• Influenza disease overview by Dr Christopher Blyth Paediatric Infection Diseases Consultant PMH
• WA Health Influenza Program overview and Meningococcal ACWY programs update by Ms Palee Holdsworth, Senior Program Officer, CDCD
• Surveillance 2017 overview and strategies for 2018 by Dr Lauren Bloomfield, Epidemiologist, CDCD
• Changing epidemiology of meningococcal disease in WA by Dr Gary Dowse, Medical Advisor, CDCD

Eligibility for government funded influenza vaccines in WA in 2018 is unchanged from 2017. The following individuals in WA are eligible to receive government funded vaccine:

• persons 65 years of age or older
• pregnant women (any trimester)
• Aboriginal individuals 6 months and older
• individuals aged 6 months and over with medical conditions that place them at risk for complications of influenza, namely:
• cardiac disease
• chronic respiratory conditions
• chronic neurological conditions
• impaired immunity
• diabetes and other metabolic disorders
• renal disease
• haematological disorders
• children aged 6 months to 10 years receiving long term aspirin therapy
• children aged 6 months to less than 5 years.

Wherever your workplace, whatever your role, reduce your risk of catching flu and passing it to patients or colleagues, and get the flu vaccine.

Due to their proximity in caring for vulnerable groups, healthcare workers are strongly recommended to receive the flu vaccine.​

• Influenza (flu) can be a serious disease that can lead to hospitalisation and sometimes even death.
• Anyone can get sick from flu, including people who are otherwise healthy.
• If you get the flu, you can spread it to others even if you don't feel sick.

WA Health urges all healthcare workers to get the influenza vaccine.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) (external site) strongly endorses routine vaccination of all pregnant women against influenza.¹

This endorsement supports existing recommendations of the National Health and Medical Research Council (external site) and the Australian Technical Advisory Group on Immunisations.^2,3

In recognition of the benefits of protecting pregnant women and their newborns against influenza, the Western Australian Department of Health recommends that all pregnant women be offered influenza vaccination as part of routine, comprehensive, antenatal care.

Vaccination against influenza in late autumn, regardless of gestational age, is optimal, but unvaccinated pregnant women should be immunised at any time during the influenza season.

Why should you recommend influenza vaccination for pregnant women?

Preventing influenza during pregnancy is an essential part of antenatal care because pregnant women are at an increased risk of serious illness due to influenza.⁴

Excess morbidity and mortality for pregnant women with influenza compared with non-pregnant women of similar age with influenza has been well documented.^4,5

The safety of influenza vaccination during pregnancy is well established; no study to date has shown an adverse consequence of inactivated influenza vaccine in pregnant women or their infants.^6,7,8

Active placental transfer of maternal antibodies makes influenza vaccine during pregnancy a highly effective measure to protect infants from influenza during the first 6 months of life.^9,10,11,12

Both maternal and infant benefit is now proven. Only 5 pregnant women need to be vaccinated to prevent 1 case of serious maternal or infant respiratory illness.

In 2012 the World Health Organisation declared that pregnant women should receive the highest priority for influenza immunisation. This recommendation was based on “compelling evidence of a substantial risk of severe disease in pregnant women, evidence that vaccine is effective against severe disease, and the evidence supporting secondary protection of infants under 6 months, in whom disease burden is also high”.

In addition, the Royal Australian and New Zealand College of Obstetricians and Gynecologists and the National Health and Medical Research Council recommend that all pregnant women be offered influenza immunisation during pregnancy.

Reporting reactions to influenza vaccine

If a patient has symptoms you think may be a reaction to a vaccine, you should report the reaction WA Vaccine Safety Surveillance (WAVSS).

Please report an adverse event following immunisation by one of the following methods:

• Use an online form at WAVSS (external site).
• Call the Central Immunisation Clinic on 9321 1312 (8.30am to 4.30pm, Monday to Friday).
• Complete a WAVSS adverse reaction reporting form (PDF 220KB) and return by:
  • Fax: 9426 9408
  • Post: Central Immunisation Clinic, PO Box 8172, Perth Business Centre, WA 6849.

More information

• Visit Healthy WA for consumer information about:
  • influenza vaccination (external site)
  • influenza immunisation in pregnancy (external site)

References

1. Royal Australian and New Zealand College of Obstetricians and Gynaecologists statement (external site) (C-Obs 45). Endorsed November 2011. Vaccination of women planning pregnancy, pregnant or breastfeeding women, and preterm infants. In Australian Immunisation Handbook, 9th Edition. Updated July 2009.
2. Summary of ATAGI recommendations for selection of seasonal influenza vaccine for children aged ≥6 months to <5 years, adults and other risk groups. Canberra: Australian Government Department of Health and Ageing; 2010.
3. Rothberg MB, Haessler SD, Brown RB. Complications of viral influenza. Am J Med. 2008 Apr; 121(4): 258-64.
4. Webb SA, Pettilä V, Seppelt I, Bellomo R et al. Critical care services and 2009 H1N1 influenza in Australia and New Zealand. N Engl J Med. 2009 Nov; 361(20):1925-34. Epub 2009 Oct 8.
5. Hewagama S, Walker SP, Stuart RL, Gordon C, Johnson PD, Friedman ND et al. 2009 H1N1 influenza A and pregnancy outcomes in Victoria, Australia. Clin Infect Dis. 2010 Mar;50(5):686-9.
6. Tamma PD, Ault KA, del Rio C, Steinhoff MC, Halsey NA, Omer SB. Safety in influenza vaccination during pregnancy. Am J Obstet Gynecol. 2009 Dec;201(6):547-52. Epub 2009 Oct 21.
7. Lacroix I, Damase-Michel C, Kreft-Jais C, Castot A, Montastruc JL. French Association of Regional Pharmacovigilance Centres 2009 H1N1 influenza vaccines in pregnant women: the French Pharmacovigilance survey. Vaccine. 2011 Feb;29(7):1357-8. Epub 2010 Dec 23.
8. Moro, PL, Border K, Zheteyeva Y et al. Adverse events in pregnant women following administration of trivalent inactivated influenza vaccine and live attenuated influenza vaccine in the Vaccine Adverse Event Reporting System, 1990-2009. Am J Obstet Gynecol. 2011 Feb;204(2): 146.e1-146.e7.
9. Zaman K, Roy E, Arifeen SE et al. Effectiveness of Maternal Influenza Immunization in Mothers and Infants. N Engl J Med 2008;359:1555-1564.
10. Benowitz I, Esposito DB, Gracey KD, Shapiro ED, Vázquez M. Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants. Clin Infect Dis. 2010 Dec;51(12):1355-61. Epub 2010 Nov 8.
11. Eick AA, Uyeki TM, Klimov A, Hall H, Reid R, Santosham M et al. Maternal Influenza Vaccination and Effect on Influenza Virus Infection in Young Infants. Arch Pediatr Adolesc Med. 2011;165(2):104-111.

Since 2008, Western Australia has offered free seasonal influenza vaccine to children aged from 6 months and under 5 years.

Thousands of influenza doses have been administered to children under 5 years each year with no significant safety concerns.

Why should you recommend influenza vaccination for young children?

The National Health and Medical Research Council (external site), Australia’s peak body for developing health advice for the community and health professionals, recommends annual vaccination for individuals 6 months or older who wish to reduce their chances of becoming ill with influenza.

Annual influenza vaccination is strongly recommended for individuals 6 months or older with a medical condition that places them at higher risk of severe influenza illness.

Children with underlying medical conditions are eligible for a free influenza vaccine through the Immunise Australia program (external site).

Experience from Australia and overseas indicates that the majority of influenza-related paediatric hospitalisations and deaths occur among children without underlying medical conditions.

Several international studies have documented the benefits of immunising healthy young children against the influenza virus.^1-4

Key points to remember about influenza vaccine dosing in children

Children six months to under 18 years of age can be immunised against influenza.

Before administering an influenza vaccine, CHECK you have the correct vaccine for the child’s age. Ages are identified on the syringe.

• FluQuadri Junior® (Sanofi Pasteur) is the only influenza vaccine for the six months to less than three years age group.
  • Do not give a half dose of any other influenza vaccine for this age group.
  • FluQuadri® (Sanofi Pasteur) is for people aged three years and over.
  • Fluarix Tetra® (GSK) is for people aged three years and over.
  • Afluria Quad® (Seqirus) is not to be given to children and must only be administered to people aged 18 years and over.

Children aged six months to under nine years of age require two doses in the first year they receive the vaccine. These must be given at least four weeks apart. While two doses in the first year are recommended, one dose does provide some protection and is preferable to receiving no doses. One annual dose of influenza vaccine is required in following years even if only one dose was given in the first year.

• A single annual dose of influenza vaccine is recommended for all children aged nine years and over.
• Parents and carers should be advised that the risk of fever may increase when a child receives both the flu vaccine and pneumococcal vaccine (Prevenar 13) at the same time.

Healthcare providers should ensure that all influenza vaccinations administered to children are recorded in the Australian Immunisation Register (AIR). Please ensure that you enter the encounter into the AIR under the specific brand name used.

Influenza vaccine safety

AusVaxSafety (external site) is a network of GPs and clinics across Australia which allows parents/carers of children recently given a flu vaccine to report back on how their children felt after vaccination, to ensure vaccines registered for use in children are safe.

Parents are asked to provide information by text message about any reactions experienced by their child following vaccination. AusVaxSafety analyses vaccine safety weekly using the information reported.

Real time vaccine safety data can be accessed via the National Centre for Immunisation Research and Surveillance (external site).

Fever and injection site reactions are expected, mild adverse reactions following immunisation.

This rapid safety surveillance can provide reassurance to parents that the influenza vaccines used in children are safe. To learn more about the latest vaccine safety data visit National Centre for Immunisation Research and Surveillance (external site) or phone 1800 750 566.

Reporting adverse events following immunisation

The continuing safety of influenza vaccine in children – both those with and without high-risk medical conditions – will be closely monitored using a combination of ongoing passive reporting via the Western Australian Vaccine Safety Surveillance (WAVSS) system and active follow-up on a subset of children.

If a person has symptoms you think may be a reaction to a vaccine, you should report the reaction to WAVSS.

Please report an adverse event following immunisation by one of the following methods:

• Use an online form at WAVSS (external site).
• Call the Central Immunisation Clinic on 9321 1312 (8.30am to 4.30pm, Monday to Friday).
• Complete a WAVSS adverse reaction reporting form (PDF 220KB) and return by:
  • Fax: 9426 9408
  • Post: Central Immunisation Clinic, PO Box 8172, Perth Business Centre, WA 6849

More information

• Visit Healthy WA for consumer information about childhood vaccination (external site).

References

1. Heinonen S, Silvennoinen H, Lehtinen P, Vainionpää R, Ziegler T, Heikkinen T. Effectiveness of inactivated influenza vaccine in children aged 9 months to 3 years: an observational cohort study. Lancet Infect Dis. 2011 Jan;. 11(1): 23-29).
2. Katayose M, Hosoya M, Haneda T, Yamaguchi H, Kawasaki Y, Sato M et al. The effectiveness of trivalent inactivated influenza vaccine in children over six consecutive influenza seasons. Vaccine. 2011 Feb; 29(9):1844-9. Epub 2010 Dec 31.
3. Cohen SA, Chui KK, Naumova EN. Influenza vaccination in young children reduces influenza associated hospitalizations in older adults, 2002-2006. J Am Geriatr Soc. 2011 Feb; 59(2):327-32.
4. Sakkou Z, Stripeli F, Papadopoulos NG, Critselis E, Georgiou V, Mavrikou M et al. Impact of influenza infection on children’s hospital admissions during two seasons in Athens, Greece. Vaccine. 2011 Feb; 29(6):1167-72. Epub 2010 Dec 18.
5. Blyth CC, Cheng AC, Finucane C, Jacoby P, Effler PV, Smith DW, Kelly H, Macartney KK, Richmond PC. Vaccine. 2015 Dec 16;33(51):7239-44. Epub 2015 Nov 6.

Influenza causes illness in people of all ages. Immunisation is the single most important measure available to prevent infection and its complications.

Influenza immunisation is recommended annually, even if a person has been vaccinated in any previous year with an influenza vaccine that contains the same strains. This is because the immunity to influenza acquired by immunisation wanes over time.

During the influenza season, the opportunities to provide influenza vaccination to persons at increased risk of influenza should not be missed during visits for routine medical care.

People with certain immunocompromising conditions (i.e. haemotopoietic stem cell transplant or solid organ transplant) who are receiving the influenza vaccine for the first time are recommended to receive 2 vaccine doses at least 4 weeks apart (irrespective of age) and one dose annually thereafter.

Greater burdens of illness still occur in Aboriginal populations including as a result of influenza infection, and so influenza vaccination is recommended for all Aboriginal people aged 6 months and older.

The highest influenza burden in Australia is seen in the elderly and children. For this reason, influenza vaccination is recommended for all people aged over 65.

In addition, influenza immunisation is recommended, but not funded for people who are at higher risk of transmitting disease to others at increased risk of complications from influenza infection, such as healthcare and childcare workers.

Reporting reactions to influenza vaccine

If a patient has symptoms you think may be a reaction to a vaccine, you should report the reaction WA Vaccine Safety Surveillance (WAVSS).

Please report an adverse event following immunisation by one of the following methods:

• Use an online form at WAVSS (external site).
• Call the Central Immunisation Clinic on 9321 1312 (8.30am to 4.30pm, Monday to Friday).
• Complete a WAVSS adverse reaction reporting form (PDF 220KB) and return by
  • Fax: 9426 9408
  • Post: Central Immunisation Clinic, PO Box 8172, Perth Business Centre, WA 6849.

More information

• Visit HealthyWA for consumer information about influenza immunisation.

WA Health and the Pharmacy Guild of Australia (WA branch) are partnering in a two-year statewide trial involving the administration of National Immunisation Program (NIP) influenza vaccines in community pharmacies.

Under the pharmacist influenza vaccination trial, pharmacists will be able to vaccinate individuals aged 65 years and older with the higher immunogenicity influenza vaccine.