Q. What are the various influenza vaccines available this season and when is the best timing to get it administered?
A. Though there are many brands of influenza vaccine available, they can be differentiated into 3 groups;
· Quadrivalent Inactivated Vaccine (QIV) which contain 2 influenza A strains: A(H3N2), A(H1N1) and 2 influenza B strains: one from each B virus lineage B/Yamagata and B/Victoria
· High-Dose Quadrivalent Inactivated Vaccine (QIV-HD) which contain the same strains as above – for people 65 years and older
· Adjuvanted Trivalent Inactivated Vaccine (TIV-adj) which contain the same A strains: A(H3N2) and A(H1N1) but only 1 B strain: B/Victoria lineage – for people 65 years and older
Though we have become accustomed to people requesting a specific COVID-19 vaccine and “shopping around”, and in some cases holding out for a particular brand, specific brand requests for the influenza vaccine are not permitted.
You may however request a “type” of flu-vaccine such as the High-Dose vaccine, as long as you meet the government-imposed criteria. However, it is not quite as simple as making your preference known when it comes to the high-dose version. It also must be available for you to receive it (duh..) and based on last year there was a scarcity of supply.
While the Ontario government did a commendable job of extolling the virtues of the high-dose version in our senior population, they really dropped the ball when it came to providing an adequate quantity to meet pent-up demand. Most pharmacies that I am aware of wound up disappointing the vast majority of their seniors who were hoping to be injected by this version and I am not particularly hopeful that they will do any better at securing enough doses this year. The good news is that the regular QIV is still an excellent vaccine and is less prone to causing side effects for those who wind up being injected with it.
Another type of vaccine that you may request would be the Nasal vaccine (FluMist). Unfortunately, it is not publicly funded, unlike all of the other vaccines, and thus you would have to pay for it from your own pocket. Also, the FluMist has not been readily available over the last couple of years so if you are interested in this for yourself or your child, call the pharmacy to put your request in early as supplies are usually limited.
As for who should opt for a flu shot, short of saying everyone, there are select groups of people that are at a much higher risk of getting seriously ill, developing complications and thus requiring hospitalization from the flu. It is obviously a good idea to avoid hospitalization at any point in time but it is even more pertinent this year since our hospital staff has been over-worked to say the least during this pandemic. Individuals who are in regular contact with those people that are deemed at high risk should also consider getting the vaccine.
As per the National Advisory Committee on Immunization (NACI), the following groups are especially encouraged to get vaccinated against the influenza virus;
- Individuals at high risk of complications:
– Pregnant women
– Residents of nursing homes/chronic care facilities
– Individuals 65 years of age and above
– Children 6 months to 4 years of age
– Indigenous peoples
– Anyone older than 6 months of age with a chronic health condition (contact your physician or pharmacy for a complete list)
- Individuals that can easily transmit the influenza virus to those high-risk people mentioned above and also to those under 6 months of age
– Health care workers and care providers in facilities and community settings
– All household contacts of those people listed as high risk
– All caregivers to children 4 years of age and younger
– All household contacts of an expected newborn during the influenza season
– All workers within a closed setting, such as a cruise ship, that provide service for high-risk persons
-Any individual that provides essential community services
– Poultry industry workers
The most readily available influenza vaccine will be the Quadrivalent Inactivated Vaccines (QIV) which provide 15 micrograms of hemagglutinin, the substance that provides us with immunity against the virus. There are four brands of QIV vaccines (FluLaval Tetra, Fluzone Quadrivalent, Afluria Tetra and Flucelvax Quad), all of which are publicly funded and considered equivalent. and all can be given to anyone 5 years of age and older. Flucelvax Quad may be administered to anyone 2 years of age and older whereas FluLaval tetra and Fluzone Quadrivalent are the only vaccines that may be administered to anyone 6 months of age and older. For those of you that like to attend a pharmacy to get your vaccine, trained pharmacists may administer to anyone 2 years of age and older. For the younger crowd, they will have to get their vaccine through your health care provider.
Flucelvax is the only QIV that is not egg-based however, the NACI affirms that people that have an egg allergy may be vaccinated against influenza with any of the vaccines.
Though all of the vaccines may be administered to those individuals that are 65 years of age and older, there are two types of vaccines that may only be given to this age category and may not be given to anyone younger. One is an Adjuvanted Trivalent Inactivated Vaccine (TIV-adj) called Fluad and contains 15 micrograms of hemagglutinin. The other is the only high-dose vaccine called Fluzone High-Dose Qauadrivalent, and contains 60 micrograms of hemagglutinin. This is four times the potency of the regular QIV and the TIV-adj. In previous years, the High-Dose option was only available as a trivalent vaccine and this year is now produced as a quadrivalent vaccine.
The province has likely begun receiving shipments of the influenza vaccine but they prioritize the first doses to go to hospitals and long-term care homes. Once their supply is replenished, often in early to mid October, the province will prioritize retirement homes and those living in congregated care settings. Once delivery to those homes have been satisfied, then the government will then begin sending vaccines to primary care providers and pharmacies. This makes it difficult to ascertain when we might receive our supply of vaccine. Since we will not be booking any clinics until we have the vaccine in our hands, the best advice we have is to register online for your flu shot and we will be in touch via email for you to book your appointment. For more information on this or any other topic, contact your pharmacist.