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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
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.
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
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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