2022 Seasonal Influenza Programme - (as at 23 March 2022) Refer to Flu kit booklet (when available) or influenza.org.nz for current information
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2022 Seasonal Influenza Programme
(as at 23 March 2022)
Refer to Flu kit booklet (when available) or influenza.org.nz for current information
Karakia
Whakataka te hau ki te uru Cease the winds from the
west
Whakataka te hau ki te tonga Cease the winds from the
south
Kia mākinakina ki uta Let the breeze blow over
the land
Kia mātaratara ki tai Let the breeze blow over
the ocean
E hī ake ana te atakura Let the red tipped dawn
come with a
He tio, he huka, he hau hū sharpened air.
A touch of frost, a promise
Tihei mauri ora! of a glorious
day.
Programme today • 5.30pm Influenza and influenza vaccine - Lisbeth Alley, IMAC • 6.10pm Recording 2022 influenza vaccines – Loren Shand, MOH • 6.20pm 2022 Influenza promotional campaign – Rachel Lorimer, MOH • 6.30pm Questions
Influenza-like illness reported 2019–2022
Influenza vs. common cold vs COVID-19
Influenza Common cold COVID-19
• Sudden onset • Mild illness • Fever
• High fever • Mild fever • Sore throat
• Severe headache • Mild headache – • Breathlessness
• Dry cough becomes moist sinuses • Headache
• Muscle ache • Occasional cough • Dry cough
• Bed rest necessary • Muscle ache • Body ache
• Can suffer serious
• Runny nose • Fatigue
complications (eg,
secondary pneumonia) • Runny nose
Influenza complications
• Pneumonia (secondary and bacterial) • Otitis media
o Respiratory failure • Death from overwhelming
• Myositis sepsis can progress rapidly
• Encephalopathy • Exacerbates underlying medical
• Myocarditis conditions (eg, pulmonary,
cardiac or metabolic disease)
• Reye’s syndrome
• Bronchitis
• Pericarditis
Influenza and cardiovascular disease • Inflammatory response to disease causes changes to blood vessels around the heart and tachycardia • Accelerates plaque generation • Thrombi can then form in vessels • Obstructed blood supply can trigger an AMI • Secondary infections such as pneumococcal pneumonia, have been linked to increased CVD risk
Prevention of CVD
• Cardiac complications of influenza infection e.g. myocarditis, are well
recognised
• 6-10 times higher risk of AMI/stroke for up to 1-week post influenza
• Vaccinated older people less likely to develop severe illness, be
hospitalised, admitted to ICU
• Vaccination as effective as interventions such as statins, antihypertensive
drugs and smoking cessation
• Increasing evidence that regular annual influenza vaccination increases
protection
J.C. Kwong, et al. Acute myocardial infarction after laboratory-confirmed influenza infection N Engl J Med, 378 (4) (2018), pp. 345-353,
C. Warren-Gash, et al. Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: a systematic reviewLancet Infect Dis, 9 (10) (2009), pp. 601-610,
A.K. Boehme, et al. Influenza-like illness as a trigger for ischemic stroke Ann Clin Transl Neurol, 5 (4) (2018), pp. 456-463.
.
Turner N, et al. The effectiveness of seasonal trivalent inactivated influenza vaccine in preventing laboratory confirmed influenza hospitalisations in Auckland, New Zealand in 2012. Vaccine. 2014;32(29):3687-93
Risks for hapū māmā and babies • Physiological changes: o Decreased lung capacity o Increased cardiac output o Altered cell-mediated immunity • An influenza infection can have serious consequences including premature birth, miscarriage/stillbirth, low birth weight and perinatal death. • 5x more likely to be hospitalised with influenza compared with non-pregnant (SHIVERS data, Auckland 2012-2014)
Co-circulation and co-infection with COVID-19
• Co-infection with ILI and COVID-19 increases risk for severe disease
• Data from the UK’s winter of 2019–2020 suggest that COVID-19 and
influenza co-infections have resulted in higher mortality rates
compared to those who only tested positive for COVID
• Age specific mortality rates were higher among older people with co-
infection
Fujita DM ,et al. COVID-19 and Influenza coinfection: The rise of Ômicron and H3N2 in Brazil - 2022. Travel medicine and infectious disease. 2022;46:102262.
Stowe J, et al. Interactions between SARS-CoV-2 and influenza, and the impact of coinfection on disease severity: a test-negative design. International Journal of
Epidemiology. 2021; 50(4):1124-1133.
Dadashi M, et al. COVID-19 and Influenza Co-infection: A Systematic Review and Meta-Analysis. Frontiers in Medicine. 2021, 8:681469Potential for 2022 flu season resurgence
• Reduced influenza incidence has been
observed in NZ, Au, UK, US and Europe
• Minimal respiratory illnesses reported
during the 2020–2021 Northern
Hemisphere winter season
• Large compensatory influenza seasons are
predicted to follow the 2019–2021 light
seasons due to:
• Reduced residual immunity from 2020 &
2021
• Re-opening of borders
(Lee, et al 2022)Flu Kit 2022 to come
• Content and references updated
• See www.influenza.org.nz/resources
• Flu kit references will be available at:
www.influenza.org.nzSummary of 2022 Influenza Vaccines – available now
https://www.influenza.org.nz/Influenza vaccine strains 2022
2022 influenza vaccines contain 4 strains
• A/Victoria/2570/2019 (H1N1)pdm09-like virus
• A/Darwin/9/2021 (H3N2)-like virus*
• B/Austria/1359417/2021-like virus*
• B/Phuket/3073/2013-like virus
*new strains 2022Influenza programme 2022 Start date: 1 April 2022 Updated information: www.influenza.org.nz • vaccine details • vaccine supply • eligible groups • Flu Kit • resources. All vaccines are ordered through HCL.
Two funded vaccines (for eligible groups) available for 2022 AFLURIA® QUAD JUNIOR AFLURIA® QUAD • Children aged
Two unfunded vaccines available for 2022 FLUAD® QUAD FLUQUADRI™ • For ≥65 years From > 6 months of age and older • Adjuvanted vaccine (MF59) • 1 or 2 doses • Stimulates an immune response to • Unfunded only - purchase through get similar effectiveness as for GPs, many pharmacies (aged 13+) younger people • Unfunded only - purchase through GPs, pharmacies
Ordering – order ALL influenza vaccines through HCL
Vaccine Age group Dose per Available Vaccination
pack to order start date
AFLURIA® 6–35 months 1
QUAD JUNIOR
AFLURIA® QUAD 3 years and over 10
7 March 1 April 2022
FLUAD® QUAD 65 years and over 10
FLUQUADRI™ 6 months and older 5
You will be advised when your order has been dispatched out
of HCL and you will be able to track and trace it as usual.2022 influenza vaccines - needles Funded: • AFLURIA® QUAD JUNIOR – pre-filled syringe with fixed needle • AFLURIA® QUAD – pre-filled syringe with fixed needle Unfunded: • 2022 FLUAD® QUAD – pre-filled syringe – no needle. • FLUQUADRI® – pre-filled syringe – needle supplied unattached.
Eligibility 2022 TBC
Influenza immunisation is recommended and FREE for those most likely to get
very sick, go to hospital or die from influenza:
1. pregnant women/ hapū māmā (any trimester)
2. people aged 65 years or older
3. people aged under 65 years with diabetes, most heart or lung conditions and
some other illnesses
4. children aged 4 years or under who have been hospitalised for respiratory
illness or have history of significant respiratory illness
TBC: Pharmac consultation underway re Māori and Pacific peoples aged between 55 and 64
years of age inclusive.Influenza vaccines for children
Age Vaccine brand Dose Number of doses
6–35 months AFLURIA® QUAD JUNIOR 0.25 mL 1 or 2*
6 months+ FLUQUADRI™ 0.5 mL 1 or 2*
(unfunded)
3–8 years AFLURIA® QUAD 0.5 mL 1 or 2*
≥9 years AFLURIA® QUAD 0.5 mL 1 dose
*Two doses separated by at least four weeks, if influenza vaccine is being used for the first time.Influenza and PCV13 • Increased risk of fever when influenza vaccine given with PREVENAR 13® in children aged 6–23 months • Advise parents/guardians whose children are recommended to receive both influenza vaccine and PCV13 • Offer to separate by two days, but not essential
Precautions and contraindications All vaccinations • Anaphylaxis to previous dose or component of the vaccine • Defer if: o Acutely unwell with fever (>38oC) o Other systemically unwell illness
Precautions and contraindications Egg allergy or anaphylaxis • All influenza vaccines can be given to people with history of egg allergy or anaphylaxis. • Influenza vaccines with up to 1 microgram of ovalbumin do not trigger anaphylaxis in sensitive individuals. • The residual ovalbumin in one dose of influenza vaccine is below this limit.
Immune checkpoint inhibitors and vaccination
A person who is currently receiving any of the immune checkpoint inhibitor treatments:
• atezolizumab (TECENTRIQ®)
• ipilimumab (YERVOY®)
• nivolumab (OPDIVO®) and,
• pembrolizumab (KEYTRUDA®).
or who has received any of these in the previous 6 months can receive any non-live
vaccine.
LIVE vaccines are contraindicatedSpacing of Influenza and COVID-19 vaccines Current advice is: • The influenza vaccine can be given concomitantly with Pfizer and AstraZeneca COVID-19 vaccines. • FLUAD® QUAD and Nuvaxovid (Novavax) or Shingrix – 3-day gap recommended (all adjuvanted vaccines) • Pregnant women are recommended to have influenza and mRNA-CV (Pfizer) COVID-19 vaccine at any stage of pregnancy (can be given the same time) Note: there is no set gap between COVID-19 disease and having your influenza vaccine – just when you are well again.
Do Influenza vaccines contain antibiotics? • FLUAD® QUAD contains traces of kanamycin and neomycin due to their use during production. • AFLURIA® QUAD and AFLURIA® QUAD JUNIOR contain traces of neomycin and polymyxin B. • These influenza vaccines should be used with caution in people with known anaphylaxis to any of these antibiotics. • No antibiotics are used in the manufacture of FLUQUADRI™.
2022 influenza vaccines All 2022 influenza vaccines available in NZ are: • inactivated and cannot cause influenza • do not contain latex • do not contain preservatives AFLURIA® QUAD, AFLURIA® QUAD JUNIOR and FLUQUADRI™ do not contain an adjuvant FLUAD® QUAD contains an adjuvant MF59 which is squalene based – from fish. Squalene is also produced naturally in the human body.
Vaccines and anticoagulants Influenza vaccines can be administered to people on anticoagulants, including aspirin, dabigatran (PRADAXA®), enoxaparin (CLEXANE®), heparin, rivaroxaban (XARELTO®), ticagrelor (BRILINTA™) and warfarin. After vaccination, apply firm pressure over the injection site without rubbing for 10 minutes, to reduce the risk of bruising.
Safety of influenza vaccination Common immune responses include: • Pain, itching and redness at site (1 in 3 adults) • Ache and pains (1 in 10 adults) • Fever, unwell, tired Note: maybe more common with adjuvanted influenza vaccine • Most significant serious reaction is anaphylaxis (1.5 per million) • Fever common in children Note: AN INACTIVATED VACCINE CANNOT GIVE YOU INFLUENZA!
Documenting influenza vaccines 2022 • Ensure all vaccinators are notified to the NIR team and have completed an AUA - includes pharmacists. • Notify all influenza vaccinations given (including to pregnant women) to the NIR/NIS - with consent • Remember to opt adults onto NIR before entering vaccination details or at same time, depending on PMS requirements • The provider should be noted as the GP in the ‘provider’ box and whoever administers the vaccine as the ‘vaccinator’ • FLUAD® QUAD and FLUQUADRI™ are recorded under normal 65+ selection
How long does a person have to wait after receiving an influenza
vaccination?
NOTE: post-vaccination wait time for 'influenza
only' vaccination is being reviewed - further
advice may follow.Vaccination during pregnancy • Trans-placental transfer of influenza-specific antibodies may provide protection for up to 6 months • Influenza vaccine used in hapū māmā since 1960s with considerable safety data • Influenza vaccination in early pregnancy is safe with no increase in major malformations • Vaccination is associated with a decrease in stillbirth rate Eick AA, et al. Maternal influenza vaccination and effect on influenza virus infection in young infants. Arch Pediatr Adolesc Med. 2011;165(2):104-11
Discuss and recommend to hapū māmā and their whānau • WHO recommends that hapū māmā be given HIGHEST PRIORITY for influenza vaccination at ANY stage of pregnancy. • Risk of influenza and complications for both • Vaccine is effective for woman and her baby during pregnancy and after birth. • Influenza vaccine has an excellent safety record during pregnancy. • Make a clear recommendation for woman to receive influenza vaccination during pregnancy.
Influenza vaccine coverage for pregnant women
By ethnicity – some groups are less protected
70
60
50
40
Percentage
30
20
10
0
2017 2018 2019 2020
Delivery Year
Māori Pacific Peoples Asian NZEO
Qlik data downloaded and analysed to July 2021Vaccination and breastfeeding • The influenza vaccine can be given when breastfeeding • Protecting the mother can help prevent her becoming infected and transmitting influenza to baby
Influenza immunisation coverage 2021
Should healthcare workers be vaccinated? YES • Protect patients at greater risk of developing complications • Improved patient and employee safety; decreased healthcare expenditure • Staff have a duty of care to protect vulnerable patients from threat of influenza illness. • Relying on patients being vaccinated is not enough; many vulnerable people have poor immune response to vaccine or may not have been vaccinated this year.
Avoiding shoulder injury related to vaccine administration (SIRVA) Landmarking the deltoid injection site • Find the acromion process • Find the deltoid tuberosity • Injection site is halfway between the two • Give vaccine in bulkiest part of the muscle- usually in line with the axilla
Questions?? Phone: 0800 466863/0800 immune Email: 0800immune@auckland.ac.nz
IMAC Flu Webinar National Immunisation Solution Loren Shand - Programme Manager for National Immunisation Programme technology 23.03.2022
National Immunisation Solution (NIS) – supporting FLU 2022 campaign
Below outlines the key messages on the NIS and how it will utilised during the 2022 Flu campaign
Flu immunisation providers will choose how to
The NIS is different from both The NIS will continue to evolve The first sector experience of
record flu by utilising either;
the current National and develop throughout 2022. the NIS will be supporting the
• the CIR (hosting a form)
Immunisation Register (which Flu Vaccination 2022 campaign.
• Using existing integrated electronic
it will replace) and the Covid Whereby ALL flu vaccinations
systems that already reports onto the NIR
Immunisation Register (which it will be captured in the NIS as of
will eventually supersede). the
Both options will then have inputs mapped
Critical is the learning derived 1st April 2022.
into the NIS
from both systems to inform
the development.MVP – 3 Key Scenarios
What is the ask of the sector:
Current Model Future state 1 April
For those that currently do not use a system (paper based or electronic)
that can submit information to the NIR to record flu vaccination You will be asked to start using direct entry into NIS via the ‘Flu form’ which
For those that currently use ImmuniseNow to record flu vaccinations direct will be hosted on the CIR
into NIR
For those that have an electronic system (mainly Patient Management You will have the option of moving to direct entry into NIS via the ‘Flu form’
Systems) that directly submit information to NIR which will be hosted on the CIR, but will not be required to do so.
If you continue to submit data to NIR directly from electronic systems for
We understand this to mainly be related to GP systems. flu we will pick this data up from NIR and place this into NIS.Determining your NIS onboarding needs
Are we planning This does
to vaccinate for NO not apply to
Flu in 2022? you
USE THIS DIAGRAM TO DETERMINE WHAT
YES YOUR ONBOARDING NEEDS ARE
Are we
vaccinating NO
COVID?
YES Do we hope to use
CIR to capture Flu
vaccinations?
Continue to
Complete Does our PMS
onboarding record flu
YES NO connect directly to YES vaccinations
steps in blue on
the NIR? in your PMS
next page
Record flu
For Flu, do we vaccinations in
NO the CIR.
capture YES
For Flu, do we use Complete
NO vaccination details
Immunise Now ? onboarding
on a paper based NO steps in orange
form? on next page
YESYour NIS Onboarding Journey
Select Pathway Site setup User setup Training Reporting Help & Support
Determine next steps based on your Ensure site is set up to vaccinate Provide users with access to NIS Getting users upskilled to Reporting requirements setup Providing a ‘one front door’
current processes for Flu 2022 and onboard workforce document flu vaccinations approach to our service desk
EXISITING COVID All existing users will
For existing vaccinators:
VACCINATING SITES No action required No action required
receive an invitation to A reporting workshop will
complete flu related be available to outline the One door support system
training and drop in flu specific reporting help@imms.health.govt.nz
Adding Flu capability For new vaccinators:
You may be contacted by your sessions functionality
complete a new user setup
DHB lead to confirm your intent form. Await confirmation
to provide flu vaccinations New users will complete
and email regarding training
training as noted in
orange stream below
NEW TO NATIONAL
Complete site setup form Receive user set up form All new user will receive an A reporting workshop will
IMMUNISATION SOLUTION email inviting them to: be available to onboard
Complete with all vaccinator details • Complete initial E- new users to enable use One door support system
Planning to deliver Flu and return form learning module of the reporting
Return completed form to NIS.engagement@health.govt.nz • Register for a Zoom functionality in NIS help@imms.health.govt.nz
vaccinations NIS.engagement@health.govt.nz webinar by providing
Await confirmation and email their email/name
Await confirmation and user setup regarding training
requestWhat you can do to prepare?
• Use the decision tree to understand your onboarding requirements – choose your lane
BLUE LANE ORANGE LANE THIS DOES NOT APPLY
Existing Vaccinator using CIR – Training Only New to CIR – register your site and As I am not delivering flu or I have a PMS
vaccinators and training system linked to the NIR
• Prepare to report all funded and unfunded flu vaccinations
• Commence your onboarding journey!
• Please email questions to NIS.engagement@health.govt.nz
• Plan for workforce to complete training the week commencing 25th March 2022 –
estimated 60 min elearning2022 Influenza Promotional Campaign Rachel Lorimer – Group Manager, Communications & Engagement, National Immunisation Programme
Campaign Overview
• Maximise the uptake of the influenza vaccine with a specific emphasis on
priority equity groups.
• Campaign messaging, tone, visuals will prioritise and connect with key equity
groups - Māori, Pasifika and disabled people.
• Grounded in research and insights.
• Leverage the learnings from the COVID-19 vaccination campaign.
• This year’s campaign will run from 1 April to 30 June and will have two phases.Campaign Phases
Phase One – Priority Groups
• From 1 April marketing activity will target those aged 65 and over and
pregnant people.
• Will include targeted advertising (local press, niche publications, digital, social)
and stakeholder engagement (e.g. Age Concern, Plunket)
• Additional activity targeting Māori, Pacific and disabled communities
with whānau approach.
• Provide DHBs, GPs and Pharmacies with resources e.g. posters, flyers to have
conversations with their patients.
Phase Two – All of New Zealand
• From May higher profile campaign to raise awareness of flu vaccination and
including workplace vaccination using broader channel media mix.
• Continued focus on priority equity groups.Flu Campaign Webpage
Channels and Resources
Resources Media Channels
Flyers Radio
Posters Print e.g local newspapers, niche
publications
Newsletter content Out-of-home
Social tiles Social
Teardrop banners TV
Website DigitalQuestions
Thank you
Questions?
Closing Karakia Unuhia, unuhia Unuhia ki te uru tapu nui Kia waatea, kia maamaa te ngaakau, Te tinana,te wairua I te ara tangata Koia raa e Rongo, whakairia ake ki runga Kia tina! Tina! Hui e! Taaiki E!
Useful contacts The Immunisation Advisory Centre (IMAC) Ph: 0800 IMMUNE (0800 466 863) Email: 0800immune@auckland.ac.nz National Influenza Campaign coordination Email: influenza@auckland.ac.nz Website: www.influenza.org.nz Healthcare Logistics (HCL) Phone: 0508 425 358 Ordering: www.hcl.co.nz or TOLL-FREE fax: 0508 408 358 ($10 fee) Seqirus (vaccine manufacturer) Phone: 0800 502 757
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