Universal Influenza Immunization Program implementation for the 2023-24 season
September 18, 2023
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To: Local health care providers
FOR IMMEDIATE ATTENTION
Important information about the 2023-24 Universal Influenza Immunization Program (UIIP)
Seasonal influenza presents an ongoing disease burden in Canada. Influenza vaccine is the most effective way to prevent influenza illness and influenza-related complications. With the influenza season fast approaching, please see key updates and important information about the 2023-24 Universal Influenza Immunization Program (UIIP). Influenza vaccine is an important component of managing health care system capacity during the influenza season, particularly in the context of ongoing COVID-19 and other respiratory virus activity.
A variety of influenza vaccine products will be available this year for ordering and immunization. It is important for health care providers to note the specific differences in age indication, dosage, and storage and handling requirements of the products being used. Refer to Table 2 below for vaccine product specific details that will be available for health care providers to order. For complete prescribing information, consult the product monographs available through Health Canada’s Drug Product Database.
Public Health Unit influenza vaccine allocation process
- Every year, the Ministry of Health allocates limited doses of the influenza vaccine to public health units— mainly based on the previous year’s distribution levels and vaccine wastage information. Full details about the provincial distribution timelines are available on the Universal Influenza Immunization Program website.
- Public Health Sudbury & Districts can expect influenza vaccine allocations throughout late September and October. Each season there may be unanticipated restrictions on the availability of publicly funded influenza vaccines or delays in vaccine delivery (e.g., production delays by manufacturers). The ministry recommends that providers do not book appointments prior to receiving influenza vaccine.
- Once the local allocations have been depleted, health units can request additional doses from the Ministry of Health but there is no guarantee of receipt.
- Please see Table 1 below for distribution of influenza vaccines in Ontario.
Health care providers can expect to receive their initial Public Health Sudbury & Districts influenza vaccine order form the week of September 25. The form will indicate the dates that initial orders may be picked up from Public Health Sudbury & Districts.
Table 1: Distribution of Influenza Vaccines in Ontario
|When||Distribution Initiated To|
|End of September to early October||Public hospitals and long-term care homes|
|Early-to-mid October||Retirement homes and other settings with vulnerable populations|
|Early-to-mid October||Primary care providers and other organizations. Pharmacists through their wholesale distributors.|
- To ensure equitable distribution throughout our catchment area, initial influenza vaccine orders may be limited, with further opportunities to re-order after the program launches and the provincial supply is replenished.
- We will confirm the amounts allocated to your site for your patient population prior to your pickup.
- Secondary orders can be faxed or emailed to 705.677.9616 or email@example.com using our standard Vaccine Order Form (PDF, 200K).
Vaccine Administration Considerations
Providers should prioritize influenza vaccine administration as outlined below.
Immunize the following groups as soon as vaccine is available:
- residents of retirement homes and other congregate livings settings
- individuals at high risk of complications or hospitalization due to influenza
- health care workers and first responders
Immunize your general patient population on or after October 30, 2023. Due to allocation restrictions, please do not plan large clinics until November when the vaccine supply has been replenished.
Co-administration of influenza and other vaccines
Influenza vaccines may be administered at the same time as, or at any time before or after, administration of other vaccines (either live or inactivated), including COVID-19 vaccines for those aged 6 months and older. At this time, it is important to note that Imvamune® vaccine (for MPOX protection) and COVID-19 vaccines should not be provided concomitantly as a precautionary measure to prevent erroneous attribution of an AEFI to one vaccine or the other. Administration should be separated by 4 weeks when possible. Please consider this when providing multiple vaccines to eligible patients. Also at this time the new RSV vaccine called Arexvy® will be available for use in eligible patients shortly. While Arexvy® may be administered concomitantly with standard dose inactivated quadrivalent influenza vaccine (unadjuvanted), it has not been studied with high-dose or adjuvanted products. Further guidance on the use of the product will be forthcoming.
The National Advisory Committee on Immunization (NACI) will continue to monitor the evidence base regarding the co-administration of influenza and COVID-19 vaccines and update its recommendations as needed. Refer to the Canadian Immunization Guide, COVID-19 Vaccine chapter for additional emerging guidance on concurrent administration with COVID-19 vaccines as new products are authorized or there are COVID-19 age eligibility expansions.
Please note that there is no evidence regarding the co-administration of recombinant zoster vaccine (RZV) [Shingrix®] with adjuvanted or high-dose influenza vaccine. No immune response interference or safety concerns have been identified when RZV is administered concurrently with standard dose, un-adjuvanted vaccine.
Immunizing older adults
- High dose quadrivalent inactivated vaccine (QIV-HD) and adjuvanted trivalent inactivated vaccine (TIV-adj) will be available for ordering this year for seniors 65 years of age and older only. See product information below.
- As vaccine protection is of critical importance, do not delay vaccination to wait for a particular product. QIV, QIV-HD, and TIV-adj all protect against the flu. For individual-level decision making, NACI states that when available, high-dose should be used over standard-dose inactivated influenza vaccine, given the burden of influenza A (H3N2) disease and good evidence of better protection compared to standard-dose in adults 65 years of age and older.
- NACI states, however, that in the absence of a specific product any of the available age-appropriate influenza vaccines should be used. There is no preferential recommendation for the use of QIV-HD versus TIV-adj vaccine for adults aged 65 and older.
UIIP product information
Table 2: Influenza Vaccine Products for the 2022/2023 Season
|Influenza Vaccine Product||Availability||Eligibility||Dosage||Post-Puncture Shelf Life for Multi-dose Vials|
Quadrivalent influenza vaccine – (QIV)
|15 mcg/0.5mL |
Multi-dose vial format (MDV)
|6 months of age and older||0.5 mL IM||28 days|
|Fluzone® Quadrivalent (QIV)|
Sanofi Pasteur Limited
|15 mcg/0.5mL |
MDV and pre-filled syringe (PFS) format
|6 months of age and older||0.5 mL IM||28 days|
|Fluzone® High-Dose Quadrivalent|
Quadrivalent high-dose influenza vaccine- (QIV-HD)
Sanofi Pasteur Limited
|60 mcg/0.7 mL |
|65 years of age or older||0.7 mL IM||Not applicable|
Trivalent adjuvanted influenza vaccine – TIV-adjuvanted (TIV-adj)
|15 mcg/0.5 mL|
|65 years of age or older||0.5 mL IM||Not applicable|
UIIP package is attached
Your UIIP package is attached. Within you will find further information on the provincial procurement of influenza vaccine as well as Q&A documents outlining eligibility and indications for the UIIP vaccine products available for immunization in the 2023–24 season. We will share any additional information regarding the influenza vaccine and roll-out for Ontario as it is shared by the province.
Thank you in advance for your ongoing commitment to protecting the heath and safety of your patients through the administration of influenza vaccines. Should you have any questions, please contact the immunization program at 705.522.9200, ext. 458.
Original Signed By
Dr. Penny Sutcliffe
Medical Officer of Health and Chief Executive Officer
Reference: Public Health Agency of Canada. National Advisory Committee on Immunization. Statement on Seasonal Influenza Vaccine for 2023-2024. May 31, 2023.
NOTE: All Advisory Alerts are found on our website.
This item was last modified on September 18, 2023