Vaccination recommendations for the 2015 influenza season

Published in Health News and Evidence

Date published: About this date

Clinical content may change after this date. This information is not intended as a substitute for medical advice from a qualified health professional. Health professionals should rely on their own expertise and enquiries when providing medical advice or treatment.

Why vaccinate? | Influenza vaccines and adverse event rates | Which vaccines are currently approved by the TGA? | Who will be eligible for free influenza vaccination? |  What are the likely side effects?  | Precautions and contraindications | Co-administration of influenza with other vaccines | Consumer information | References

Summary

  • A double strain change from the 2014 influenza vaccine has led to manufacturing delays. To ensure sufficient supplies of influenza vaccine are available, the 2015 program start date has been set back. This year, the National Seasonal Influenza Immunisation Program will begin on 20 April 2015.

Health professionals and the public are also being advised that:1

  • eligibility for NIP-funded influenza vaccination in Aboriginal and Torres Strait Islander people has now been expanded to include children aged 6 months to < 5 years.
  • the recommended age for children requiring two doses in the first year they receive influenza vaccine has been changed from < 10 years to < 9 years, consistent with other international recommendations.
  • quadrivalent influenza vaccines are available for use in 2015.

Why vaccinate?

Influenza can lead to serious illness, including pneumonia, sometimes requiring hospitalisation, and may even lead to death.

Risk of complications from influenza is higher in some populations, including, but not limited to, those with certain pre-existing medical conditions, those aged 65 or older and pregnant women.23

In Australia, determining the true disease burden of influenza has been difficult because relatively few hospitalisations or deaths are specifically coded as influenza related.2, 4, 5

By using regression analysis, epidemiologists have estimated that 18,404 (95% >CI 15,918 to 20,889) influenza-attributable hospitalisations occur annually in Australia across all age-groups,6 while in those aged 50 and over an estimated 13,500 hospitalisations and 3000 deaths occur each year due to influenza.4

Vaccination is the primary strategy used to protect those at high risk against the disease and control influenza.2, 3, 7

Influenza viruses are classified as type A, B or C, with A and B clinically important to humans.237 The viruses are constantly evolving through frequent point mutations in the genes coding for the surface glycoprotein antigens haemagglutinin (HA) and neuraminidase (N).2, 7

This process, known as antigenic variation, is responsible for the seasonal variation between influenza strains and is a key reason why the composition of the influenza vaccines undergoes annual review2, 3, 7 by the Australian Influenza Vaccine Committee (AIVC).

The AIVC evaluates available data and advises the Therapeutic Goods Administration on the vaccine composition for each season.8

To ensure continuing protection against influenza, people vaccinated in 2014 still need to be vaccinated in 2015.

Influenza vaccines and adverse event rates

During the 2010 influenza season an excess of febrile reactions occurred in children under 5 years of age after immunisation with Fluvax.9

This vaccine is no longer approved in Australia for children under 5 years of age and should only be used in children aged 5 to under 9 years after carefully considering potential risks and benefits on an individual basis.10

Available data on four vaccines approved for use from 6 months of age (Agrippal, Fluarix, Influvac and Vaxigrip) indicate a very low risk of fever, which is usually mild and transient, after vaccination.11

In 2013 the Government funded an active postmarketing surveillance study of TGA-registered influenza vaccines for use in children.12 The study involved 893 children aged 6 months to < 10 years who received either one or two doses of a 2013 seasonal influenza vaccine.

Fever after vaccination was reported in 5.5% (95% CI 4.1% to 7.3%) to 6.5 % (95% CI 3.5% to 10.9%) of children, and recorded temperature elevations were generally low grade. One febrile convulsion occurred in a child with a known seizure disorder.12

Injection-site reactions occurred in 21.2% (95% CI 18.5% to 24.1%) of children after the first vaccination dose, compared with 6.0% (95% CI 3.1% to 0.2%) after the second dose, and most were mild.12

Health professionals are encouraged to report all adverse events associated with influenza vaccination to the TGA or through State/Territory-based arrangements.

Which vaccines are currently approved by the TGA?

The TGA has registered nine influenza vaccines for the Australian 2015 influenza season; six are trivalent and three are quadrivalent.1, 13

The vaccine strains for 2015 have been altered to reflect the recommendations made by the WHO in September 2014.13, 14

For the trivalent vaccines, two strains have changed compared with the 2014 vaccines used in Australia and the 2014/15 vaccines used in the recent Northern Hemisphere winter.

The trivalent vaccines will contain:11

  • A (H1N1): an A/California/7/2009 (H1N1)-like virus, 15 micrograms HA per 0.5 mL dose
  • A (H3N2): an A/Switzerland/9715293/2013 (H3N2)-like virus, 15 micrograms HA per 0.5 mL dose
  • B: a B/Phuket/3073/2013-like virus, 15 micrograms HA per 0.5 mL dose.

The quadrivalent vaccines contain the same strains as the trivalent vaccines with the addition of a second influenza B strain (B/Brisbane/60/2008-like virus, 15 micrograms HA per 0.5 mL dose).13, 14

Having the extra influenza B strain may provide additional benefit; however, the magnitude of this will depend on which influenza B strains are circulating and how much cross-protection between B strains occurs.1

Read more about flu vaccines and safety in children.

Table 1. Influenza vaccines for use in Australia in the 2015 southern hemisphere influenza season1

Vaccine product valency/
name
Suitable for administration Egg ovalbumin content Available through NIP
6 months to < 5 years 5 years to < 9 years 9 years and above Adult

TRIVALENT

Agrippal15

a

✔ 

✔ 

✔ 

<0.2 micrograms/ 0.5 mL dose

No

Fluarix16

a

✔ 

✔ 

✔ 

≤ 0.05 micrograms/ 0.5 mL dose

Yes

Fluvax17

b

Cautionc

✔ 

✔ 

≤ 1.0 micrograms/ 0.5 mL dose

Yes

Influvac18

a

✔ 

✔ 

✔ 

NR

No

Vaxigrip19

a

✔ 

✔ 

✔ 

≤ 0.05 micrograms/ 0.5 mL dose

Yes

Vaxigrip Junior19

For use in children aged 6–35 months only

≤ 0.025 micrograms/ 0.25 mL dose

Yes

QUADRIVALENT

Fluarix Tetra20

≥ 3 yearsd

✔ 

✔ 

✔ 

≤ 0.05 micrograms/ 0.5 mL dose

No

FluQuadri21

≥ 3 yearsd

✔ 

✔ 

✔ 

≤ 1.0 micrograms/ 0.5 mL dose

No

FluQuadri Junior21

For use in children aged 6–35 months only

≤ 0.05 micrograms/ 0.25 mL dose

No

a. Children aged 6–35 months require a 0.25 mL dose.

b. Children aged 6 months to 5 years must not receive bioCSL Fluvax.17

c. Febrile events have been observed in children aged 5 years to under 9 years after immunisation with Fluvax.17 The TGA and the Product Information for bioCSL Fluvax advise that use of this vaccine in children aged 5 to under 9 should be based on careful consideration of potential benefits and risks in the individual. 13 , 17 ATAGI does not recommend use of this vaccine in this age group.1

d. Do not use in children aged less than 3 years. Registered for use in individuals aged 3 years and older only.1

NR: not reported in the current Australian Product Information.18

Who will be eligible for free influenza vaccination?

In 2015 the following people are eligible to receive free influenza vaccine under the National Immunisation Program (NIP):22

  • pregnant women
  • persons aged 65 years and older
  • persons who identify as Aboriginal and/or Torres Strait Islander and are aged 6 months to less than 5 years, or 15 years and older
  • persons aged 6 months and older with specified medical conditions that put them at increased risk of influenza complications.

Annual influenza vaccination is recommended for any adult or child aged 6 months or older who wishes (or whose parents and/or carers wish them) to reduce the likelihood of becoming ill with influenza. However, not all individuals will be eligible for free vaccination under the NIP.

The Australian Immunisation Handbook identifies a number of other populations in whom seasonal influenza vaccination is recommended but may not be NIP funded.2

What are the likely side effects?

The most common side effects from influenza vaccination are: 2, 3, 23

  • localised pain, redness, swelling and transient induration
  • mild febrile response
  • mild myalgia, arthralgia
  • drowsiness or tiredness.

If these effects occur they usually last for 1–2 days. They may be more pronounced in children under 5 years.3

Anaphylaxis after influenza vaccination has been reported but is rare.2, 23

Precautions and contraindications

All influenza vaccines currently available in Australia contain traces of egg protein.2

It is reported that influenza vaccines with ≤ 1.0 microgram of residual egg ovalbumin per dose can be safely given to people with an egg allergy; however, as a low risk of anaphylaxis is present, ensure vaccination is administered by staff with the knowledge and facilities to manage such a reaction.2, 3

Health professionals are advised to confirm the egg protein content in an individual vaccine using the most current Australian Product Information, as this value can vary between years (see Table 1).

Influenza vaccine is contraindicated in anyone who has experienced anaphylaxis after a previous dose of any influenza vaccine or exposure to any vaccine component.2, 3

Co-administration of influenza with other vaccines

Influenza vaccines may be co-administered with other vaccines; however, there may be a small increase in risk of fever and febrile convulsions with concurrent administration of inactivated influenza vaccine and 13-valent pneumococcal conjugate vaccine (13vPCV) in children aged 6 months to 5 years, especially in those aged 12–24 months.2

The Australian Immunisation Handbook recommends that immunisation service providers advise parents regarding this, and provide the option of administering these two vaccines on separate days (with an interval of not less than 3 days).2

Consumer information

Information about flu vaccines as well as more general information about vaccination can be found on the NPS MedicineWise Vaccines and immunisation knowledge hub.

References

  1. Australian Technical Advisory Group on Immunisation. Clinical advice for immunisation providers regarding the administration of 2015 seasonal influenza vaccines. 2015 [Online PDF] (accessed 25 February 2015).
  2. Australian Technical Advisory Group on Immunisation. The Australian Immunisation Handbook. 10th edn. Australian Government Department of Health, 2013, [Online PDF] (accessed 5 March 2015).
  3. National Centre for Immunisation Research & Surveillance. Influenza vaccines for Australians | NCIRS, 2014. [Online PDF] (accessed 5 March 2015).
  4. Newall AT, Wood JG and Macintyre CR. Influenza-related hospitalisation and death in Australians aged 50 years and older. Vaccine 2008;26:2135–41. [PubMed]
  5. Muscatello DJ, Amin J, MacIntyre CR, et al. Inaccurate ascertainment of morbidity and mortality due to influenza in administrative databases: a population-based record linkage study. PLoS One 2014;9. [PubMed]
  6. Newall AT, Scuffham PA. Influenza-related disease: the cost to the Australian healthcare system. Vaccine 2008;26:6818–23. [PubMed]
  7. Noh JY, Kim WJ. Influenza vaccines: unmet needs and recent developments. Infect Chemother 2013;45:375–86. [PubMed Central]
  8. Therapeutic Goods Administration. Australian Influenza Vaccine Committee (AIVC). Department of Health, 2014. [TGA] (accessed 5 March).
  9. Therapeutic Goods Administration. Seasonal flu vaccine: Investigation into febrile reactions in young children following 2010 seasonal trivalent influenza vaccination. Department of Health, 2010. [TGA] (accessed 5 March).
  10. Therapeutic Goods Administration. Seasonal flu vaccine: 2015 seasonal influenza vaccines for use in children. Department of Health, 2015. [TGA] (accessed 5 March).
  11. Immunise Australia Program. Health Professional. 2015. [Immunise Australia] (accessed 5 March 2015).
  12. Wood NJ, Blyth CC, Willis GA, et al. The safety of seasonal influenza vaccines in Australian children in 2013. Med J Aust 2014;210:596–600. [PubMed]
  13. Therapeutic Goods Administration. 2015 seasonal influenza vaccines. 2015. [TGA] (accessed 12 March 2015).
  14. World Health Organization. Recommended composition of influenza virus vaccines for use in the 2015 southern hemisphere influenza season. 2014. [WHO] (accessed 6 March 2015).
  15. Novartis Vaccines and Diagnostics Pty. Ltd. Agrippal. North Ryde, NSW: 2014. [TGA] (accessed 12 March 2015).
  16. GlaxoSmithKline Australia Pty Ltd. Fluarix. Abbotsford, Victoria: 2014. [TGA] (accessed 12 March 2015).
  17. CSL Limited. Fluvax. Parkville, Victoria: 2014. [TGA] (accessed 12 March 2015).
  18. Abbott Australasia Pty Ltd. Influvac. Macquarie Park, NSW: 2014. [TGA] (accessed 12 March 2015).
  19. Sanofi. VAXIGRIP® VAXIGRIP® Junior: Inactivated Influenza Vaccine (Split Virion). Macquarie Park, NSW: 2014. [TGA] (accessed 12 March 2015).
  20. GlaxoSmithKline Australia Pty Ltd. Fluarix Tetra. 2014. [TGA] (accessed 12 March 2015).
  21. Sanofi. FluQuadri™, FluQuadri™ Junior: Inactivated Quadrivalent Influenza Vaccine (Split Virion). Maquarie Park, NSW: 2015. [TGA] (accessed 12 March 2015).
  22. Immunise Australia Program. Influenza (Flu). Australian Government Department of Health, 2015. [Immunise Australia] (accessed 5 March).
  23. Mahajan D, Dey A, Cook J, et al. Surveillance of adverse events following immunisation in Australia, 2012. Commun Dis Intell 2014;38:E232–46. [Online PDF]