Schedule vaccines

• Influvac Tetra is the funded influenza vaccine for 2024, for 6 months of age and over.
• Flucelvax Quad and FluQuadri are unfunded vaccines, for 6 months of age and over.
• Afluria Quad is an unfunded vaccine, for 3 years of age and over.
• Fluad Quad is an unfunded vaccine, for 65 years and over.
• For ages 6 months to 8 years (inclusive), if an influenza vaccine is being administered for the first time a second dose is required at least four weeks later, for all others a single dose is required.  ‍Children under 9 years of age who are receiving influenza vaccine for the first time have a better immune response after two priming doses of the influenza vaccine.  

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Preparation and Administration

Preparation

Influvac Tetra, Flucelvax Quad, FluQuadri, Fluad Quad, FluQuadri and Afluria Quad should all be shaken before administration and are all delivered as a single 0.5mL dose.  

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Influvac Tetra comes with an attached 16mm needle. In this instance there is no concern with using a smaller length needle in larger arms. The datasheet allows for both IM and SC administration. We do recommend a 90 degree angle unless patient has a medical condition where an angled approach is more appropriate.

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‍Pre vaccination screening, informed consent, and post vaccination information

A comprehensive pre-vaccination screening must be completed with the vaccine recipient prior to consent.  The IMAC pre-vaccination screening tool can be found here.

The consumer handout What you need to know about the flu vaccination (HP8682) is available to assist with pre-vaccination screening and to provide post-vaccination information. If written consent is required, the 2024 flu vaccination consent form (HP7990) can be used.  

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Waiting after receiving a 2024 influenza vaccination

* The observation period can be reduced to the relevant asterisked time in the table above for people who meet all the following criteria:

• are aged 13 years and over
• do not have a history of severe allergic reactions
• have been assessed for any immediate post vaccination adverse reactions (5 minutes)
• are aware of when they need to and how to seek post-vaccination advice
• will have another adolescent or adult with them for the first 20 minutes post vaccination
• will not drive, skate, scoot, ride a bike or operate machinery until 20 minutes post vaccination
• have the ability to contact emergency services if required

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Special considerations

‍‍Egg allergy

Influvac Tetra, Flucelvax Quad, Fluad Quad, FluQuadri and Afluria Quad can be given to people with an egg allergy or a known history of egg anaphylaxis.

See Vaccine Safety page below for more information and other more common situations that may arise during pre-vaccination screening.

‍Pregnancy

One dose of Influvac Tetra, the inactivated quadrivalent influenza vaccine is recommended and funded each influenza season at any stage of pregnancy through to 31 December 2024. Influenza vaccination provides direct protection from the complications of influenza, both during pregnancy and postpartum.  The newborn is also protected through passive immunity for the first few months of life.  

For more information see page 15 of Everything you need to know about FLU2024 for more pregnancy-specific info and click here for a detailed factsheet on influenza and vaccination during pregnancy.  

‍Children

Influenza infection rates are generally highest in children.  Vaccination of children can help provide additional protection to those around them, particularly for babies and older people living in the same house.  Click here for a detailed factsheet on influenza and vaccination for children.  

‍Older people

Influvac Tetra is funded for those over 65 years.  Increasing the number of older people vaccinated against influenza annually can have a significant impact on improving health outcomes in older people, especially in the context of ongoing co-circulation of other respiratory diseases, such as COVID-19 and RSV.  

The factsheet, Influenza and vaccination for older people, can be found here, and for more information on adjuvanted vaccines in this population click here.  

‍Māori and Pacific peoples

Māori and Pacific people are at greater risk of developing underlying health conditions, such as cardiovascular disease and chronic respiratory disease, at a younger age than other ethnicities, which increases the risk of severe influenza and complications. Influenza vaccination is recommended.  

‍Mental health

Individuals with mental health disorders are at an increased risk of comorbid health conditions that predispose them to severe complications associated with influenza disease. Influvac Tetra is funded for people under 65 years of age who have serious mental health conditions or are currently accessing secondary or tertiary mental health and addiction services.  

‍Immunocompromised

Individuals who are immunocompromised due to treatment or underlying conditions are at high risk of severe influenza and complications. It is important to offer vaccination prior to the initiation of chemotherapy or immunosuppressive therapy. When this is not possible, influenza vaccination is recommended and can be given whilst receiving most treatments.

Healthcare workers

The WHO and Health New Zealand recommend that healthcare workers are a priority group for influenza vaccination, not only for their own protection by also to reduce the spread of influenza to vulnerable patients, including those who are pregnant.  

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Spacing with other vaccines

National Immunisation Schedule vaccines: can all be given at the same time as any influenza vaccine, preferably in a different limb.  

Note: Individuals (or parents/legal guardians/power of attorneys) should be informed of the small risk of febrile convulsions in concomitant delivery of PVC13 and influenza vaccines in children aged 6 months to under 5 years. If the individual has a history of febrile convulsions, separation of these vaccines by two days can be offered but is not essential.

When administering Fluad Quad with other adjuvanted vaccines - eg Shingrix - consumers should be informed of the possibility of a stronger post-vaccination response when two or more of these are administered together.

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Individuals with thrombocytopenia and coagulation disorders

The vaccine can be given intramuscularly (IM) to individuals with stabilised thrombocytopenia, bleeding disorders and to those who are on anticoagulant therapy. The risk of a haematoma should be included as part of the informed consent process.  

After vaccination, apply firm pressure over the injection site without rubbing for 10 minutes to reduce the risk of bruising.

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Travel

Influenza vaccination is recommended for those planning to travel internationally, including within the Pacific region. If it is getting close to 6 months since their last influenza vaccination, vaccination is recommended prior to travel. Note that any second vaccination is not funded.

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Storage

All influenza vaccines are marked with an expiry date that must be checked before vaccine administration.  The expiry date of the vaccine is the last day of the month in the year indicated on the packaging.

Influenza vaccines must always be stored as per the cold chain between +2°C and +8°C, including for off-site vaccinations. Protect from light.  

Refer to the National Standards for Vaccine Storage and Transportation for Immunisation Providers 2017 (2nd Edition).

Sites should ensure their Cold Chain Policy is up to date (including contact details for immunisation coordinators) and Cold Chain Accreditation is current. If off-site vaccination is to be offered, the Cold Chain Accreditation must specifically include this.

The influenza vaccines currently used in New Zealand are inactivated. They do not contain live viruses and cannot cause influenza.

Influenza vaccine is generally well tolerated. Some systemic responses to vaccination may appear influenza-like. Common responses associated with the non-adjuvanted influenza vaccines (Influvac Tetra) in children and adults include pain, redness, and/or swelling at the site of injection. Local responses are almost always mild. Systemic responses such as headache, muscle aches and fatigue may occur in adults. Fever, irritability, and loss of appetite are more likely to occur in children. These are generally mild and usually resolve after a day or so. Systemic events may appear influenza-like.  

Fever is a common adverse event in children after vaccination. Convulsions associated with fever can occur in susceptible children. Around 3–8 children in 100 aged under 7 years will experience a febrile convulsion, most likely when aged between 16 and 30 months.  

Adults aged 65 years or older are more likely to experience local and/or systemic responses to the adjuvanted influenza vaccine, Fluad Quad than the non-adjuvanted Influvac Tetra vaccine because the adjuvant enhances the person’s immune response.

The most significant serious adverse event associated with influenza vaccination is anaphylaxis, a serious allergic response that usually comes on within minutes of receiving the vaccine. This occurs around once in a million influenza vaccine doses.  

Vaccine-related serious adverse events, such as a convulsion associated with fever or cellulitis-like local reaction, are rare.

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Contraindications and precautions for influenza vaccine

Influenza vaccination is contraindicated for individuals who have had documented anaphylaxis to any ingredient in the vaccine (with the exception of egg allergies - see below) or to a previous dose of inactivated influenza vaccine. These individuals should not receive the vaccine.

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Other considerations

Immunocompromised
Individuals who are immunocompromised can receive an influenza vaccination. Those who are immunocompromised are at high risk of severe influenza and complications. If possible, offer vaccination prior to the initiation of chemotherapy or immune suppressant medication. When this is not possible, influenza vaccination can be given while an individual is receiving most treatments. Following cessation of chemotherapy, normal immune responses return after about 30 days. Specialist’s advice should be sought when considering influenza vaccination of individuals who have received a haematopoietic stem cell or solid organ transplantation in the preceding 6 months.

The response to influenza vaccination in those with a poorly functioning immune system is likely to be low; additional preventative strategies are important to reduce their exposure to influenza. It is advisable for all close contacts of immunocompromised people, aged from 6 months, to also receive an influenza vaccine (unfunded).  

Egg allergy or egg anaphylaxis
Influvac Tetra, Fluad Quad, FluQuadri and Afluria Quad are egg-based vaccines, but can be administered to people with a history of egg allergy or egg anaphylaxis. Studies have shown that influenza vaccines containing one microgram or less of ovalbumin do not trigger anaphylaxis in sensitive individuals. Each dose of Influvac Tetra, Fluad Quad, FluQuadri and Afluria Quad contains less than one microgram of ovalbumin.

Flucelvax Quad does not contain ovalbumin, as eggs are not used in the manufacturing process.  

‍Seafood, shellfish or other food allergy or anaphylaxis
People with a seafood or shellfish allergy or anaphylaxis can receive an influenza vaccine, including Fluad Quad that contains the MF59 adjuvant derived from shark liver.

Allergy or anaphylaxis to other foods or products are not a contraindication for influenza vaccination.  ‍

Sulfonamide (sulphur) allergy
Influvac Tetra, Flucelvax Quad, Fluad Quad, FluQuadri or Alfuria Quad can be given to people with a sulfonamide (sulphur) allergy.

Sulfonamide (sulphur) antibiotics, such as co-trimoxazole, sulfasalazine, and sulphite preservatives used in food, are different to medicines containing the words sulfate or sulphate, (eg, neomycin sulphate). Sulfate itself does not cause allergic reactions. It is safe to use a sulfate when a person has a sulfonamide allergy or a sulfite intolerance.

Antibiotics
Influvac Tetra contains traces of gentamicin and tylosine tartrate. Fluad Quad contains traces of kanamycin and neomycin. Afluria Quad contains traces of neomycin and polymixin B. The vaccines are contraindicated in people with known anaphylaxis to these respective antibiotics.  

No antibiotics are used to manufacture Flucelvax Quad or FluQuadri.

History of Guillain–Barré syndrome (GBS)
No association was found between administering a million doses of influenza vaccine and GBS in adults aged from 65 years in the US. The risk of developing GBS is increased following influenza infection, and the magnitude of the risk is several times greater than that possibly occurring following influenza vaccination.

If GBS has occurred within 6 weeks of previous influenza vaccination, the decision to give an influenza vaccine should be based on careful consideration of the potential benefits and risks.

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Post Vaccine Symptom Check (PVSC)

Health New Zealand will again be using the Post Vaccine Symptom Check survey tool to monitor the safety of the influenza vaccine in 2024. This survey is one of the many tools used in Aotearoa New Zealand to monitor vaccine safety. Any consumer who has received an influenza vaccination could be contacted to participate in the PVSC. The data collected will help monitor adverse events following vaccination, identify potential safety issues, and understand how an individual’s health or daily routine may have been affected after their vaccination.

PVSC does not replace the reporting of AEFI through the traditional channels and adverse events should also be reported directly to the Centre for Adverse Reactions Monitoring (CARM).

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Reporting adverse events following influenza vaccination

Healthcare professionals and vaccinators are professionally and ethically responsible for reporting any serious or unexpected adverse events after the administration of all medicines, including the influenza vaccine, regardless of whether or not they consider the event to have been caused by the vaccination. CARM Reports can be completed online here.  

Influenza immunisation protects around 7–8 pregnant women out of 10 from serious influenza related illness requiring hospital treatment. Around half of infants whose mother had an influenza immunisation during pregnancy are also protected from influenza for up to 6 months after birth.

Very little information on how effective the influenza vaccine in infants under 2 years of age has been collected. The information collected suggests about 6–7 in 10infants in this age group will be protected from influenza.

Influenza immunisation will protect around 6–7 in 10 healthy children under 3 years of age, around 6–7 in 10 healthy children under 16 years of age, and 4–6 in 10healthy adults from influenza. The influenza vaccine only has a modest reduction in the time healthy adults take off work due to influenza.

The influenza vaccines have a modest effect, around up to 60%, in preventing confirmed influenza in those aged 65 years and over living in the community and can reduce the number of older people needing to be hospitalised with influenza-related pneumonia and complications. Influenza vaccine has also been shown to reduce the risk of influenza-related pneumonia in older people living in long term care facilities who develop complications related to influenza.

The Institute of Environmental Science and Research (ESR) reported in late 2023, the estimated crude vaccine effectiveness for the preceding flu season (2023) was 80.4% and 58.6% for influenza-confirmed ARI cases and severe acute respiratory illness (SARI) cases, respectively.

Preliminary data from ESR suggests that influenza activity in2023 was described at a low-to-moderate level. Influenza-associated SARI hospitalisations were higher in both young children (aged 0–4 years) and the elderly (above 65 years), compared to other age groups, and higher in Pacific peoples and Māori ethnic groups.

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Adjuvanted influenza vaccines

The urgent need for more effective influenza vaccines in the elderly population arises from unique challenges and vulnerabilities associated with ageing. A natural decline in the immune system’s effectiveness is a phenomenon known as immunosenescence. This age-related weakening of the immune response makes older people more susceptible to infections, such as influenza.

Due to immunosenescence, older people are also associated with a heightened risk of influenza-related complications. People aged 65 years or older are at a higher risk for influenza-related mortality. Research indicates that this age group accounts for 7–8 out of 10 influenza-related deaths and 5–7 out of 10 influenza-related hospitalisations, each flu season.

Adjuvanted influenza vaccines are designed to enhance and prolong the immune response. Adjuvants, such as MF59, are added to a vaccine to boost the body’s immune response and improve the vaccine’s effectiveness, especially for those with compromised or weakened immune systems. The more robust an immune response, the better the protection against influenza viruses for the upcoming flu season.

Studies have found a modest improvement in vaccine effectiveness in those above 65 years for those who have received an adjuvanted influenza vaccine, compared with a standard influenza vaccine.

A recent systematic review examining real-world data found that adjuvanted trivalent influenza vaccines were more effective than standard trivalent and quadrivalent influenza vaccines in reducing influenza-related outcomes in older adults. The relative vaccine effectiveness (rVE) of adjuvanted influenza vaccines ranged from 7.5%to 36.3% against standard influenza vaccines in reducing medical encounters and hospitalisations.

In the interest of reducing uncertainties surrounding variations in single-season vaccine effectiveness estimates, a cohort study estimated the relative effectiveness of trivalent adjuvanted influenza vaccines versus non-adjuvanted trivalent/quadrivalent influenza vaccines in preventing all-cause hospitalisation over 18 consecutive flu seasons. The study found that the adjuvanted vaccine cohort was associated with a 12% lower chance of hospitalisation for older adults.

A study that expands on CDC mathematical modelling to estimate the number of additional influenza-related outcomes averted with adjuvanted versus standard influenza vaccines, found that adjuvanted trivalent influenza vaccines were more effective, preventing twice as many influenza illnesses over three seasons in adults over the age of 65 years. Proportionate decreases were also observed in related healthcare use and complications.

For more information on adjuvanted influenza vaccines, including effectiveness and safety, click here.

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Cell-based influenza vaccines

There are no randomised trials comparing the efficacy of egg-based and cell-based vaccines, but a number of other types of trials have been performed.

Some studies have shown that cell-based influenza vaccines, such as Flucelvax, have been more effective at preventing illness or inducing an immune response in comparison to standard egg-based vaccines during certain seasons. Cell-based advantage appears to be more pronounced during seasons where substantial variations exist between the egg-based vaccine strains and the circulating strains in the population.

A recent review evaluating the effectiveness of seasonal cell-based quadrivalent influenza vaccine compared to quadrivalent and trivalent egg-based influenza vaccines found an overall pooled relative vaccine effectiveness (rVE) of 8.4%.

Both egg-based and cell-based influenza vaccines effectively prevent severe disease and hospitalisations. Although certain studies indicate modest improvements for cell-based vaccines, the margin of efficacy against egg-based vaccines fluctuates across seasons.

For more information on cell-based influenza vaccines, including effectiveness and safety, click here.  

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• Beyer WEP, McElhaney J, Smith DJ, Monto AS, Nguyen-Van-Tam JS, Osterhaus ADME. Cochrane re-arranged: Support for policies to vaccinate elderly people against influenza. Vaccine. 2013;31(50):6030-3.
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