MVEC influenza recommendations 2018

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

  • All children 6 months to < 5 years (Victorian state funded program commencing May 2018)
  • Adults ≥ 65 years of age
  • Pregnant women (at any stage of pregnancy)
  • People with specific medical risk factors [refer to ATAGI position statement-Table 2]
  • Aboriginal & Torres Strait Islanders aged 6 months to < 5 years and ≥ 15 years of age

For people outside of this criteria, the influenza vaccine is available for private purchase.

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

There are a number of key messages for the 2018 season:

  • Quadrivalent influenza vaccines (QIV) continue to be funded on the National Immunisation Program
  • For those aged ≥ 65 years, we preferentially recommend the new higher-immunogenicity trivalent influenza vaccines (TIV) available (Fluad and Fluzone High-dose – details below)
  • There is one change for the influenza vaccine in 2018, with the A(H3N2) strain changing to Singapore/2016
  • MVEC continue to recommend co-administration of influenza and pneumococcal vaccines at any age (i.e. both vaccines can be administered on the same day)
  • If children < 9 years only received a single influenza vaccine for the 1st time in 2017, only a single dose is recommended in 2018
  • Two doses of the QIV (1-month apart) are recommended for two groups:
    • Children 6-months to < 9 years, the very 1st year they receive the QIV (see Table below )
    • Immunosuppressed patients, the 1st year they receive the QIV
    • NB: If immunosuppressed and ≥ 65 years, only a single dose of the TIV (Fluad or Fluzone High-dose) is recommended

The quadrivalent inactivated influenza vaccine (QIV) in 2018 will contain:

  • A H1N1 pandemic09 (A/Michigan/2015)
  • A (H3N2) (A/Singapore/2016)
  • B /Brisbane/2008
  • B /Phuket/2013

Dosing guidelines by age

Age Dose Vaccine Brand Number of doses in the 1st year the vaccine is received Number of doses in subsequent years
< 6 months Not recommended (poor immune response)  
6 months to < 3 years 0.25ml FluQuadri Jnr 2 (4-weeks apart) 1
3 years to 8 years 0.5ml Fluarix Tetra/ FluQuadri 2 (4-weeks apart) 1
9 years to 17 years 0.5ml Fluarix Tetra/ FluQuadri 1 1
18 years to 64 years 0.5ml FluQuadri/ Fluarix Tetra/ Afluria Quad*/ Influvac Tetra 1 1
≥ 65 years# 0.5ml Fluzone High-dose (TIV)/ Fluad (TIV) 1 1

* Please note that Seqirus Afluria Quad is NOT registered for use in children aged <18 years.
# TIV formulations are preferentially recommended for adults ≥ 65 years of age. Quadravalent influenza vaccines (FluQuadri/ Fluarix Tetra/ Afluria Quad*/ Influvac Tetra) are licenced but not preferred for those ≥ 65 years.

Influenza vaccine in the ≥ 65 year age group

In 2017, there was a significant increase in seasonal influenza cases and unfortunately those ≥ 65 years were not optimally protected by the QIV, particularly the H3N2 strain. In order to provide better protection in 2018 against hospitalisation with influenza and pneumonia, higher-immunogenetic trivalent influenza vaccines (TIV) have been added to the immunisation schedule for the older population. Fluad and Fluzone High-dose are funded and the preferred vaccines in this age group. However, there is no preference for use between either of these two TIVs. Both provide protection against 2 Influenza A strains, and 1 Influenza B strain . Whilst there is one less B strain in these vaccines compared to the QIV, the important benefit will be increased protection from the three TIV strains. [NB: standard TIVs are no longer available in Australia]

Both vaccines are safe but can cause mild side effects such as injection site reactions and fever. This may occur slightly more commonly than the standard QIV formulations.

Influenza vaccine in immunocompromised patients

Recommendation: Patients who are immunocompromised due to an underlying disease and/or immune suppressant therapy [refer to the Australian Immunisation Handbook for further details on immune suppression] are recommended to have 2 doses the very 1st year they receive the QIV influenza vaccine .

An exception is the ≥ 65 years, who are recommended to have a single dose of the TIV (details above)

As there is only one strain change to the QIV in 2018 (as detailed above), a single influenza dose is recommended for those immunocompromised patients who had the QIV in 2017.

Influenza vaccine and egg allergy

Based on prospective and retrospective studies of influenza vaccination in those with and without egg allergy (including egg anaphylaxis), the presence of egg allergy does not increase the risk of allergic reactions to the influenza vaccine.

The influenza vaccine can be administered in community vaccination clinics (which may or may not have direct medical practitioner supervision), General Practitioner surgeries or Immunisation clinics, as a single dose followed by the recommended 15 minute observation period. Refer to resources below for further details.

Influenza vaccine and pneumococcal conjugate vaccine (PCV) in children < 5 years

Recommendation: PCV13 and influenza vaccines can be co-administered on the same day. This includes infants at 6-months and 12-months of age.

Influenza vaccine and pregnancy

Pregnant women are more at risk of serious illness due to influenza compared to non-pregnant women.

Catching the flu whilst you are pregnant can lead to serious illness such as pneumonia and can cause miscarriage or premature labour.

Pregnant women are more likely to be hospitalised than non-pregnant women due to the flu.

The influenza vaccination will protect the mother and baby from the risk of serious illness and hospitalisation.

Recommendation: We recommend the QIV for all pregnant women.

It is Free, and it can be received safely at any time during pregnancy.

Vaccine safety

SAEFVIC would be happy to discuss any vaccine safety (adverse event following immunisation) queries.

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

Resources

Reviewed by: Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute) and Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)

Date: September 2018

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.