2021 to 2022 seasonal influenza vaccine: Mobile guide for health professionals

Last updated: November 2021

Important notice: This guidance is based on currently available scientific evidence and expert opinion. The content will be reviewed regularly and updates will be made as necessary throughout the influenza season as the public health context evolves and new evidence emerges.

The following is a summary of recommendations from the National Advisory Committee on Immunization (NACI).

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Who should receive the vaccine

Everyone 6 months of age and older should receive the vaccine unless they have contraindications to the vaccine.

It is especially important that the following people receive the vaccine:

People at high risk of severe COVID-19 related illness

People at high risk of influenza-related complications or hospitalization

People capable of transmitting influenza to those at high risk of influenza-related complications or hospitalization

Others

The influenza vaccine is a critical tool to protect against influenza-related disease and to reduce the influenza-associated burden on the Canadian healthcare system. This is even more important this influenza season:

Schedule

Adults and children 9 years of age and older should receive 1 dose of influenza vaccine each year.

Children 6 months to less than 9 years of age who have never received the influenza vaccine in a previous influenza season should:

If they have been properly vaccinated with one or more doses in the past, they should receive 1 dose of influenza vaccine per season thereafter.

Contraindications

Who should not receive the vaccine

Who should not receive a live attenuated influenza vaccine

In addition to the above-mentioned contraindications, NACI also recommends that live attenuated influenza vaccine (LAIV) should not be given to:

LAIV should not be administered until 48 hours after antiviral agents active against influenza are stopped, for example:

These 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 these anti-viral agents are administered within this time frame (from 48 hours pre-vaccination with LAIV to 2 weeks post-vaccination):

Considerations for influenza vaccination during the COVID-19 pandemic

Individuals with symptoms of COVID-19 or an acute respiratory infection

During the COVID-19 pandemic, individuals should postpone influenza vaccination until they have recovered if they have:

This is because they can pose an unnecessary risk to others and healthcare providers if they have COVID-19. Individuals with COVID-19 symptoms should visit a healthcare professional or contact their local public health authority for information on getting tested.

Individuals currently in quarantine (self-isolation) for SARS-CoV-2 infection (COVID-19)

For additional advice, refer to the following guidance document developed in consultation with NACI:

Simultaneous administration with other vaccines

Seasonal influenza vaccines (including the LAIV) may be given:

the administration of other vaccines, including COVID-19 vaccines.

NACI will continue to:

Consult the NACI guidance concerning the use of COVID-19 vaccines for further information on the simultaneous administration of COVID-19 vaccines with other vaccines.

Choice of vaccine product

Abbreviations

HAART
highly active antiretroviral therapy
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
IM
intramuscular
LAIV
live attenuated influenza vaccine
LAIV4
egg-based quadrivalent live attenuated influenza vaccine

Children

For children 6 to 23 months of age:

For healthy children (2 to 17 years of age):

For children with immune compromising conditions (2 to 17 years of age):

For children with severe asthma or medically attended wheezing in previous 7 days (2 to 17 years of age):

Adults

For healthy adults (18 to 59 years of age):

For adults with chronic health conditions (18 to 59 years of age):

For adults 60 to 64 years of age:

For adults 65 years of age or older:

Specific populations

For people who are pregnant:

For healthcare workers:

Table 1. Influenza vaccine type (route of administration) by age group and number of doses
Age group IIV3-SDTable 1 footnote a or IIV4 –SDTable 1 footnote b
(IM)
IIV4-ccTable 1 footnote c (IM) IIV3-Adj
(IM)Table 1 footnote d
IIV3-HDTable 1 footnote e (IM) IIV4-HDTable 1 footnote f (IM) LAIV4Table 1 footnote g (intranasal) Number of doses required
6 to 23 months 0.5 mLTable 1 footnote h - 0.25 mL - - - 1 or 2Table 1 footnote i
2 to 8 years 0.5 mL - - - - 0.2 mL
(0.1 mL per nostril)
1 or 2Table 1 footnote i
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 - - - 0.2 mL
(0.1 mL per nostril)
1
60 to 64 years 0.5 mL 0.5 mL - - - - 1
65 years or older 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.7 mL - 1

Table 1 footnotes

Table 1 footnote a

IIV3-SD formulations (Agriflu® (6 months and older), Fluviral® (6 months and older), and Influvac® (3 years and older)) are authorized but will not be available for use in Canada during the 2021-2022 influenza season.

Return to footnote a referrer

Table 1 footnote b

Afluria® Tetra (5 years and older), Flulaval® Tetra (6 months and older), Fluzone® Quadrivalent (6 months and older), Influvac® Tetra (3 years and older)

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Table 1 footnote c

Flucelvax® Quad (Seqirus) standard dose mammalian cell culture-based quadrivalent inactivated influenza vaccine (currently recommended by NACI for use in adults and children 9 years and older) is now authorized by Health Canada for use in persons ≥2 years of age. Refer to the product monograph for further details. This updated authorized age for use supersedes the information for Flucelvax Quad found within the NACI Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2021–2022. NACI will be reviewing the current recommendations and supporting evidence on the use of Flucelvax Quad.

Return to footnote c referrer

Table 1 footnote d

IIV3-Adj formulations (Fluad Pediatric® ((6–23 months) and Fluad® (65 years and older)) are authorized in Canada, however only Fluad® (65 years and older) is being supplied for the 2021-2022 influenza season.

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Table 1 footnote e

Fluzone® High-Dose (65 years and older) was previously authorized, but marketing of the vaccine has been discontinued as of February 2021.

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Table 1 footnote f

Fluzone® High-Dose Quadrivalent (65 years and older)

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Table 1 footnote g

FluMist® Quadrivalent (2–59 years)

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Table 1 footnote h

Evidence suggests moderate improvement in antibody response in infants, without an increase in reactogenicity, with the use of full vaccine doses (0.5 mL) for unadjuvanted inactivated influenza vaccines. This moderate improvement in antibody response without an increase in reactogenicity is the basis for the full dose recommendation for unadjuvanted inactivated vaccine for all ages. For more information, refer to Statement on Seasonal Influenza Vaccine for 2011–2012.

Return to footnote h referrer

Table 1 footnote i

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 i referrer

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