Seasonal Influenza Vaccine Pocket Guide 2019/20 Edition

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Organization: Public Health Agency of Canada

Type: Pocket guide

Date Published: 2019-08-16

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Recommendations from the National Advisory Committee on Immunization (NACI) 2019–2020

Who should receive the vaccine?

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

People at high risk of influenza-related complications or hospitalization

  • All pregnant womenFootnote 1;
  • Adults and children with the following chronic health conditions: 
    • cardiac or pulmonary disorders (includes bronchopulmonary dysplasia, cystic fibrosis, and asthma);
    • diabetes mellitus and other metabolic diseases;
    • cancer, immune compromising conditions (due to underlying disease, therapy, or both);
    • renal disease;
    • anemia or hemoglobinopathy;
    • neurologic or neurodevelopment conditions (includes neuromuscular, neurovascular, neurodegenerative, neurodevelopmental conditions, and seizure disorders [and, for children, includes febrile seizures and isolated developmental delay], but excludes migraines and psychiatric conditions without neurological conditions);
    • morbid obesity (body mass index [BMI] of 40 and over); and
    • children 6 months to 18 years of age undergoing treatment for long periods with acetylsalicylic acid, because of the potential increase of Reye's syndrome associated with influenza.
  • People of any age who are residents of nursing homes and other chronic care facilities;
  • Adults 65 years of age and older;
  • All children 6 - 59 months of age; and
  • Indigenous peoples.

People capable of transmitting influenza to those at high risk

  • Health care and other care providers in facilities and community settings who, through their activities, are capable of transmitting influenza to those at high risk;
  • Household contacts, both adults and children, of individuals at high risk, whether or not the individual at high risk has been vaccinated:
    • household contacts of individuals at high risk;
    • household contacts of infants less than 6 months of age, as these infants are at high risk but cannot receive influenza vaccine;
    • members of a household expecting a newborn during the influenza season;
  • Those providing regular child care to children 6-59 months of age, whether in or out of the home; and
  • Those who provide services within closed or relatively closed settings to people at high risk (e.g., crew on a ship).

Others

  • People who provide essential community services; and
  • People who are in direct contact with poultry infected with avian influenza during culling operations.

Who should not receive the vaccine?

  • People who have had an anaphylactic reaction to a previous dose of influenza vaccine; 
  • People who have had an anaphylactic reaction to any of the vaccine components, with the exception of egg; and
  • People who have developed Guillain-Barré Syndrome (GBS) within 6 weeks of a previous influenza vaccination.

Schedule

Children 9 years of age and older and adults should receive 1 dose of influenza vaccine each year.

Children 6 months to less than 9 years of age receiving seasonal influenza vaccine for the first time in their life should be given 2 doses of influenza vaccine, with a minimum interval of 4 weeks between doses. If they have properly been vaccinated with one or more doses in the past, they should receive 1 dose of influenza vaccine per season thereafter.

Simultaneous administration with other vaccines

All seasonal influenza vaccines may be considered for administration at the same time as, or at any time before or after, administration of other live attenuated or inactivated vaccines. 

Choice of vaccine product

Children

Children 6–23 months of age

  • IIV4 should be used.
  • If IIV4 is not available, any available IIV3 should be used.

Healthy Children (2–17 years of age)

  • IIV4 should be used, including children with chronic health conditions without contraindications.
  • If IIV4 is not available, any available IIV3 should be used.

Children with immune compromising conditions (2–17 years of age)

  • IIV4 should be used.
  • If IIV4 is not available, any available IIV3 should be used.

Adults

Healthy adults (18–59 years of age)

  • IIV3 or IIV4 should be used.

Adults with chronic health conditions (18–59 years of age)

  • IIV3 or IIV4 should be used.

Adults 60–64 years of age

  • IIV3 or IIV4 should be used.

Adults ≥65 years of age

  • IIV3 high dose should be used over IIV3 standard dose. IIV3 adjuvanted and IIV4 standard dose may also be used.

Others

Pregnant women

  • IIV3 or IIV4 should be used.

Healthcare workers

  • IIV3 or IIV4 should be used.

NEW: Influenza products abbreviations have been updated from previous NACI influenza statements to describe various types of influenza vaccines better.

Abbreviations: IIV3: trivalent inactivated influenza vaccine; IIV4: quadrivalent inactivated influenza vaccine.

Recommended dosage & route, by age, for the 2019–2020 season
Age group Influenza vaccine type
(route of administration)
Number of doses required
IIV3Footnote a or IIV4Footnote b
standard dose (IM)
IIV3 adjuvantedFootnote c (IM) IIV3 high doseFootnote d (IM)
6–23 months 0.5 mL 0.25 mL - 1 or 2Footnote e
2–8 years 0.5 mL - - 1 or 2Footnote e
9–17 years 0.5 mL - - 1
18–59 years 0.5 mL - - 1
60–64 years 0.5 mL - - 1
≥65 years 0.5 mL 0.5 mL 0.5 mL 1

Abbreviations: IIV3: trivalent inactivated influenza vaccine; IIV4: quadrivalent inactivated influenza vaccine; IM: intramuscular.

Note: Live attenuated influenza vaccine (FluMist® Quadrivalent) is not available in Canada for the 2019-2020 influenza season.

Footnote a

Agriflu® (6 months and older), Fluviral® (6 months and older), Influvac® (3 years and older)

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Footnote b

Afluria® Tetra (5 years and older), Flulaval® Tetra (6 months and older), Fluzone® Quadrivalent (6 months and older)

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Footnote c

Fluad Pediatric® (6–23 months) or Fluad® (65 years and older)

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Footnote d

Fluzone® High-Dose (65 years and older)

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Footnote e

Children 6 months to less than 9 years of age receiving seasonal influenza vaccine for the first time in their life should be given 2 doses of influenza vaccine, with a minimum interval of 4 weeks between doses. Children 6 months to less than 9 years of age who have been properly vaccinated with one or more doses of seasonal influenza vaccine in the past should receive 1 dose of influenza vaccine per season thereafter.

Return to footnote e referrer

Source:  2019 Public Health Agency of Canada.  An Advisory Committee Statement, National Advisory Committee on Immunization (NACI), Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2019–2020 (See under Influenza for full document as well as related addenda available at www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci.html).

Footnote 1

The risk of influenza-related hospitalization increases with length of gestation, i.e., it is higher in the third trimester than in the second.

Return to footnote 1 referrer

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