be ordered from healthed.govt.nz.                        Other influenza vaccination settings
Influenza coverage reports by District Health Board (DHB),        The Ministry is working towards expanding access to
Primary Health Organisation (PHO), age, ethnicity and             ImmuniseNow in the future for other influenza vaccination
deprivation are available for providers, including general        settings such as DHB staff health clinics.
practice, with access to the Business Objects NIR Datamart.
                                                                  Occupational health providers are expected to notify a
                                                                  person's general practice when they have administered an
Recording adult influenza vaccination,                            influenza vaccine so their records can be updated.
including pregnant women, on the NIR in:
General Practice                                                  For questions about recording influenza
The NIR and Practice Management Systems (PMS) record all
                                                                  vaccination on:
influenza vaccinations given in general practice for all age      •   The NIR, please contact your DHB NIR administrator or
groups and for pregnant women.                                        the Ministry of Health Support team:

To ensure an adult’s influenza vaccination information is             Email: onlinehelpdesk@health.govt.nz
recorded on the NIR, you must select the opt-on button on             Phone: 0800 855 066, select option 5 and then select
your PMS.                                                             option 3
To help avoid errors in recording influenza on the NIR:           •   ImmuniseNow, contact the Ministry of Health Support
•	Ensure you have the most up-to-date PMS software version           Team (details directly above)

•	Send a list of all the vaccinators and general practitioners   •	Your general practice or pharmacy PMS, please contact
   (GPs) who will deliver the influenza vaccine in your              your vendor directly
   practice to your local DHB NIR administrator before the
   beginning of the influenza season to ensure they are
   entered into the system
•	Vaccinators should validate the vaccinee’s address in all
   address fields before they are messaged to the NIR

9         Key reference material
Influenza vaccination consent form
Patient/Guardian
Surname: 											                                             First name:

Phone: 									                                 Date of birth: 					                     Gender:        M      F     NHI:

Ethnicity: 	    NZ European     Maori    Samoan       Cook Island Maori     Tongan                                 Niuean        Chinese
                 Indian   Other (such as Dutch, Japanese, Tokelauan) Please state:

Name of guardian (if applicable):

Address:

Your doctor’s name / surgery address:

This form confirms that you have given your consent to have an influenza vaccination.
If any of the following apply to you then please advise your healthcare professional:

      •   Currently unwell with a high fever                            • 	Had treatment for cancer during the
      • Allergic to any food or medicine                                    last 12 months
      • 	Taking blood thinning medication or                           • 	Had a severe response to an influenza
          have a bleeding disorder                                          immunisation in the past

Possible responses to influenza vaccination:
Influenza vaccination is usually well tolerated. Possible responses include pain, redness and/or swelling at the
injection site for a day or two; a mild fever, muscle aches or headache within the first two days. Rarely, an allergic
response can occur.

You should remain under observation to watch for an allergic response
for 20 minutes after your vaccination.
The influenza vaccine does not protect against other respiratory viruses such as the common cold. For more
information on the influenza vaccine, please refer to the consumer medicine information sheet located at
medsafe.govt.nz.

   The Ministry of Health keeps a record of influenza vaccinations on the National Immunisation Register so that authorised health
   professionals can find out what vaccinations have been given. It helps to monitor the population's protection against influenza. If you do
   not want your vaccination recorded on the National Immunisation Register please advise your doctor, nurse or healthcare professional.

   I have read or have had explained to me information about influenza vaccination, and I have had a chance to ask questions that were
   answered to my satisfaction. I believe I understand the benefits and risks of influenza vaccination. I understand getting the vaccination
   is my choice. I agree to get the vaccination and that it is recommended that I wait here for 20 minutes after my vaccination.

   I consent to this information being given to my healthcare provider to update applicable records.

   Signed: 															                                                      Date:

   Signed by Guardian (if applicable):

   Relationship to the patient:

                                                                                                  The influenza vaccine is a
   Vaccination record (clinical use only)
                                                                                                  prescription medicine. Talk to your
   Vaccine:                                      Administered: Left / right arm                   healthcare professional about the
   Vaccine batch number:                         Expiry date:                                     benefits and possible risks.
   Vaccinator:

                                                                                                    Key reference material                 10
Useful contact information
All the information and contacts you may need:

Vaccination eligibility, clinical queries and                     Claiming funded vaccine
general information                                               Sector Services Help Desk
The Immunisation Advisory Centre (IMAC)                           Phone: 0800 855 066, select option 2
The University of Auckland                                        The manual claim form is available from
Phone: 0800 IMMUNE (0800 466 863)                                 health.govt.nz/new-zealand-health-system/claims-provider-
Email: 0800immune@auckland.ac.nz                                  payments-and-entitlements/immunisation-subsidy

The New Zealand Pharmaceutical Schedule is available from
PHARMAC at pharmac.govt.nz.
                                                                  Reporting adverse events following
                                                                  immunisation
Ordering printed influenza resources                              Centre for Adverse Reactions Monitoring (CARM)
                                                                  Phone: (03) 479 7247
Refer to the last page in this document for information on all
                                                                  Email: carmnz@otago.ac.nz
the influenza resources available.
                                                                  Website: nzphvc.otago.ac.nz
HealthEd                                                          (online reporting, use your practice number as login)
Website: healthed.govt.nz
The following three resources are ordered from HealthEd.          National Influenza Immunisation
They replace the After your flu immunisation leaflet and          Programme promotion
Avoid flu during pregnancy brochure used in previous years.       Email: influenza@auckland.ac.nz
•   After your child is immunised (HE1504),                       Website: influenza.org.nz

•	After your immunisation (HE2505) for teenagers and             Your Immunisation Coordinator may be able to assist with
   adults, and                                                    more information.

•   Immunise during pregnancy (HE2503), also available in
    Chinese Simplified, Chinese Traditional, English, Hindi,
                                                                  National Immunisation Register
    Māori, Samoan and Tongan                                      Ministry of Health Support team
                                                                  Email: onlinehelpdesk@health.govt.nz
The National Immunisation Register leaflet (HE2423) for           Phone: 0800 855 066, select option 5 and then option 3
adults is also ordered from HealthEd.
                                                                  Your District Health Board NIR administrator may be able
All other influenza resources can be ordered from:                to assist with more information.
Website: influenza.org.nz
                                                                  ImmuniseNow
Ordering vaccine
                                                                  Ministry of Health Support team
Healthcare Logistics (HCL)                                        Phone: 0800 855 066, select option 5 and then option 3
ONLINE: hcl.co.nz
(preferred option, registration required)                         Vaccine data sheets
TOLL-FREE fax: 0508 408 358*                                      Medsafe
                                                                  Website: medsafe.govt.nz
*Faxed or emailed orders incur a manual order processing fee
of $10 per order. The fax order form is available on page 8 and   Influenza information for health professionals
through the Resources section on influenza.org.nz.                Website: influenza.org.nz

Enquiries
Phone: 0508 425 358                                               Ministry of Health influenza vaccination
                                                                  policy and position statements
Cold chain                                                        Ministry of Health Influenza webpage
Your Immunisation/Cold Chain Coordinator.                         Website: health.govt.nz/our-work/preventative-health-
                                                                  wellness/immunisation/influenza
The National Standards for Vaccine Storage and
Transportation for Immunisation Providers 2017 (2nd
Edition), and the Ministry of Health National Immunisation
Programme cold chain management webpage

Website: health.govt.nz/coldchain

11        Key reference material
Summary table for 2020 funded influenza vaccines
                       Vaccine brand:                                AFLURIA® QUAD                                                                    AFLURIA® QUAD JUNIOR

                       Manufacturer:                                 • Seqirus • Phone: 0800 502 757

                       Funding status:                               • F ully funded for eligible adults and children aged 3 years or older,         • Fully
                                                                                                                                                            funded for eligible children aged under 3 years, i.e. aged 6–35
                                                                        when administered 1 April through 31 December 2020                              months, when administered 1 April through 31 December 2020

                       Dosage:
                                                                        Age                   Dose                       Number of doses                  Age                 Dose                      Number of doses

                                                                       6–35 months           NOT FOR USE IN THIS AGE GROUP                               6–35 months         0.25 mL                   1 or 2*

                                                                       3–8 years             0.5 mL                     1 or 2*                          3–8 years
                                                                                                                                                                                 NOT FOR USE IN THESE AGE GROUPS
                                                                       ≥ 9 years             0.5 mL                     1                                ≥ 9 years

                                                                      *Two doses separated by at least four weeks if an influenza vaccine is being     *Two doses separated by at least four weeks if an influenza vaccine is
                                                                       used for the first time.                                                          being used for the first time.

                       Presentation:                                 • Pre-filled syringe with needle: 0.5 mL                                         • Pre-filled syringe with needle: 0.25 mL

                                                                                                                                  AFLURIA® QUAD and AFLURIA® QUAD JUNIOR

                       Influenza strains for 2020:                   • A/Brisbane/02/2018 (H1N1) pdm09-like virus • A/South Australia/34/2019 (H3N2)-like virus • B/Washington/02/2019-like virus
                                                                     • B/Phuket/3073/2013-like virus

                       Route of administration:                      • Intramuscular

                       Precaution:                                   • Influenza vaccination may be contraindicated or need to be delayed for people receiving the following cancer treatments, atezolizumab
                                                                        (TECENTRIQ®), ipilimumab (YERVOY®), nivolumab (OPDIVO®) and pembrolizumab (KEYTRUDA®).
                                                                       For more information, refer to page 16 of this Booklet.

                       Components of special note:                   • Neomycin, polymixin B • Each 0.5 mL dose contains less than 1 microgram of ovalbumin

                       Latex:                                        • Latex-free

                       Storage:                                      • Vaccines must be stored, protected from light, at +2°C to +8°C. DO NOT FREEZE
                                                                     • Temperature-monitored chilly bins must be used if vaccines are temporarily stored outside the vaccine refrigerator or being transported
                                                                     • Quarantine vaccines stored outside the required temperature range and contact your Immunisation/Cold Chain Coordinator

                       Order from:                                   • Healthcare Logistics (HCL) • Phone: 0508 425 358 • Fax: 0508 408 358            • hcl.co.nz

Clinical information
                       AFLURIA® QUAD and AFLURIA® QUAD JUNIOR are prescription only medicines.                                                                                                                         influenza.org.nz
                                                                                                                                                                                                                          0800 IMMUNE
                       Please refer to the Medsafe data sheets for further details.                                                                                                                                     (0800 466 863)

   12
                                                                                                                                                                                                                         immune.org.nz
                       medsafe.govt.nz and influenza.org.nz
Questions and answers about the
2020 funded influenza vaccines
What are the funded influenza vaccines                          Can AFLURIA® QUAD or AFLURIA® QUAD
for 2020?                                                       JUNIOR be administered to people receiving
•   AFLURIA® QUAD (Seqirus) is the funded influenza vaccine     anticoagulant medication?
    for adults and children aged 3 years or older               Yes. Influenza vaccines can be administered to people on
•   AFLURIA® QUAD JUNIOR (Seqirus) is the funded influenza      anticoagulants, including aspirin, dabigatran (PRADAXA®),
    vaccine for children aged under 3 years, i.e. aged 6–35     enexoparin (CLEXANE®), heparin, ticagrelor (BRILINTA™)
    months                                                      and warfarin.28 After vaccination, apply firm pressure over
                                                                the injection site without rubbing for 10 minutes to reduce
Both are quadrivalent vaccines. For more information,           the risk of bruising.
please refer to the Medsafe data sheets (medsafe.govt.nz
or influenza.org.nz) and Summary of 2020 funded influenza
vaccines table on page 12.
                                                                Can AFLURIA® QUAD or AFLURIA® QUAD
                                                                JUNIOR be administered simultaneously
What are the influenza vaccine strains                          with other vaccines?
for 2020?                                                       Yes. Influenza vaccine can be administered with other
                                                                vaccines, such as Tdap, the zoster (shingles) vaccine,
The funded quadrivalent influenza vaccines in 2020 offer
                                                                meningococcal, pneumococcal or the childhood National
protection against the following influenza strains:24
                                                                Immunisation Schedule vaccines. However, the vaccines
•   A/Brisbane/02/2018 (H1N1)pdm09-like virus                   must be given at different injection sites.
•   A/South Australia/34/2019 (H3N2)-like virus
                                                                Can AFLURIA® QUAD and AFLURIA® QUAD
•   B/Washington/02/2019-like virus
                                                                JUNIOR be given to people with egg allergy
•   B/Phuket/3073/2013-like virus                               or anaphylaxis?
                                                                Yes. These vaccines can be administered to people with a
Is there a minimum interval between an                          history of egg allergy or egg anaphylaxis at general practices,
influenza vaccination at the end of 2019 and                    pharmacies or at the workplace, although the data sheet
this year’s vaccination?                                        advises caution in people who have a history of egg anaphylaxis.
No minimum interval is required between an influenza            Studies have shown that influenza vaccines containing one
vaccination in 2019 and one in 2020. The 2020 influenza         microgram or less of ovalbumin do not trigger anaphylaxis in
vaccination can be given from 1 April, as soon as the vaccine   sensitive individuals.4 The residual ovalbumin in one dose of
is available.                                                   AFLURIA® QUAD or AFLURIA® QUAD JUNIOR is below this limit.5

Why is an influenza vaccination                                 Can AFLURIA® QUAD and AFLURIA®
recommended every year?                                         QUAD JUNIOR be given to people with a
Yearly vaccination is recommended for two reasons: first,
                                                                sulfonamide (sulfur) allergy?
because protection from the previous vaccination lessens        Yes. Sulfonamide (sulfur) antibiotics, such as co- trimoxazole,
over time; and second, because the circulating influenza        sulfasalazine, and sulfite preservatives used in food, are
viruses can change and the strains in the vaccine usually       different to medicines containing the words sulfate or
change each year in response to the changing virus pattern.     sulphate, e.g. neomycin sulfate.34

13       Clinical information
How are AFLURIA® QUAD and AFLURIA®                              Can you get influenza from AFLURIA® QUAD
QUAD JUNIOR produced?                                           and AFLURIA® QUAD JUNIOR?
AFLURIA® QUAD and AFLURIA® QUAD JUNIOR are split virion         No. These vaccines have been made from influenza viruses
vaccines that contain disrupted haemagglutinin proteins         that have been concentrated, inactivated, and then broken
from the surface of the virus. Influenza virus is grown in      apart. Neither AFLURIA® QUAD nor AFLURIA® QUAD JUNIOR
embryonated hens’ eggs from disease-free flocks and             can cause influenza as the vaccines do not contain any
inactivated. The haemagglutinin protein for each strain is      live viruses.5
harvested, purified and inactivated for use in the vaccine.5
                                                                Sometimes influenza vaccination is accused of causing the
                                                                disease. There are two possible reasons for this. First, when
Do AFLURIA® QUAD and AFLURIA® QUAD                              vaccinated, the body responds to vaccination by producing
JUNIOR contain antibiotics?                                     an immune response. This can include systemic symptoms
Yes. Both vaccines contain traces of neomycin and polymixin     such as fever, headache or fatigue, which may mistakenly
B due to their use during production.5 The vaccines should be   be assumed to be early signs of influenza but are the body
used with caution in people with known anaphylaxis to either    responding to the vaccination. Second, other respiratory
of these antibiotics.                                           viruses and bacteria circulate during the winter months and
                                                                influenza vaccination does not protect against these.
Are AFLURIA® QUAD and AFLURIA® QUAD                             Most of these other viruses cause milder infections. However,
JUNIOR latex free?                                              some viruses and bacteria may produce influenza- like
                                                                symptoms and/or quite severe illness that can lead to the
Yes. Neither AFLURIA® QUAD nor AFLURIA® QUAD JUNIOR
                                                                suggestion that influenza vaccination is ineffective. These
syringes or related components contain natural rubber latex.5
                                                                illnesses should not be confused with influenza.

Do AFLURIA® QUAD and AFLURIA® QUAD                              How effective are the vaccines against
JUNIOR contain blood products?                                  influenza strains not included in
No. Blood products are not used in the manufacturing
processes for these vaccines.5,35
                                                                the formulation?
                                                                Effectiveness can be reduced by a difference between
                                                                circulating virus strains and vaccine strains. The influenza
Do AFLURIA QUAD and AFLURIA
                 ®                               ®
                                                     QUAD       virus keeps changing and new vaccines are formulated for
JUNIOR contain thiomersal?                                      each northern and southern hemisphere season. There may
No. Both these vaccines are preservative free. They do not      be some cross protection against a virus type that is not
contain thiomersal.5                                            in the vaccine35,36 but the amount of protection cannot be
                                                                guaranteed or easily quantified.

                                                                Does the influenza vaccine protect
                                                                against coronaviruses?
                                                                Influenza vaccine does not protect against coronavirus
                                                                infections; however, it will help prevent a serious illness that
                                                                causes hundreds of deaths each winter in New Zealand.

    Pharmacist vaccinators
    Many community pharmacies offer influenza vaccination for individuals aged 13 years
    or older. Some community pharmacies also provide funded influenza vaccination for:

       	 pregnant women, and

       	 people aged 65 years or over

                                                                                          Clinical information            14
Safety of inactivated
influenza vaccines
Common responses to vaccination                                   vaccinations) and the vaccination campaign was halted and
                                                                  surveillance of GBS expanded. 44
Influenza vaccine is generally well tolerated.
                                                                  Epidemiological studies since then have suggested either
Common responses associated with inactivated influenza            no increased risk or a possible slight increase in risk of
vaccines in adults and children include pain, redness and/or      around one case per million adult influenza vaccinations. A
swelling at the site of injection. Local responses are almost     meta-analysis of these studies identified a small increase in
always mild. Systemic events such as headache, muscle             the risk of GBS following influenza vaccination. 45 However,
aches and fatigue may occur in adults.37,38 Fever, irritability   studies have also identified that the risk of GBS following an
and loss of appetite are more likely to occur in children.39,40   episode of influenza-like illness is significantly higher than
These are generally mild and usually resolve after a day or       the risk following influenza vaccination, especially in older
so. Systemic events may appear influenza-like. However,           adults. 46,47 This highlights the importance of balancing the
the influenza vaccines currently used in New Zealand do not       potential risks of disease with the potential risks and benefits
contain live viruses5 and cannot cause the disease.               of influenza vaccination to make an informed decision. 48

Serious events associated with                                    Febrile events following influenza
influenza vaccination                                             vaccination
The most significant serious adverse event associated with        Fever is a common adverse event in children after
influenza vaccination is anaphylaxis, a serious allergic          vaccination.39,40 Convulsions associated with fever can occur
response that usually comes on within minutes of receiving        in susceptible children. Around 3–8 children in 100 aged
the vaccine. This occurs around once in a million influenza       under 7 years will experience a febrile convulsion, most likely
vaccine doses. 41                                                 when aged between 16 and 30 months. 49
With the possible exceptions of Guillain-Barré syndrome           In one study, children aged 6–23 months were two to three
(refer below) and that side effects related to some new           times more likely to develop a fever of 38°–39°C during the
immune-stimulant cancer treatments could be triggered,            first 24 hours after receiving influenza and PCV13 (PREVENAR
refer to page 16, other vaccine-related serious adverse           13®) vaccines at the same visit compared with children who
events, such as a convulsion associated with fever or             received the vaccines on separate days.29
cellulitis-like local reaction, are rare.6,36,42
                                                                  Parents/guardians whose children are recommended
                                                                  to receive both influenza vaccine and PCV13 should be
Guillain-Barré syndrome and
                                                                  advised of the possible increase in risk of fever following
influenza vaccination                                             concurrent administration of these vaccines. Separating
Guillain-Barré syndrome (GBS) has an annual incidence of          administration of these vaccines by 2 days can be offered,
around 1–4 cases per 100,000 people worldwide. 43                 but is not essential.
During a swine influenza vaccination campaign in the United       For the PREVENAR 13® data sheet, please refer to the
States in the 1970s, an increase in GBS was observed              Medsafe website medsafe.govt.nz.
in vaccine recipients (around one case per 100,000

Reporting adverse events
following influenza vaccination
Healthcare professionals/vaccinators are professionally           •   treatment required
and ethically responsible for reporting any serious or            •	outcome if known but do not delay reporting while
unexpected adverse events after the administration of all             waiting outcome information
medicines, including the influenza vaccine, regardless of
                                                                  Some providers are able to report events through their
whether or not they consider the event to have been caused
                                                                  practice management system. Reports can be completed
by the vaccination.
                                                                  online (nzphvc.otago.ac.nz), or the form can be downloaded
Information should include:                                       and printed using the above link, completed and mailed to:
•   vaccinee’s details                                            Freepost 112002
•   the vaccine administered                                      The Medical Assessor
•   vaccine batch number                                          Centre for Adverse Reactions Monitoring
                                                                  University of Otago Medical School
•   date of onset of symptoms
                                                                  PO Box 913, Dunedin 9054
•   type and duration of adverse event                            or faxed to: (03) 479 7150

15        Clinical information
Contraindications and precautions
to receiving influenza vaccine
Who should not receive the vaccine?                                  Influenza vaccination may be
Influenza vaccination is contraindicated for individuals who         contraindicated or need to be delayed
have had documented anaphylaxis to any ingredient in the             for people receiving some newer
vaccine except egg,4 or a previous dose of inactivated influenza
vaccine. These individuals should not receive the vaccine.
                                                                     cancer treatments
                                                                     The     immune-stimulant       actions    of     atezolizumab
                                                                     (TECENTRIQ ®), ipilimumab (YERVOY®), nivolumab (OPDIVO ®)
                                                                     and pembrolizumab (KEYTRUDA®) on the immune system
                                                                     increase a person’s risk of developing autoimmune
                                                                     conditions. It is not known whether receipt of an influenza
                                                                     vaccine whilst receiving these treatments or for up to 6
                                                                     months after treatment increases a theoretical risk of
                                                                     triggering the occurrence of these side effects.
                                                                     Please contact the person’s oncologist or 0800 IMMUNE
                                                                     (0800 466 863) for current advice about influenza
                                                                     vaccination for these people BEFORE administering
                                                                     the vaccine.3

Effectiveness of inactivated
influenza vaccines
The efficacy (prevention of illness among vaccinated                 influenza-like illness.54 Vaccine effectiveness may not be as
individuals in controlled trials) and effectiveness (prevention      high in older people.55-58 However, older people who have
of illness in vaccinated populations) of influenza vaccines is       been vaccinated but subsequently get influenza are less likely
dependent on several factors. The age, immune status and             to have severe disease,59,60 complications,59,61,62 including
health of the recipient are important as well as the match           cardiovascular events,61,63 hospitalisation,55,64 increased
between circulating viral strains and the vaccine. Research          disability or frailty65,66 or influenza-related death.55,64 Table 1
comparing vaccinated with unvaccinated participants show             on the following page summarises selected current estimates
outcome measures that include laboratory-confirmed                   of inactivated influenza vaccine efficacy and/or effectiveness
infection with influenza virus provide the most robust evidence      against a range of clinical outcomes.
of vaccine efficacy.
                                                                     Pooled New Zealand data from the Southern Hemisphere
Trivalent influenza vaccines contain two influenza A strains         Influenza and Vaccine Effectiveness Research and
(a H1N1 and a H3N2 strain) and one influenza B strain (from          Surveillance (SHIVERS) study have shown that influenza
either the Yamagata or Victoria line). Quadrivalent influenza        vaccine effectiveness over 2012–2015 was around 46% (95%
vaccines contain two influenza A strains (a H1N1 and a H3N2)         confidence interval 35–55%) preventing influenza-like illness
and two influenza B strains (one from each line). Receipt            presentations to general practice and 52% (41–62%) preventing
of a quadrivalent influenza vaccine broadens the immune              influenza-related hospitalisations.52,67-69 Low influenza activity
response, which may provide additional protection if influenza       in 2018 caused imprecision in the assessment of influenza
B viruses from both lines are circulating or the predominant         vaccine effectiveness. Estimated vaccine effectiveness in
circulating influenza B virus is not from the line included in the   preventing influenza-like illness presentations to general
trivalent vaccine.50                                                 practice was 38% (95% confidence interval 1–61%) and in
                                                                     preventing influenza-related hospitalisations was 35% (95%
When influenza vaccine strains match circulating influenza
                                                                     confidence interval 12–52%).14
viruses, protection against influenza is primarily dependent
on circulating antibodies. These peak during the first month
after vaccination and decrease over 6 months (influenza A
(H1N1) and B viruses) or 5 months (influenza A (H3N2) viruses)           How long after vaccination does it take for
after vaccination.51                                                     antibodies to be produced?
Influenza vaccines are effective in children. However, less              It can take up to 2 weeks for the vaccine to provide
evidence is available for children aged under 2 years.36,52 In           the best influenza protection. However, influenza
healthy adults, influenza vaccines are effective in reducing             vaccinations can be given when influenza virus
cases of influenza particularly when the vaccine and                     activity has been identified as protective antibody
circulating virus strains are well matched.36,53 Inactivated             levels have been observed to develop rapidly from
influenza vaccine effectiveness is around 60% against                    4 days after vaccination.22
laboratory-confirmed influenza and just below 20% against

                                                                                                Clinical information              16
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