The seasonal influenza vaccine for 2011 protects against the same virus strains as in 2010. However, people who were vaccinated in 2010 still require a vaccination this year as immunity diminishes over time. Two brands of vaccine are available this year – children aged between six months and nine years should receive Fluarix, children aged over nine years and adults should receive either Fluarix or Fluvax.
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- Two brands of influenza vaccination are available in 2011 - Fluarix may be given to adults and children aged over
six months, Fluvax is recommended only for adults and children aged over nine years
- The seasonal influenza vaccine for 2011 contains strains identical to the previous year’s vaccine, including
Pandemic (H1N1) Influenza 09 strain (Swine Flu)
- People who were vaccinated in 2010 are still recommended to be vaccinated in 2011
- Similar eligibility criteria for free seasonal influenza vaccination apply in 2011, however vaccinations for all
children are not funded this year (unless eligible under other criteria such as those with pre-existing conditions)
- Vaccine order forms require a separate order to be placed for vaccines for children aged under nine years and for
adults and children aged over nine years
What’s in the flu vaccine this year?
The seasonal influenza vaccination for 2011 contains the same strains that were in the 2010 vaccination (Stage Two):
- A/California/7/2009(H1N1)-like strain (“Swine flu”)
- A/Perth/16/2009 (H3N2)-like strain
- B/Brisbane/60/2008-like strain
People vaccinated last year are still recommended to be vaccinated in 2011 as immunity diminishes over time.
Different vaccine brand recommended for children aged under nine years
There are two brands of influenza vaccine available in 2011:
- Fluarix – approved for adults and children aged six months and over.
- Fluvax – only recommended for use in adults and children aged nine years and over, also should not
be given to any child with a history of febrile convulsion.
- For children aged between six months and nine years, use only Fluarix
- For all others, use either Fluarix or Fluvax
N.B. Vaccine order forms in 2011 require a separate order to be placed for vaccines for children aged under nine years
and for adults and children aged over nine years.
Fluvax brand associated with febrile convulsions in young children
In 2010, there was an increase in reports of fever and febrile convulsions associated with the Fluvax brand of influenza
vaccination in the Southern Hemisphere. Fluvax brand is now not indicated for use in children aged under five years. Febrile
reactions also appear to be more common in children aged between five and nine years, therefore use of Fluvax in this
age group is not recommended.
It is stressed that these reports were only associated with the Fluvax brand and that children aged between six months
and nine years can still be safely vaccinated using the alternative brand – Fluarix.
Febrile reactions following Fluvax administration in New Zealand
In a sample of 23 general practices in New Zealand in 2010, it was found that fever occurred significantly more frequently
within 24 hours of administration of Fluvax in children aged under five years, compared to Vaxigrip, the other vaccine
brand available that year. Of the 104 vaccinations with Fluvax, 31% of children developed fever after the event. This
compares to 11% of the 267 vaccinations with Vaxigrip. There were 16 occurrences of fever measured at 39°C or above and
one febrile seizure with Fluvax, compared to no occurrences of either event in the children who received Vaxigrip. The
authors of the study concluded that Fluvax was associated with unacceptably high rates of febrile reactions and that
there has been insufficient safety evaluation of seasonal influenza safety in this population. They suggest that there
should be active monitoring of a limited number of doses of seasonal influenza vaccine at the beginning of each influenza
How many doses this year?
Children aged between six months and nine years:
ever influenza vaccine – two doses,* at least four weeks apart
dose received in 2010 – one or two doses,† at least four weeks apart
- Two doses received in 2010 – one dose
Adults and children aged over nine years: one dose
Who is eligible for free influenza vaccination?
- Anyone aged 65 years or over
- Anyone aged 65 years or under with one (or more) of the following medical conditions:
- Cardiovascular and cerebrovascular disease (except hypertension or dyslipidaemia)
- Chronic respiratory disease (except asthma not requiring regular preventive treatment)
- Chronic renal disease
- Cancer (except non-invasive basal or squamous cell carcinoma)
- Other chronic conditions including; epilepsy, rheumatoid arthritis, autoimmune disease, immune suppression, HIV,
cerebral palsy, multiple sclerosis, muscular dystrophy, children on long-term aspirin, congenital myopathy, haemoglobinopathies,
hydrocephaly, motor neurone disease, myasthenia gravis, neuromuscular and CNS diseases, Parkinson’s disease,
sickle cell anaemia and transplant recipients.
- Pregnant women
N.B. Eligibility criteria apply until July 31st 2011
For a full list of eligible conditions, visit: www.influenza.org.nz/?t=887 or
check with the Immunisation Advisory Centre, Ph 0800 466 863 or email 0800IMMUNE@auckland.ac.nz
Who else should be vaccinated?
Although not subsidised, parents should be encouraged to have children aged between six months and five years vaccinated,
especially if any of the following factors are present, which may increase the risk of complications from influenza:
- Māori or Pacific ethnicity
- Living in a low socioeconomic area, crowded household or exposed to second-hand cigarette smoke
- Recurrent medical presentations
Lead by example – get immunised
It is strongly recommended that all healthcare workers receive a seasonal influenza vaccine each year. This is not only
for personal protection, but more importantly to protect vulnerable patients who may have a poor response to the influenza
vaccine themselves and are at risk of complications from influenza.
Traditionally the uptake of influenza vaccine among healthcare workers is low. A 2006 editorial suggested that uptake
among healthcare workers in New Zealand was between 20 to 40%, with the lowest coverage among nurses.2 The
major barrier to vaccination is perceived to be educational, i.e. a lack of personal concern about influenza and concern
about adverse effects of the vaccine.
Some countries, e.g. the United States, are currently considering introducing mandatory influenza vaccine for healthcare
workers in some areas. Unvaccinated workers are seen to be jeopardising public health and seasonal influenza vaccination
is regarded as a safe, low-cost and effective method to greatly enhance patient safety.3
Other groups of people who should be strongly encouraged to have an influenza vaccine include teachers and childcare
Best Practice Tip: Send a message strongly encouraging
influenza vaccination to all staff in the workplace via email, intranet or a notice in the tea room or meeting areas.
It is important that messages are endorsed by senior staff. If the observation period is a barrier to receiving the vaccine,
consider using “I’ve been immunised” stickers to enable the staff member to keep working during the
Why get immunised?
Immunisation is the single most effective intervention to prevent the influenza virus. A lack of education about the
risks of influenza and concerns about the safety and effectiveness of the vaccine is most likely the greatest barrier
to immunisation. Improved communication to increase vaccine uptake is the key.
Convincing people to have the 2011 influenza vaccine may be more challenging than usual. The vaccine targets identical
strains as those targeted by the stage two vaccine in 2010, and this may lead to people being less motivated to be vaccinated
again. Despite much publicity surrounding “swine flu”, rates of influenza in 2010 were still in the medium
range compared to previous years. Widely reported adverse reactions in young children administered Fluvax in 2010 may
also reduce patient confidence.
Take the opportunity to talk to all patients about whether influenza vaccine is appropriate for them. Target people
who are at risk of complications of influenza, and those who are eligible to receive funded vaccination. Ensure that balanced
and informative information about influenza vaccine is provided and that any barriers to vaccination are identified and
Remind healthcare professionals about their responsibilities to their patients and the importance of being vaccinated
Common myths and misconceptions about influenza vaccination
“It gives me a cold”
Influenza vaccination does not carry a risk of transmission of the common cold or influenza viruses.
The virus strains within the vaccine are subunit proteins, i.e. not live. The body’s immune response to vaccination
can result in symptoms such as fever, malaise and myalgia, but these are usually mild and of short duration. People are
vaccinated at a time of year when other respiratory viruses are circulating and by chance, they may contract such a virus
at a similar time.
“But I got vaccinated last year”
Each year, the seasonal influenza vaccine constituents are carefully selected based on the predicted strains for that
year. In the Southern hemisphere, this prediction can be based on which strains were prevalent in the preceding Northern
Hemisphere winter. For this reason, it is important to be vaccinated each year to cover against the particular strains
represented in that year’s vaccine.
However, perhaps the key reason to be vaccinated each year is that immunity lessens over time and those most at risk
need maximum protection. Although the constituents in the 2011 vaccine are the same as last year, vaccination is still
recommended. While healthy individuals are likely to have immunity lasting longer than a season it is difficult to predict
with each individual how long immunity will last.
“It doesn’t work”
It is still possible to contract influenza after being vaccinated. This is especially true for elderly people, those
with chronic conditions that may impair immune responses and infants aged under two years. However, the severity of the
illness and risk of hospitalisation is likely to be reduced in those who have been vaccinated. In some cases a person
may have been exposed to the influenza virus prior to being vaccinated.
In healthy adults, influenza vaccine is approximately 80% effective in preventing influenza, provided that the vaccine
and circulating virus strains are well matched.4
Influenza activity in New Zealand in 2010
Influenza activity in New Zealand in 2010 has been classified in the low to medium range compared to the past 19 years
of surveillance. There was a cumulative incidence of influenza of 947 cases per 100 000 people, which was the seventh
lowest incidence recorded since 1992. Influenza activity started late in the season last year, with incidence peaking
in late August. The highest rates of notification were seen in children aged under one year and high hospitalisation
and notification rates were seen among Māori and Pacific peoples.5
“My immune system is strong”
People who rarely contract viruses such as influenza or the common cold can be regarded as having a strong or healthy
immune system. Vaccinations such as seasonal influenza vaccine enhance a healthy immune system and make people more resilient
“I prefer natural remedies such as echinacea and vitamin C”
There is no consistent evidence that natural remedies such as echinacea or vitamin C are clinically effective in reducing
the occurrence or severity of influenza viruses.
“Vaccines contain mercury”
Both Fluvax and Fluarix are preservative free.
Historically, some vaccines contained thiomersal as a preservative. Thiomersal is a mercury derivative and there was
some concern that exposure to mercury was associated with neurological deficits including autism. However, this association
has now been invalidated by multiple epidemiological studies.
N.B. All vaccines on the current New Zealand immunisation schedule are thiomersal free.
An influenza resource kit from the National Influenza Strategy Group will be sent out to all practices before the influenza
programme commences. This kit, along with other influenza-related resources, is also available to download or order from: www.immune.org.nz/?t=890
For further information about managing influenza, including the use of
antiviral medicines, see “Diagnosing and managing influenza”,
BPJ 21 (Jun, 2009).
Thank you to Dr Nikki Turner, Director, Immunisation Advisory Centre, Senior Lecturer, Division of
General Practice and Primary Health Care, University of Auckland for expert guidance in developing this article.
- Petousis-Harris H, Poole T, Booy R, Turner N. Fever following administration of two inactivated influenza vaccines
– a survey of parents of New Zealand infants and children 5 years of age and under. Vaccine 2011;[Epub ahead of print].
- Jennings L. Influenza vaccination among New Zealand healthcare workers: low rates are concerning. NZ Med J 2006;119(1233).
- Ottenberg A, Wu J, Poland G, et al. Vaccinating healthcare workers against influenza: the ethical and legal rationale
for a mandate. Am J Public Health 2011;101(2):212-6.
- Demicheli V, Pietrantonj C, Jefferson T, et al. Vaccines for preventing influenza in healthy adults. Cochrane Database
Syst Rev 2009;(3).
- Hope V, Huang QS, Bandaranayake D. Recommendation for seasonal influenza vaccine composition for New Zealand 2011.
Report prepared for the Ministry of Health. 2010.