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Webinar on vaccination for health professionals: Seasonal influenza 2023–2024

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

Recorded for health care professionals: 2023-09-19

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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.

Minimizing influenza-related morbidity and mortality will reduce the burden on the health care system.

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

Historically, 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:

Sources:

A return to pre-pandemic-like pattern

The influenza burden was at historical lows during the COVID-19 pandemic. Influenza returned into circulation in the 2022–2023 season, arriving early with a rapid progression. In 2023–2024 there is a possibility of simultaneous outbreaks of respiratory viruses in Canada ('tridemic' of flu, RSV and COVID-19).

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.

The epidemic threshold is 5% tests positive for influenza. When it is exceeded, and a minimum of 15 weekly influenza detections are reported, a seasonal influenza epidemic is declared.

Figure 1. Percentage of tests positive in Canada compared to previous seasons, week 2022–35 to 2023–34
Figure #. Text version below.
Figure 1: Text description
Percentage of tests positive for influenza, 2022–2023 compared to previous seasons
Surveillance week Percentage of tests positive, 2022–2023 Percentage of tests positive, 2021–2022 Percentage of tests positive, 2020–2021 Maximum percentage of tests positive Minimum percentage of tests positive Average percentage of tests positive
35 0.2 0.0 0.0 1.9 0.1 0.8
36 0.2 0.0 0.0 2.3 0.3 1.1
37 0.2 0.0 0.0 1.8 0.4 1.0
38 0.5 0.0 0.0 2.4 0.5 1.3
39 0.7 0.0 0.0 2.9 0.7 1.7
40 1.0 0.0 0.0 2.3 1.1 1.7
41 1.4 0.1 0.0 3.0 1.3 1.7
42 2.4 0.1 0.0 3.4 0.9 2.2
43 5.5 0.1 0.0 5.3 0.8 2.8
44 10.8 0.2 0.1 8.5 1.2 3.7
45 16.2 0.1 0.0 10.1 1.4 4.6
46 20.3 0.2 0.0 14.1 1.5 6.1
47 24.3 0.2 0.1 15.4 1.4 7.7
48 24.1 0.3 0.1 18.2 0.8 10.6
49 21.2 0.3 0.0 19.7 1.6 13.0
50 17.4 0.3 0.0 27.0 2.4 16.8
51 12.5 0.2 0.0 29.1 3.3 20.1
52 8.0 0.1 0.0 34.5 4.3 24.5
1 4.6 0.1 0.0 31.7 5.8 23.4
2 2.3 0.1 0.0 29.1 7.1 23.0
3 1.5 0.1 0.0 30.1 12.2 23.6
4 1.1 0.1 0.0 29.5 15.9 24.0
5 1.0 0.0 0.0 30.6 19.6 24.9
6 1.0 0.1 0.0 32.4 17.9 25.0
7 0.9 0.0 0.0 32.5 16.3 25.1
8 1.1 0.1 0.0 32.9 17.5 25.1
9 1.3 0.1 0.0 34.3 16.8 24.6
10 1.4 0.2 0.0 36.0 16.0 23.2
11 1.7 0.3 0.0 31.4 16.2 21.4
12 1.9 0.9 0.0 30.0 15.0 20.1
13 2.4 1.5 0.0 28.3 14.5 19.6
14 2.2 2.5 0.0 23.2 12.7 17.9
15 2.5 3.9 0.0 20.7 11.9 16.3
16 2.4 7.0 0.0 18.5 11.6 14.5
17 2.4 9.7 0.0 17.3 9.8 12.8
18 2.3 11.3 0.0 13.0 7.9 10.3
19 2.1 12.6 0.0 11.9 5.0 9.0
20 2.1 10.4 0.0 9.1 3.2 7.2
21 1.6 9.8 0.0 7.4 3.0 5.6
22 1.6 8.4 0.0 5.0 2.2 3.9
23 1.3 7.0 0.0 4.4 0.9 2.9
24 1.0 5.0 0.0 4.4 0.8 2.2
25 1.0 3.0 0.0 3.9 0.6 1.9
26 0.7 2.3 0.0 3.1 0.7 1.8
27 0.6 1.2 0.0 2.8 0.4 1.5
28 0.8 0.8 0.0 1.8 0.4 0.9
29 0.5 0.7 0.0 1.6 0.5 1.1
30 0.5 0.4 0.0 1.5 0.5 0.9
31 0.5 0.3 0.0 1.9 0.6 1.1
32 0.7 0.2 0.0 1.2 0.5 0.9
33 0.6 0.2 0.0 1.7 0.4 0.9
34 0.6 0.2 0.0 1.6 0.4 0.9

Source: FluWatch report: July 23 to August 26, 2023 (weeks 30–34)

2022–2023 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.

Influenza infection can also worsen certain chronic conditions.

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.

Respiratory illness season: Overlapping symptoms

The frequency of symptoms of SARS-CoV-2 and for other respiratory viruses are shown in the radar plot in Figure 2 (aggregated across all SARS-CoV-2 variants of concern). The points represent the mean estimates, shaded areas represent the 95% confidence intervals (CI). SARS-CoV-2 includes the wild-type, Alpha, Delta, Omicron BA1, Omicron BA2 and Omicron BA5 variants.

Figure 2. Symptom profile of common respiratory viruses: Frequency of symptoms reported during illness by virus type
Figure 2. Text version below.
Figure 2: Text description
Frequency of symptoms reported during illness by virus type [95% confidence interval]
Characteristic Overall, N = 11,766Footnote 1 Wild-type, N = 262 [95% CI]Footnote 1Footnote 2 Alpha, N = 445 [95% CI]Footnote 1Footnote 2 Delta, N = 1,640 [95% CI]Footnote 1Footnote 2 Omicron BA1, N = 2,282 [95% CI]Footnote 1Footnote 2 Omicron BA2, N = 4,012 [95% CI]Footnote 1Footnote 2 Omicron BA5, N = 2,345 [95% CI]Footnote 1Footnote 2 Influenza, N = 222 [95% CI]Footnote 1Footnote 2 Rhinovirus, N = 283 [95% CI]Footnote 1Footnote 2 RSV, N = 84 [95% CI]Footnote 1Footnote 2 Seasonal CoV, N = 191 [95% CI]Footnote 1Footnote 2
Sore throat 57% 40% [34, 46] 39% [34, 43] 43% [40, 45] 53% [51, 55] 62% [61, 64] 65% [63, 66] 72% [65, 77] 81% [76, 86] 58% [47, 69] 72% [65, 78]
Cough 74% 65% [58, 70] 60% [55, 65] 65% [63, 67] 61% [59, 63] 79% [78, 81] 81% [79, 82] 91% [86, 94] 87% [83, 91] 83% [73, 90] 79% [72, 84]
Runny nose 64% 35% [30, 42] 36% [31, 40] 57% [54, 59] 57% [55, 59] 71% [69, 72] 63% [61, 65] 89% [84, 93] 93% [89, 96] 88% [79, 94] 95% [91, 98]
Sneezing 55% 36% [30, 42] 37% [32, 42] 47% [44, 49] 49% [47, 51] 60% [59, 62] 55% [53, 57] 76% [70, 81] 90% [86, 94] 77% [67, 86] 90% [84, 93]
Fever 20% 23% [18, 28] 24% [20, 29] 23% [21, 25] 14% [12, 15] 14% [13, 15] 19% [18, 21] 74% [67, 79] 47% [41, 53] 38% [28, 49] 51% [44, 59]
Headache 64% 67% [61, 73] 65% [60, 69] 65% [63, 67] 61% [59, 63] 62% [60, 63] 66% [64, 68] 78% [72, 83] 73% [68, 78] 57% [46, 68] 68% [61, 75]
Fatigue 64% 71% [65, 77] 62% [57, 66] 64% [62, 67] 57% [55, 59] 68% [66, 69] 72% [70, 74] 54% [47, 60] 28% [23, 33] 60% [48, 70] 10% [6.7, 16]
ARIFootnote 3 87% 78% [73, 83] 76% [71, 80] 81% [79, 83] 80% [79, 82] 91% [90, 91] 90% [89, 91] 99% [96, 100] 99% [97, 100] 100% [95, 100] 99% [97, 100]
ILIFootnote 4 14% 17% [13, 22] 17% [13, 20] 17% [15, 19] 8.7% [7.6, 9.9] 12% [11, 13] 16% [15, 18] 49% [42, 55] 12% [8.3, 16] 20% [13, 31] 12% [7.5, 17]
Age
0–15 11% 8.4% [5.5, 13] 9% [6.6, 12] 23% [21, 25] 15% [14, 17] 4.5% [3.9, 5.2] 3.2% [2.5, 4.0] 43% [36, 50] 19% [15, 25] 36% [26, 47] 20% [15, 26]
16–44 19% 35% [29, 41] 37% [33, 42] 27% [25, 29] 23% [22, 25] 14% [13, 16] 9.6% [8.4, 11] 23% [17, 29] 29% [24, 34] 16% [9.2, 26] 29% [23, 36]
45–64 39% 35% [30, 42] 38% [33, 43] 35% [33, 37] 35% [33, 37] 41% [40, 43] 43% [41, 45] 29% [23, 36] 36% [30, 42] 30% [20, 41] 38% [31, 45]
65 + 32% 21% [16, 27] 16% [13, 20] 15% [14, 17] 26% [24, 28] 40% [38, 41] 45% [42, 47] 5.5% [3.0, 9.6] 16% [12, 21] 19% [11, 29] 14% [9.2, 19]
Missing 5 0 0 0 0 0 0 2 0 3 0
Proportion 100% 2.2% 3.8% 14% 19% 34% 20% 1.9% 2.4% 0.7% 1.6%
1

%

Return to footnote 1 referrer

2

CI confidence interval.

Return to footnote 2 referrer

3

ARI acute respiratory infection (experiencing at least one of the following: cough, fever or runny nose).

Return to footnote 3 referrer

4

ILI influenza like illness (experiencing fever and cough).

Return to footnote 4 referrer

Source: Symptom profiles of community cases infected by influenza, RSV, rhinovirus, seasonal coronavirus, and SARS-CoV-2 variants of concern (Scientific Reports journal)

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

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

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

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 reassortment 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

World Health Organization (WHO) recommendations for influenza vaccine composition for 2023–2024

Egg-based vaccines

Cell culture or recombinant-based vaccines

For trivalent influenza vaccines for use in the 2023–2024 northern hemisphere influenza season, the WHO recommends that the A(H1N1)pdm09, A(H3N2) and B/Victoria lineage viruses noted above be used.

Source: Recommended composition of influenza virus vaccines for use in the 2023–2024 northern hemisphere influenza season (World Health Organization)

Influenza vaccine effectiveness

Figure 3. Canadian Sentinel Practitioner Surveillance Network influenza vaccine effectiveness estimates % (95% CI) 2004–05 to 2022–23 seasons (any influenza type/subtype)
Figure 3. Text version below.
Figure 3: Text description
Canadian Sentinel Practitioner Surveillance Network influenza vaccine effectiveness estimates
Season Vaccine effectiveness estimate percentages
2022–23 54%
2021–22 36%
2020–21 N/AFootnote 1
2019–20 53%
2018–19 56%
2017–18 37%
2016–17 44%
2015–16 46%
2014–15 9%
2013–14 68%
2012–13 50%
2011–12 59%
2010–11 37%
2009–10 93%
2008–09 56%
2007–08 60%
2006–07 46%
2005–06 61%
2004–05 40%
1

Due to absence of influenza circulation in BC during the COVID-19 pandemic, vaccine effectiveness evaluation could not be performed.

Return to footnote 1 referrer

For the period from 2020 to 2021, due to absence of influenza circulation in BC during the COVID-19 pandemic, vaccine effectiveness evaluation could not be performed.

Source: Sentinel Practitioner Surveillance Network (BC Centre for Disease Control)

Canada's Vaccination Coverage Survey results 2022–2023

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 4. Seasonal flu vaccination coverage, 2019–2020 to 2022–2023 flu seasons
Figure 4. Text version below.
Figure 4: Text description
Seasonal flu vaccination coverage (percent vaccinated)
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 42 30 44 70
2020–2021 40 29 41 70
2021–2022 39 27 38 71
2022–2023 43 31 43 74

Source: Seasonal Influenza Vaccine Coverage Survey results, 2022–2023

Results of the Survey on Vaccination during Pregnancy 2021

Impact of the COVID-19 pandemic on vaccination during pregnancy:

Those who had received a recommendation to vaccinate from their primary health care provider during pregnancy, were more likely to receive vaccination against pertussis and influenza during pregnancy compared to those who did not.

Source: Results of the Survey on Vaccination during Pregnancy 2021

New supplemental statement on influenza vaccination during pregnancy (forthcoming fall 2023)

Key takeaways: Impact of influenza

  1. Influenza can lead to severe complications, including hospitalization and death (especially in high-risk populations).
    1. Most people recover fully in 7 to 10 days.
  2. For best possible protection, it is recommended to get the influenza vaccine annually.
    1. Circulating strains of influenza tend to change from year to year.
    2. Vaccination can help prevent influenza and its complications and may prevent transmission to others.
    3. The effectiveness of influenza vaccine may not persist beyond a year.
  3. The 2022–2023 influenza season saw the return to pre-pandemic-like influenza trends in Canada.
  4. The potential co-circulation of influenza, COVID-19 and other respiratory viruses this season, raises concerns for high-risk populations and health care capacity especially in the current health care system context.
  5. A health care provider recommendation to get vaccinated against influenza can increase the likelihood of a person getting vaccinated.

Interactive poll

True or false: Those 18 to 65 years of age with chronic medical conditions are closer to the 80% influenza vaccination goal rate than those 65 years of age and older.

The answer is false.

Health care provider role in vaccine uptake: Building confidence, enabling access, and identifying and addressing barriers

Conversations about the seasonal influenza vaccine might look a little different going forward

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 deliver 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.

Source: Addressing vaccine hesitancy in the context of COVID-19: A primer for health care providers

Key factors that influence vaccine uptake

The WHO behavioural and social drivers of vaccination (BeSD) framework summarizes the key factors that influence vaccine uptake.

Figure 5. The WHO behavioural and social drivers of vaccination framework
Figure 5. Text version below.
Figure 5: Text description

The behavioural and social drivers (BeSD) of vaccination are defined as beliefs and experiences specific to vaccination that are potentially modifiable to increase vaccine uptake. The BeSD of vaccination can be grouped and measured in 4 domains. Each domain contains several themes (constructs) that relate to the relevant domain. The 4 domains consist of:

  1. Thinking and feeling: Perceived disease risk; vaccine confidence (includes perceived benefits, safety and trust)
  2. Social processes: Social norms (includes support of family and religious leaders); health worder recommendation; gender equity
  3. Motivation: Intention to get recommended vaccines
  4. Practical issues: Availability; affordability; ease of access; service quality; respect from health workers

In the algorithm, the domains of thinking and feeling, and social processes can influence an individual's domain of motivation. Motivation can in turn be influenced by the domain of practical issues. The interaction between these 4 domains ultimately influences an individual's decision to get vaccinated (uptake).

Sources:

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 clients 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 clients' questions, values and experiences related to vaccination.
  3. Activate the 'right' emotions. Be intentional about tapping into positive emotions (protection, self-care and community-mindedness) rather than evoking shame, sadness or guilt. Avoid judgement and labels.

Source: Addressing vaccine hesitancy in the context of COVID-19: A primer for health care providers

Key takeaways: Addressing vaccine hesitancy

  1. Discuss the importance of influenza vaccines with your clients, especially if they are:
    1. at increased risk of influenza-related complications
    2. capable of transmitting influenza to those at high risk
    3. at high risk of other respiratory viruses
    4. providing essential community services
  2. Seek to understand the factors that are preventing an individual from getting vaccinated by starting respectful, culturally sensitive, and age-appropriate discussions on vaccines, which take into account their diverse needs.
  3. Use the BeSD framework to identify and address barriers to vaccine uptake (thinking and feeling, social processes, motivation, and practical issues).

Interactive poll

Multiple choice: Within the WHO's behavioural and social drivers of vaccination framework, social norms and health worker recommendations are part of which key factor?

  1. thinking and feeling
  2. social processes
  3. motivation
  4. practical issues

The answer is B, social processes.

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:

People at high risk of influenza-related complications or hospitalization

Groups at high risk

Adults and children with high-risk chronic health conditions

People capable of transmitting influenza to those at high risk

1. Health care providers and other care providers in facilities and community settings:

Includes any person, paid or unpaid, who provides services, works, volunteers, or trains in a hospital, clinic, or other health care facility.

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

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

3. Those providing regular child care to children 0 to 59 months of age, whether in or out of the home.

4. Those who provide services within closed or relatively closed settings to people at high risk (e.g., crew on a ship).

Others at higher risk of exposure

New or updated information for 2023–2024

Age indication Flucelvax Quad

NACI recommends that Flucelvax Quad (IIV4-cc) may be considered among the quadrivalent influenza vaccines offered to adults and children 6 months of age and older (discretionary NACI recommendation).

Age indication Influvac Tetra

NACI recommends that Influvac Tetra (IIV4-SD) may be considered among the standard dose inactivated quadrivalent influenza vaccines offered to individuals 3 years of age and older (discretionary NACI recommendation).

NACI concludes that there is insufficient evidence for recommending vaccination with Influvac Tetra in children younger than 3 years of age (discretionary NACI recommendation).

Access the list of the types of influenza vaccines available in Canada for the 2023–2024 season

New supplemental statement on use of influenza vaccination during pregnancy

NACI continues to strongly recommend that influenza vaccines should be offered annually, at any stage in the pregnancy (i.e., in any trimester).

Guidance on concurrent administration of influenza and COVID-19 vaccines

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 parenteral or intranasal seasonal influenza vaccines) for those aged 6 months of age and older.

Update to standard-dose trivalent inactivated influenza vaccine (IIV3-SD) authorization and availability

All standard dose, egg-based inactivated influenza vaccines authorized and available in Canada for the 2023–24 season are expected to be quadrivalent.

Updated presentation of the statement

As part of a modernization process to improve readability and access to information, the influenza NACI statement is now separate from the Canadian Immunization Guide chapter on influenza.

Source: NACI statement on seasonal influenza vaccine for 2023–2024

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 been vaccinated with 1 or more doses in any previous influenza season 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.

Who should not receive the influenza vaccine?

Note: 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.

Influenza vaccination should usually be postponed in people with serious acute illnesses but not for minor or moderate acute illnesses. For more information, visit the acute illness section in the contraindications and precautions: Canadian Immunization Guide page.

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

When you should not receive a live attenuated influenza vaccine

NACI recommended dose and route of administration, by age, for influenza vaccine types authorized for the 2023–2024 influenza season

NACI recommended dose and route of administration, by age, for influenza vaccine types authorized for the 2023–2024 influenza season
Age group Influenza vaccine type (route of administration) Number of doses required
IIV4-SD (IM) IIV4-cc
(IM)		 IIV3-Adj
(IM)		 IIV4-HD
(IM)		 RIV4
(IM)		 LAIV4
(intranasal)
6 to 23 months 0.5 mL 0.5 mL 0.25 mL no data no data no data 1 or 2
2 to 8 years 0.5 mL 0.5 mL no data no data no data 0.2 mL
(0.1 mL per nostril)		 1 or 2
9 to 17 years 0.5 mL 0.5 mL no data no data no data 0.2 mL
(0.1 mL per nostril)		 1
18 to 59 years 0.5 mL 0.5 mL no data no data 0.5 mL 0.2 mL
(0.1 mL per nostril)		 1
60 to 64 years 0.5 mL 0.5 mL no data no data 0.5 mL no data 1
65 years and older 0.5 mL 0.5 mL 0.5 mL 0.7 mL 0.5 mL no data 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; 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: NACI statement on seasonal influenza vaccine for 2023–2024

Key takeaways: NACI recommendations

  1. NACI has issued recommendations for health care providers on the appropriate selection of seasonal influenza vaccine for the 2023–2024 season, including:
    1. information on seasonal influenza and influenza vaccines
    2. vaccine products recommended for specific groups and ages
    3. contraindications
    4. dosage and routes of administration
  2. See the complete recommendations on the choice of seasonal influenza vaccine and more in the:
    1. NACI statement: Seasonal influenza vaccine for 2023–2024
    2. Canadian Immunization Guide Chapter on influenza vaccine

Interactive poll

Multiple choice: Which of the following groups is considered a higher risk population?

  1. people in direct contact with poultry infected with avian influenza during culling operation
  2. adults and children with high-risk chronic health conditions
  3. all children 6 to 59 months of age
  4. all of the above

The answer is D, all of the above.

Antiviral agents

Are antivirals recommended to treat influenza?

Which antivirals are approved in Canada for the treatment of 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 ≥7 years
  • not recommended in patients with airway diseases (e.g., asthma, COPD)
Peramivir
(IV)
  • given intravenously (approved but not marketed in Canada)
  • aged ≥2 years
Baloxavir Marboxil
(oral)
  • oral tablets (1 dose)
  • aged ≥12 years (approved but not marketed in Canada)

Amantadine continues to not be recommended due to resistance for influenza A.

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 (AMMI) Disease Canada's Use of antiviral drugs for seasonal influenza: Foundation document for practitioners (update 2019).

AMMI Canada 2023 updates

Vaccination guides

The newly revised vaccination guides are available to download:

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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

LAIV4: egg-based quadrivalent live attenuated influenza vaccine

RIV: recombinant influenza vaccine

RIV4: recombinant quadrivalent influenza vaccine

Which seasonal influenza vaccines are not available in Canada for the 2023–2024 flu season?

IIV3-SD formulations will not be authorized or available for use in Canada during the 2023–2024 influenza season.

The following IIV3-SD formulations are discontinued and are no longer available for use in Canada:

Which seasonal influenza vaccines are available in Canada for the 2023–2024 flu season?

Seasonal influenza vaccines available in Canada for the 2023–2024 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 (3 months and older)

 Flucelvax Quad (6 months of age and older)

Fluad Pediatric (6 months to 23 months)

Fluad (65 years and older)

 Fluzone High-Dose Quadrivalent (65 years and older) FluMist Quadrivalent (2 to 59 years) Supemtek (18 years and older)

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

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 influenza-like illness (ILI) trends such as the start, peak and end of the influenza season in Canada. 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 the community spread of ILI in Canada as a FluWatcher.

FluWatchers answer a few quick questions each week to help detect period of increased or unusual ILI activity in Canada.

Canada needs more FluWatchers. The more volunteers that report, the more accurate the data.

Vaccine Injury Support Program

Access the Vaccine Injury Support Program website (Pan-Canadian program, outside Quebec).

Access the Vaccine Injury Compensation Program website (Quebec).

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.

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 Association of Medical Microbiology and Infectious Disease Canada: Guidance on the use of antiviral drugs for influenza in the COVID-19 pandemic setting in Canada. Official Journal of the Association of Medical Microbiology and Infectious Disease Canada. 7(1), 1-7. doi.org/10.3138/jammi-2022-01-31.

Ben Moussa M., Buckrell S., Rahal A., Schmidt K., Lee L., Bastien N., Bancej, C. National influenza mid-season report, 2022–2023: A rapid and early epidemic onset (PDF). Canada Communicable Disease Report. 2023;49(1):10-4. doi: 10.14745/ccdr.v49i01a03.

Geismar, C., Nguyen, V., Fragaszy, E. et al. (2023). Symptom profiles of community cases infected by influenza, RSV, rhinovirus, seasonal coronavirus, and SARS-CoV-2 variants of concern. Nature Scientific Reports. 13(12511), 1-8. doi.org/10.1038/s41598-023-38869-1.

Government of Canada. (2023, September 1). FluWatch report. FluWatch report: July 23 to August 26, 2023 (weeks 30–34).

Government of Canada. (2023, May 31). Government of Canada. Retrieved from Influenza vaccine: Canadian Immunization Guide.

Government of Canada. (2023, May 31). Government of Canada. Retrieved from Statement on seasonal influenza vaccine for 2023–2024.

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

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

Harrison, R., Mubareka, S., Papenburg, J., Schober, T., Allen, U.D., Hatchette, T.F., Evans, G.A. (2023). AMMI Canada 2023 update on influenza: Management and emerging issues. Journal of the Association of Medical Microbiology and Infectious Disease Canada.

Schanzer D.L., Sevenhuysen C., Winchester B., et al. (2013). Estimating Influenza Deaths in Canada, 1992–2009. PLoS ONE. 8(11). doi:10.1371/journal.pone.0080481.

World Health Organization. (2022, April 13). Behavioural and social drivers of vaccination: tools and practical guidance for achieving high uptake.

World Health Organization. (2023, January 12). Influenza (Seasonal).

World Health Organization. (2022, May 20). Understanding the behavioural and social drivers of vaccine uptake WHO position paper – May 2022.

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