Shipments:
The Middlesex-London Health Unit received our first shipment of influenza vaccine which has been distributed to hospitals and long term care facilities, with some going to health care providers’ offices. Another shipment is expected in early October and will be distributed to health care providers by the end of the second week in October. After that, health care providers can order additional influenza vaccine by faxing the completed vaccine order form to 519-663-9581.
Since health care providers’ offices have received only a small portion of their total requirement with the first allocation, you may want to consider giving priority to immunizing your high risk clients until the second allocation of vaccine arrives. However, the vaccine is recommended for anyone six months of age and over.
Strains:
The vaccines being used for the 2012-2103 influenza season will provide protection against three strains of influenza (two of which are new since last year – H3N2 and B) as follow:
• A/California/7/2009 (H1N1)pdm09-like virus;
• A/Victoria/361/2011 (H3N2)-like virus; and
• B/Wisconsin/1/2010-like virus (B Yamagata lineage).
Products:
This year there are four publicly-funded influenza vaccines available which are all given via the intramuscular route as follows:
• Vaxigrip (by Sanofi Pasteur);
• Agriflu (by Novartis);
• Fluviral (by GlaxoSmithKline); and
• Fluad (by Novartis).
Vaxigrip, Fluviral and Agriflu are authorized for those 6 months of age and older. Fluad, which contains an adjuvant (MF59 – oil in water emulsion) is only authorized for use in those 65 years of age and older. In Ontario, Fluad is currently only being provided for residents in nursing homes who are 65 years of age and older. Therefore, it will only be distributed to nursing homes and retirement homes and only for use in residents who are 65 years of age or older. Staff members in long term care facilities and residents less than 65 years of age should receive either Vaxigrip, Fluviral or Agriflu.
Agriflu comes as pre-filled syringes, each containing 0.5 ml. The packaging of this product may take up increased space in your refrigerator, so please plan for that. Vaxigrip and Fluviral come in 10 dose vials. Please mark the date the vial is first punctured and ensure that the vial is discarded 7 days (Vaxigrip) and 28 days (Fluviral) after first entry. Please note that the Health Unit cannot accommodate requests for specific vaccine products.
Agriflu, Vaxigrip and Fluad contain neomycin. Agriflu and Fluad contain kanamycin. Fluviral does not contain either neomycin or kanamycin. Vaxigrip and Fluviral contain thimerosal.
Dosage in children:
As of the 2011-2012 influenza season, the National Advisory Committee on Immunization (NACI) has been recommending that children 6 to 35 months of age receive 0.5 ml per dose of influenza vaccine. The rationale for this change is the demonstration of a modest improvement in immunity with the 0.5 ml dose compared to the 0.25 ml dose, without any increase in adverse effects. Some product monographs still indicate that the dosage for children 6 to 35 months of age is 0.25 ml. Based on the available evidence, NACI may make recommendations that differ from the product monograph, as has been done in this case. At the Health Unit clinics, we will be following the NACI recommendations to use 0.5 ml for children 6 to 35 months of age. Children between 6 months and less than 9 years of age who have never received the seasonal influenza vaccine before still require 2 doses of the vaccine (each of 0.5 ml) this season; the doses are administered at least four weeks apart.
Egg Allergies:
As of the 2011-2012 influenza season, the National Advisory Committee on Immunization (NACI) changed the recommendations regarding the management of egg allergic people based on a growing number of studies that have demonstrated that most egg-allergic persons can safely receive inactivated influenza vaccine. The exact recommendations can be found on pages 21-22 of the NACI statement. It should be noted that these recommendations apply to egg allergic individuals and not individuals who are allergic to the influenza vaccine. Past allergic reaction to the influenza vaccine remains a contraindication to repeat vaccination. It should also be noted that the above recommendation for egg allergic people currently pertains to inactive influenza vaccines only (eg. Agriflu, Vaxigrip, Fluviral and Fluad) and not live vaccines (eg not Flumist – which is not available through the publicly-funded program).
Additional Information:
On our website there is a yellow button called “Influenza Info” where influenza information is available, such as the Health Unit’s community influenza clinic schedule, product monographs and the National Advisory Committee on Immunization Statement on Influenza Vaccine for the 2012-2013 Season.
Bryna Warshawsky and Marlene Price