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Public Health Agency of Canada Vaccine Confidence Webinar: Seasonal influenza 2022–2023

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Organization: Public Health Agency of Canada in partnership with the National Collaborating Center for Infectious Diseases

Recorded for health care professionals: 2022-09-28

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Housekeeping

Please use the question and answers tab to pose questions to presenters at any time.

For technical and troubleshooting questions, please contact: nccid@umanitoba.ca.

Webinar recording and slides will be made available after the webinar at nccid.ca.

Speakers

Moderator

Disclosures of conflicts of interest

Webinar objectives

At the end of this webinar, participants will be able to:

Setting the stage: What is the burden of influenza and which populations are at highest risk?

Burden of influenza before the COVID-19 pandemic

Burden of influenza varies from year to year.

Globally: Every year, worldwide seasonal influenza causes an estimated:

The global annual attack rate was estimated to be 5 to 10% in adults and 20 to 30% in children.

In Canada: Influenza and pneumonia are ranked among the top 10 leading causes of death in Canada. Each year in Canada, it is estimated that influenza causes approximately:

The influenza burden has been at historical lows during COVID-19. In 2022-2023 there is a possibility of simultaneous outbreaks of influenza and COVID-19 in Canada. Minimizing influenza-related morbidity and mortality will reduce the burden on the health care system.

Source: World Health Organization: Influenza (seasonal)

The COVID-19 pandemic and associated health measures impacted influenza patterns for the 2021-2022 season

The burden of influenza was at historical lows during COVID-19. A return of community transmission of influenza was observed in the 2021-2022 season. The resurgence of seasonal influenza did not follow usual seasonal patterns.

The shaded area represents the maximum and minimum number of influenza tests or percentage of tests positive reported by week from seasons 2014-2015 to 2019-2020. Data from week 11 of the 2019-2020 season onwards are excluded from the historical comparison due to the COVID-19 pandemic.

Figure 1. Number of influenza tests and percentage of laboratory tests positive in Canada, by surveillance weeks 2021-35 to 2022-34
Figure 1. Text version below.
Figure 1: Text description
Number of influenza tests, 2021-2022 compared to previous seasons
Surveillance week Number of tests,2021-2022 Number of tests, 2020-2021 Maximum number of tests Minimum number of tests Average number of tests
35 7,061 4,996 1,979 1,311 1,705
36 7,939 5,192 2,208 1,323 1,707
37 9,256 5,335 2,631 1,778 2,135
38 9,725 6,024 3,039 1,987 2,502
39 9,608 6,707 3,356 2,365 2,859
40 10,699 7,127 4,078 2,443 3,134
41 10,290 6,817 4,339 2,673 3,240
42 12,383 6,755 4,649 2,648 3,526
43 13,261 8,227 4,996 3,084 3,862
44 15,353 9,615 4,966 2,994 4,020
45 17,330 10,748 5,912 3,117 4,508
46 16,221 11,955 5,589 3,176 4,564
47 16,701 13,103 6,541 3,587 5,018
48 18,356 18,762 7,416 3,569 5,645
49 19,816 19,649 8,559 3,836 6,377
50 22,397 16,189 9,464 4,017 7,155
51 28,377 14,059 11,142 3,487 8,822
52 29,528 12,290 11,338 4,272 9,184
1 28,332 11,681 14,932 5,371 12,552
2 23,595 14,097 16,104 5,315 13,289
3 19,510 17,002 15,001 5,270 11,820
4 16,409 15,391 15,414 5,873 11,441
5 15,927 16,607 16,595 6,739 11,456
6 13,843 12,949 16,121 8,324 11,339
7 13,103 20,727 14,443 8,074 10,842
8 12,142 21,290 14,024 7,606 10,865
9 11,235 21,891 14,520 7,507 10,956
10 10,704 20,896 17,681 7,005 11,084
11 10,168 21,220 12,714 6,435 9,175
12 10,754 23,087 10,431 5,976 8,238
13 11,757 25,811 9,989 6,063 7,699
14 12,637 26,303 8,830 4,773 7,046
15 13,239 26,284 7,836 5,090 6,527
16 15,435 26,792 6,826 5,000 5,890
17 17,960 29,154 6,603 4,440 5,305
18 18,525 22,152 5,640 4,143 4,780
19 17,602 12,725 5,480 3,680 4,311
20 16,473 9,738 5,097 3,046 3,862
21 15,899 7,442 4,001 2,577 3,197
22 15,683 6,765 3,790 2,424 2,944
23 14,192 6,341 3,257 1,969 2,591
24 12,567 5,942 3,120 2,034 2,449
25 12,656 5,774 2,659 1,731 2,148
26 13,128 5,972 2,600 1,573 1,988
27 12,622 5,213 2,163 1,554 1,833
28 11,840 4,900 2,223 1,451 1,857
29 10,682 5,122 2,256 1,436 1,796
30 10,166 5,275 1,950 1,463 1,664
31 10,093 5,398 2,022 1,386 1,671
32 9,653 4,692 1,928 1,269 1,574
33 9,418 5,616 2,089 1,251 1,671
34 9,328 5,851 2,098 1,374 1,698
Percentage of tests positive for influenza, 2021-2022 compared to previous seasons
Surveillance week Percentage of tests positive, 2021-2022 Percentage of tests positive, 2020-2021 Maximum percentage of tests positive Maximum percentage of tests positive Average percentage of tests positive
35 0.04 0.02 1.87 0.11 0.82
36 0.01 0.00 2.28 0.30 1.13
37 0.03 0.00 1.78 0.40 0.99
38 0.00 0.02 2.35 0.55 1.30
39 0.01 0.00 2.95 0.67 1.71
40 0.02 0.00 2.33 1.08 1.70
41 0.06 0.01 3.02 1.32 1.72
42 0.05 0.00 3.40 0.87 2.18
43 0.05 0.01 5.32 0.84 2.83
44 0.20 0.07 8.55 1.20 3.70
45 0.13 0.04 10.10 1.39 4.63
46 0.16 0.03 14.11 1.51 6.05
47 0.20 0.07 15.36 1.44 7.71
48 0.34 0.05 18.20 0.84 10.61
49 0.28 0.04 19.71 1.64 13.01
50 0.25 0.01 27.02 2.36 16.82
51 0.20 0.01 29.09 3.30 20.11
52 0.10 0.00 34.54 4.28 24.48
1 0.08 0.00 31.66 5.85 23.41
2 0.12 0.00 29.10 7.06 23.01
3 0.05 0.01 30.07 12.24 23.63
4 0.05 0.00 29.45 15.89 23.96
5 0.04 0.00 30.62 19.60 24.90
6 0.05 0.02 32.39 17.89 25.00
7 0.02 0.01 32.51 16.28 25.05
8 0.08 0.00 32.87 17.45 25.14
9 0.12 0.00 34.28 16.80 24.59
10 0.16 0.00 35.99 16.05 23.22
11 0.27 0.01 31.41 16.19 21.41
12 0.86 0.00 30.03 15.03 20.10
13 1.52 0.00 28.25 14.50 19.56
14 2.49 0.00 23.16 12.66 17.86
15 3.86 0.01 20.73 11.95 16.27
16 6.99 0.00 18.52 11.64 14.48
17 9.68 0.00 17.30 9.76 12.83
18 11.29 0.00 13.02 7.88 10.26
19 12.51 0.00 11.95 4.96 8.98
20 10.33 0.01 9.13 3.19 7.22
21 9.42 0.01 7.45 2.97 5.60
22 8.44 0.00 4.96 2.19 3.86
23 7.01 0.00 4.39 0.87 2.86
24 5.01 0.02 4.36 0.81 2.25
25 3.03 0.00 3.95 0.63 1.88
26 2.25 0.00 3.08 0.69 1.81
27 1.23 0.00 2.83 0.42 1.48
28 0.79 0.00 1.84 0.41 0.91
29 0.68 0.00 1.55 0.47 1.09
30 0.38 0.04 1.46 0.46 0.90
31 0.30 0.00 1.93 0.58 1.11
32 0.18 0.00 1.19 0.52 0.92
33 0.18 0.00 1.69 0.40 0.85
34 0.23 0.02 1.57 0.42 0.92

Source: FluWatch report: July 24 to August 27, 2022 (weeks 30-34)

2021-2022 seasonal influenza in Canada

Sources:

Typical influenza symptoms

Most common symptoms include:

Other common symptoms include:

In some people, especially children, nausea, vomiting and diarrhea may occur.

While most people recover in 7 to 10 days, severe illness can develop. Some groups are at increased risk of influenza-related complications and hospitalization.

Influenza A and B are the main influenza viral strains that cause seasonal outbreaks in humans

Influenza A viral strains are classified into subtypes based on 2 surface proteins:

  1. haemagglutinin (HA)
  2. neuraminidase (NA)

Of these, the influenza A viruses that have caused widespread human disease over the decades are:

Influenza B viral strains have evolved into 2 lineages:

  1. B/Yamagata/16/88-like viruses
  2. B/Victoria/2/87-like viruses

Over time, antigenic variation (antigenic drift) of strains occurs within an influenza A subtype or B lineage. 'Antigenic shift' due to a re-assortment of genes can also occur. This can cause an abrupt, major change in an influenza A virus.

Every year, seasonal influenza vaccines are developed in response to year-over-year changes of the influenza virus

Influenza vaccine effectiveness

Figure 2. Canadian Sentinel Practitioner Surveillance Network influenza vaccine effectiveness estimates % (95%CI) 2004-05 to 2019-20 seasons (any influenza type/subtype)
Figure 2. Text version below.
Figure 2: Text description
Season Vaccine effectiveness estimate percentages
2019-20 52%
2018-19 56%
2017-18 38%
2016-17 44%
2015-16 45%
2014-15 9%
2013-14 68%
2012-13 50%
2011-12 59%
2010-11 38%
2009-10 93%
2008-09 56%
2007-08 60%
2006-07 46%
2005-06 61%
2004-05 40%

Source: BC Centre for Disease Control: Sentinel Network

World Health Organization (WHO) recommendations for influenza vaccine composition for 2022-2023

Egg-based vaccines

Cell culture or recombinant-based vaccines

For trivalent influenza vaccines for use in the 2022-2023 northern hemisphere influenza season, the WHO recommends that the A(H1N1)pdm09, A(H3N2) and B/Victoria lineage viruses noted above be used for the quadrivalent vaccines.

Source: WHO: Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season (PDF)

Canada's Vaccination Coverage Survey results 2021-2022

Canada's goal is to have 80% of those who are at higher risk of complications from influenza vaccinated. We still have progress to make to reach that target.

Figure 3. Seasonal flu vaccination coverage, 2019-2020 to 2021-2022 flu seasons
Figure 3. Text version below.
Figure 3: Text description
Flu season All adults (18+) People aged 18-64 without chronic medical conditions People aged 18-64 with chronic medical conditions Seniors (65+)
2019-2020 41.8 30.0 43.6 70.3
2020-2021 40.4 29.2 40.5 70.4
2021-2022 38.7 26.8 37.6 71.0

Source: Seasonal Influenza Vaccine Coverage Survey results, 2021-2022

Key takeaways: Impact of influenza

Interactive poll

True or false: Some groups, such as those 65 years of age and older and adults with chronic medical conditions, are at increased risk of influenza-related complications and hospitalization.

The answer is true.

Health care provider role in vaccine uptake: Identifying and addressing barriers

Conversations about the seasonal influenza vaccine might look a little different than before the COVID-19 pandemic.

Key factors that can influence vaccine hesitancy

The reasons for vaccine hesitancy are varied and complex. The '5C' model summarizes the key factors that can influence vaccine hesitancy.

The 5Cs of vaccine hesitancy

Confidence: level of trust in the effectiveness and safety of vaccines, the systems that delivers vaccines and the motives of those who establish vaccine policies.

Complacency: perception that risks of vaccine-preventable disease are low and vaccines are not necessary.

Convenience: extent to which vaccines are available, affordable, accessible, and individuals' ability to understand (as a reflection of language and health literacy) the need for vaccinations.

Calculation: individual engagement in extensive information searching and evaluation of risks of infections versus vaccination.

Collective responsibility: extent to which one is willing to protect others by one's own vaccination.

Discussions on vaccine confidence start by identifying a person's knowledge, attitudes and beliefs towards flu vaccines

The Seasonal Influenza Vaccination Coverage Survey is conducted every year to collect information on influenza vaccine uptake in Canada. The following data points are taken from the most recent survey, for which data collection took place between January 4 and February 11, 2022.

The most commonly reported reason among all adults for not getting their flu shot is they are healthy and/or they never get the flu (23%).

The majority of the population (67%) stated that the COVID-19 pandemic has no impact on their likelihood of getting the flu shot this year.

Results indicate that 92% of the respondents believed that the flu shot is safe, but 38% of them believe they might get the flu from the flu vaccine, and 35% agreed that the flu vaccine does not protect them against getting the flu.

Source: Seasonal Influenza Vaccination Coverage Survey results, 2021-2022

Understanding the factors that are preventing people from getting vaccinated is key to starting supportive discussions on vaccines

  1. Be transparent about the risks and benefits of vaccination and inform patients of the risks of not getting vaccinated.
  2. Cultivate a 'safe space' for discussions about vaccination. Try engaging in active listening and creating opportunities to learn about patients' questions, values and experiences related to vaccination.
  3. Activate the 'right' emotions. Be intentional about tapping into positive emotions (hope, love, pride and the concern for others) rather than evoking shame, sadness or guilt. Avoid judgement and labels.

To learn more about addressing vaccine hesitancy in your practice visit: Addressing vaccine hesitancy in the context of COVID-19: A primer for health care providers

Key takeaways: Addressing vaccine hesitancy

Interactive poll

True or false: According to the 2021-2022 Vaccine Coverage survey: the most commonly reported reason among all adults for not getting their flu shot is that they are healthy and/or they never get the flu.

The answer is true.

NACI recommendations

About NACI

Who should receive the influenza vaccine?

People 6 months of age and older who do not have contraindications to the vaccine, particularly:

Source: Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2022-2023

People at high risk of influenza-related complications or hospitalization

Adults and children with high-risk chronic health conditions

Groups at high risk

People capable of transmitting influenza to those at high risk

Health care providers and other care providers in facilities and community settings, including paid and unpaid:

Due to their occupation and close contact with people who may be infected with influenza, they are themselves at increased risk of infection.

People capable of transmitting influenza to those at high risk

Household contacts, both adults and children, of individuals at high risk, whether the individual at high risk has been vaccinated or not, for example:

Others at risk of exposure

Seasonal influenza vaccine schedule

Adults and children 9 years of age and older should receive 1 dose.

Children 6 months to less than 9 years of age who have never received the influenza vaccine in a previous influenza season should receive 2 doses with a 4-week interval.

Children 6 months to less than 9 years of age who have been vaccinated with more than 1 dose in any previous influenza season should receive 1 dose.

New or updated information for 2022-2023

New information

Inclusion of recombinant quadrivalent seasonal influenza vaccine

Supemtek (RIV4) is the first and, to date, the only recombinant influenza vaccine licensed in Canada. It may be considered for use among the quadrivalent influenza vaccines offered to adults 18 years of age and older.

Guidance on the use of seasonal influenza vaccine in the presence of COVID-19

NACI guidance outlines that administration of COVID-19 vaccines may occur at the same time as, or at any time before or after influenza immunization (including all seasonal influenza vaccines or live attenuated influenza vaccines [LAIV]) for those aged 5 years and older.

Access the list of the types of influenza vaccines available in Canada for the 2022–2023 season.

Updated information

Age indication Flucelvax Quad

Flucelvax Quad (IIV4-cc) standard dose mammalian cell culture-based quadrivalent inactivated influenza vaccine is now authorized by Health Canada for use in adults and children 6 months and older.

Age indication Influvac Tetra

Influvac Tetra (IIV4-SD) egg-based, subunit, quadrivalent inactivated influenza vaccine is now authorized by Health Canada for use in adults and children 6 months and older.

NACI statements for the expanded indications of both Flucelvax Quad and Influvac Tetra have not yet been released but are expected in the next iteration of the influenza statement (2023-2024).

Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2022–2023

Who should not receive the influenza vaccine?

The contraindications listed above are specific to influenza vaccines. To find contraindications for other vaccines, consult the relevant NACI statement, Canadian Immunization Guide and product monograph.

Who should not receive a live attenuated influenza vaccine (LAIV)?

In addition to the contraindications mentioned in the previous section, NACI recommends that LAIV should not be given to people with:

LAIV is not contraindicated for people with a history of stable asthma or recurrent wheeze.

LAIV is not contraindicated in breastfeeding individuals; however, there is limited data for the use of LAIV in lactating individuals

LAIV should not be administered until 48 hours after antiviral agents active against influenza (e.g., oseltamivir, zanamivir) are stopped. Those antiviral agents, unless medically indicated, should not be administered until 2 weeks after receipt of LAIV. This is so that the antiviral agents do not inactivate the replicating vaccine virus.

If the above anti-viral agents are administered from 48 hours pre-vaccination with LAIV to 2 weeks post-vaccination:

NACI recommended dose and route of administration, by age, for influenza vaccine types authorized for the 2022-2023 influenza season

Age group Influenza vaccine type (route of administration) Number of doses required
IIV3-SD or IIV4-SD (IM) IIV4-cc (IM) IIV3-Adj (IM) IIV4-HD (IM) RIV4 (IM) LAIV4 (intranasal)
6 to 23 months 0.5 mL - 0.25 mL - - - 1 or 2
2 to 8 years 0.5 mL 0.5 mL - - -

0.2 mL

(0.1 mL per nostril)

 1 or 2
9 to 17 years 0.5 mL 0.5 mL - - -

0.2 mL

(0.1 mL per nostril)

 1
18 to 59 years 0.5 mL 0.5 mL - - 0.5 mL

0.2 mL

(0.1 mL per nostril)

 1
60 to 64 years 0.5 mL 0.5 mL - - 0.5 mL - 1
65 years and older 0.5 mL 0.5 mL 0.5 mL 0.7 mL 0.5 mL - 1

Abbreviations

IIV3-Adj: adjuvanted trivalent inactivated influenza vaccine; IIV4-cc: quadrivalent mammalian cell-culture based inactivated influenza vaccine; IIV4-HD: high-dose quadrivalent inactivated influenza vaccine; IIV3-SD: standard-dose trivalent inactivated influenza vaccine; IIV4-SD: standard-dose quadrivalent inactivated influenza vaccine; RIV4: quadrivalent recombinant influenza vaccine; IM: intramuscular; LAIV4: quadrivalent live attenuated influenza vaccine.

To learn more about specific recommendations on the choice of seasonal influenza vaccine, visit: Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2022-2023

Key takeaways: NACI recommendations

Interactive poll

Which one of the following is the LAIV intranasal vaccine contraindicated for?

  1. children over 24 months of age
  2. people who are pregnant
  3. people with mild asthma

The answer is B, people who are pregnant.

Antiviral agents

Are antivirals recommended to treat influenza?

Which antivirals are approved in Canada for the treatment of influenza?

Antiviral Considerations
Oseltamivir (oral)
  • oral capsule, liquid suspension
  • persons 1 year and older
  • generic version available
Zanamivir (inhalation)
  • powder for oral inhalation through a plastic device
  • aged greater than or equal to 7 years
  • not recommended in patients with airway diseases (e.g., asthma, COPD)
Peramivir (IV)
  • given intravenously (approved but not marketed in Canada)
  • aged greater than or equal to 2 years
Baloxavir Marboxil (PO)
  • oral tablets (1 dose)
  • aged greater than or equal to 12 years (approved but not marketed in Canada)

All circulating viruses (H3N2, H1N1pdm09, and B) are resistant to adamantanes.

Source: Association of Medical Microbiology and Infectious Disease Canada: 2021-2022 guidance on the use of antiviral drugs for influenza in the COVID-19 pandemic setting in Canada

General principles on influenza antiviral therapy

The following recommendations are based on the Association of Medical Microbiology and Infectious Disease Canada's Guidance on the use of antiviral agents for the 2019-2020 influenza season.

Access the full guidance from the Association of Medical Microbiology and Infectious Disease Canada on the use of antiviral drugs for seasonal influenza.

Question and answer session

Thank you

Please complete our short webinar evaluation survey when you leave.

A link to the recording and PDF will be available at nccid.ca after the webinar.

Visit nccid.ca to register for the French webinar on Seasonal Influenza 2022-2023 scheduled for September 29, 2022, at 1 pm Eastern Time.

Visit nccid.ca for more and upcoming PHAC webinars.

Supplemental information

Abbreviations

IIV: inactivated influenza vaccine

IIV3: trivalent inactivated influenza vaccine

IIV3-Adj: adjuvanted egg-based trivalent inactivated influenza vaccine

IIV3-HD: high-dose egg-based trivalent inactivated influenza vaccine

IIV3-SD: standard-dose egg-based trivalent inactivated influenza vaccine

IIV4: quadrivalent inactivated influenza vaccine

IIV4-cc: standard-dose cell culture-based quadrivalent inactivated influenza vaccine

IIV4-HD: high-dose egg-based quadrivalent inactivated influenza vaccine

IIV4-SD: standard-dose egg-based quadrivalent inactivated influenza vaccine

LAIV: live attenuated influenza vaccine

LAIV3: egg-based trivalent live attenuated influenza vaccine

LAIV4: egg-based quadrivalent live attenuated influenza vaccine

RIV: recombinant influenza vaccine

RIV4: recombinant quadrivalent influenza vaccine

Which seasonal influenza vaccines are available in Canada for the 2022-2023 flu season?

IIV4-SD IIV4-cc IIV3-Adj IIV4-HD LAIV4 RIV4

Flulaval Tetra (6 months and older)

Fluzone
Quadrivalent (6 months and older)

Afluria Tetra (5 years and older)

Influvac Tetra (6 months and older)

Flucelvax
Quad (6 months of age and older)

Fluad Pediatric (6months-23 months)

Fluad (65 years and older)

Fluzone
High-Dose Quadrivalent (65 years and older)

FluMist
Quadrivalent (2-59 years)

Supemtek (18 years and older)

Not all products will be made available in all jurisdictions and availability of some products may be limited.

Which seasonal influenza vaccines are not available in Canada for the 2022-2023 flu season?

IIV3-HD formulations will not be authorized or available for use in Canada during the 2022-2023 influenza season.

The following IIV3-SD formulations are authorized but will not be available for use in Canada during the 2022-2023 influenza season:

Seasonal influenza guidance

Seasonal influenza awareness resources

The Public Health Agency of Canada offers free resources for health professionals:

Social media posts for flu awareness

FluWatch

Sentinel practitioners

Are you a physician or nurse involved in primary care?

You can help monitor the influenza-like illness (ILI) across Canada and help us understand the effects of COVID-19 on seasonal respiratory viruses. With more data, FluWatch can better detect signals of increased or unusual ILI activity.

Canada needs your ILI data. Sign up today for a more prepared tomorrow.

Email: fluwatch-epigrippe@phac-aspc.gc.ca

FluWatchers

Canadian volunteers

Not a physician or nurse?

You can still help monitor ILI and COVID-19 in Canada as a FluWatcher.

FluWatchers answer 2 yes or no questions each week to help show Canadians when and where ILI and COVID-19 activity is occurring in Canada.

Canada needs more FluWatchers. The more volunteers that report, the more accurate the data. Google 'FluWatchers' for more info and to sign up!

Seasonal influenza awareness resources

Free resources for frontline providers, available for download on the Immunize Canada website.

Immunize Canada is a national coalition of non-governmental, professional, health, government and private sector organizations with a specific interest in promoting the understanding and use of vaccines recommended by NACI.

Vaccine Injury Support Program

Access the Vaccine Injury Support Program website

References

Aoki, F., Allen, U., Mubareka, S., Papenburg, J., Stiver, G., and Evans, G. (2019). Use of antiviral drugs for seasonal influenza: Foundation document for practitioners: Update 2019 Official Journal of the Association of Medical Microbiology and Infectious Disease Canada. 4(2), 60-82. Aoki, F., Papenburg, J., Mubareka, S., Allen, U., Hatchette, T., & Evans., G. (2022). 2021-2022 AMMI, doi/10.3138/jammi.2019.02.08

Aoki, F., Papenburg, J., Mubareka, S., Allen, U., Hatchette, T., and Evans., G. (2022). 2021-2022 Association of Medical Microbiology and Infectious Disease Canada: Guidance on the use of antiviral drugs for influenza in the COVID-19 pandemic setting in CanadaOfficial Journal of the Association of Medical Microbiology and Infectious Disease Canada. 7(1), 1-7. doi.org/10.3138/jammi-2022-01-31

Bancej, C., Rahal, A., Lee, L., Buckrell, S., Schmidt, K., and Bastien, N. (2022). National FluWatch mid-season report, 2021-2022: Sporadic influenza activity returns. Canadian Communicable Disease Report. 48(1), 39-45. doi:10.14745/ccdr.v48i01a06

Government of Canada. (2022, September 02). FluWatch report. FluWatch report, July 24 to August 27, 2022 (weeks 30-34).

Government of Canada. (2022, June 8). Retrieved from Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2022-2023.

Government of Canada. (2022, July 11). Seasonal Influenza Vaccination Coverage Survey results, 2021-2022.

Government of Canda. (2021, May 7). Addressing vaccine hesitancy in the context of COVID-19: A primer for health care providers.

World Health Organization. (2018, November 6). Influenza (seasonal).

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