Seasonal influenza and COVID-19 vaccinations: 2024 edition

“Flu season” 2024

The Influenza Immunisation Programme for 2024 runs from 2^nd April to 31^st December.¹ Influvac® Tetra is the sole funded vaccine this year for adults and children aged six months and over who meet eligibility criteria (see: “Changes to the funding groups for 2024”).² It is also available to purchase for those not eligible for funded vaccination.

Four other non-funded influenza vaccines are also available for purchase in 2024: Flucelvax® Quad and FluQuadri™ for use in children aged six months and over and adults, Fluad® Quad for use in adults aged 65 years and over and Alfuria® Quad for use in children aged three years and over and adults.¹

Changes to the funding groups for 2024

Changes have been made this year to the criteria for funded influenza vaccination, compared to 2023. Funded access remains for:²

• People aged 65 years and over
• People aged six months to under 65 years with specific long-term conditions or mental health conditions or addictions
• People who are pregnant
• Children aged six months to under five years who have been hospitalised for, or have a history of, significant respiratory illness

People aged 55 – 64 years of Māori or Pacific ethnicity and children aged 3 – 12 years are no longer eligible for funded influenza vaccination (unless they meet other criteria or funding is available through your local PHO). However, these populations remain high-risk groups and should still be encouraged to get vaccinated (although cost may be a barrier to access).^{1, 2}

Who else should be encouraged to get vaccinated?

All adults and children aged six months and over should be encouraged to get immunised against influenza.² Immunisation is particularly recommended (but not funded) for the following groups:²

• Māori and Pacific peoples aged 55 – 64 years
• People with asthma who are not taking regular preventive treatment
• People with hypertension or dyslipidaemia without evidence of end-stage organ disease
• Health care workers or other essential workers
• People in close contact with others who are at increased risk of complications from influenza, e.g. child care staff, family members, caregivers
• People aged under 65 years living in residential care facilities and staff
• People who are homeless^*

^*Recommended in the Immunisation Handbook; people living in sub-standard housing are also likely to benefit from influenza vaccination, but cost is likely to be a significant barrier in these groups unless funding is available from other sources

Influenza vaccination is also recommended (but not funded) for people travelling overseas and for those at increased risk of complications from influenza, e.g. people who are obese, who smoke or have alcohol dependency (risk also increases with cumulative factors).²

New strains included this season

Influvac® Tetra contains two new strains (in bold below) and retains two strains from the 2023 vaccine:¹

• A/Victoria/4897/2022(H1N1) pdm09-like virus
• A/Thailand/8/2023 (H3N2)-like virus
• B/Austria/1359417/2021-like virus
• B/Phuket/3073/2013-like virus

Fluad® Quad, FluQuadri™ and Alfuria® Quad contain the same strains as Influvac® Tetra.¹

Flucelvax® Quad includes A/Wisconsin/67/2022 (H1N1) pdm09-like virus, A/Massachusetts/18/2022 (H3N2)-like virus, B/Austria/1359417/2021-like virus and B/Phuket/3073/2013-like virus.¹

Egg and latex allergy

Influenza vaccines manufactured using chicken eggs (i.e. Influvac® Tetra, Fluad® Quad, FluQuadri™ and Alfuria® Quad) contain some residual egg white protein (ovalbumin), but vaccines containing less than one microgram of ovalbumin do not trigger anaphylaxis.^{1, 2} The residual ovalbumin in one dose of Influvac® Tetra, Fluad® Quad, FluQuadri™ and Alfuria® Quad is lower than one microgram, therefore, the vaccine can be safely administered at general practices, pharmacies or workplaces to people with a history of anaphylaxis to eggs.^{1, 2} Flucelvax® Quad is a cell-based vaccine that does not contain egg protein.^{1, 2}

Influvac® Tetra does not contain any latex, but the supplier is unable to confirm that the product did not come into contact with any latex materials during the manufacturing and packaging process.¹ Flucelvax® Quad is not considered latex-free; consider an alternative influenza vaccine for people with a history of anaphylaxis to latex.¹ Fluad® Quad, FluQuadri™ and Alfuria® Quad influenza vaccines are latex-free.¹

The dosing schedule for influenza vaccination remains the same as in previous years

One dose is usually sufficient for all influenza vaccines.^{1, 2} Any of the influenza vaccines may be administered at the same time as a COVID-19 vaccine (in a different injection site).¹

Second dose recommended in some groups: Children aged under nine years who have not previously been vaccinated against influenza are recommended to receive a second dose at least four weeks after their first dose; if they are eligible for funded influenza vaccination, the second dose will also be funded.^{1, 2} A second dose is also recommended for people who are immunocompromised (any age) if they have not previously been vaccinated against influenza; the second dose is not funded (even if the first dose is funded).²

Post-vaccination observation period

The observation period following influenza vaccination alone and after concomitant vaccination with influenza and another vaccine, e.g. COVID-19, is 20 minutes.¹ The observation period can be reduced to five minutes after influenza vaccination alone, or 15 minutes after concomitant influenza and COVID-19 vaccination for people who meet all of the following criteria:¹

• Aged ≥ 13 years
• No history of severe allergic reactions
• Have been assessed for immediate adverse reactions to the vaccine(s) (i.e. for five minutes)
• Have an adult with them for 20 minutes after vaccination
• Have been advised not to drive, skate, scoot, bike or operate machinery until 20 minutes after vaccination
• Know when and how to seek advice after vaccination and can contact emergency services if required

The 2024 Flu kit booklet for health professionals is available from the Immunisation Advisory Centre: www.immune.org.nz/factsheets/2024-flu-kit

For further information on influenza vaccines, see: www.immune.org.nz/vaccine/influenza-vaccine

COVID-19 vaccination

There are two types of COVID-19 vaccines available and funded in New Zealand: messenger RNA COVID-19 vaccines (mRNA-CV; Comirnaty™) and an adjuvanted recombinant spike protein COVID-19 vaccine (rCV; Nuvaxovid®).²

Available vaccines, eligibility and dosing

Three Comirnaty™ COVID-19 vaccines (30 microgram,10 microgram and 3 microgram), indicated for different age groups, and one Nuvaxovid® vaccine (for people aged ≥ 12 years) are available in New Zealand (Table 1).² All available COVID-19 vaccines are latex-free.²

Comirnaty™ vaccines are the preferred vaccine for most people for primary or additional doses (see: “Guidance on additional doses”).² Nuvaxovid® is an alternative COVID-19 vaccine to Comirnaty™ and can be administered for a primary course in people aged ≥ 12 years and for additional doses in people aged ≥ 18 years.² Nuvaxovid® may be suitable for people with a contraindication to mRNA-CV, or who have experienced an adverse reaction to mRNA-CV, or for people who prefer an alternative vaccine to mRNA-CV.²

The Comirnaty™ Omicron XBB.1.5 mRNA-CV (30 microgram) vaccine has replaced the original mRNA-CV 30 microgram (tozinameran) and mRNA-CV BA.4/5 (15/15 microgram; tozinameran and famtozinameran) vaccines for both primary and additional doses in people aged ≥ 12 years.² An application has been received by Medsafe for Nuvaxovid® Omicron XBB.1.5 (Novavax) vaccine for use in people aged ≥ 12 years, however, an approval decision is yet to be made.

Reminder: The observation period following COVID-19 vaccination is at least 15 minutes (see: “Post-vaccination observation period”).²

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Table 1. Summary of COVID-19 vaccines available in New Zealand.²

	Comirnaty™			Nuvaxovid®
	XBB.1.5 mRNA-CV 30 microgram	mRNA-CV 10 microgram	mRNA-CV 3 microgram	rCV
Eligibility	People aged 12 years and over	Children aged 5 – 11 years	Children aged six months to four years with severe immunocompromise or complex or multiple health conditions that increase their risk of severe illness from COVID-19	People aged 12 years and over
Cap colour	Grey Single dose vial = light grey Multidose vial = dark grey N.B. Due to similarities in cap colour, ensure the right vial is being selected.	Orange	Maroon	Blue
Dilution required?	No	Yes	Yes	No
Primary course dosing	One dose primary course Administer one primary dose to people who have not previously been vaccinated against COVID-19 or who have not completed a primary course with another COVID-19 vaccine (administer from three months after most recent dose) For people with severe immunocompromise, administer three primary doses at eight week intervals. The second and third primary doses need to be prescribed as their use is considered “off-label” (unapproved; Section 29). N.B. If the spacing between doses is more than three months a prescription is not required, however, protection may be suboptimal.	Two dose primary course Two primary doses are administered at least eight weeks apart (can be given a minimum of three weeks apart if needed) Children who turn age 12 years during the primary course should be given XBB.1.5 mRNA-CV for subsequent primary doses For people with severe immunocompromise, a third primary dose is recommended at least eight weeks after the second dose (unapproved use; Section 29). N.B. If the spacing between doses is more than three months a prescription is not required, however, protection may be suboptimal.	Three dose primary course The second dose can be administered from three weeks after the first. The third dose should be given at least eight weeks after the second. Children who turn age five years during the primary course still require a three dose primary course; complete the primary course with the mRNA-CV 10 microgram vaccine	Two dose primary course Two primary doses are administered at least eight weeks apart (can be given a minimum of three weeks apart if needed) A prescription is required if given as part of a primary course when a mRNA-CV vaccine was administered previously (unapproved use; Section 29)

mRNA-CV = messenger RNA COVID-19 vaccine, rCV = adjuvanted recombinant spike protein COVID-19 vaccine

Guidance on additional doses

All people aged 16 years and over are recommended to receive one additional dose (previously referred to as a booster dose) following completion of the primary course.² mRNA-CV (XBB.1.5) is the preferred vaccine for additional doses.² rCV can be administered, however, a prescription is required for patients aged under 18 years as additional doses are not approved for use in people aged 12 – 17 years.²

Further additional doses are available (regardless of the number of prior doses received) for people aged 30 years and over, people aged 16 – 29 years who are pregnant and people aged 12 – 29 years who are at higher risk of severe illness from COVID-19.²

People who are particularly recommended to receive additional doses include those who are:²

• Aged ≥ 65 years
• Of Māori or Pacific ethnicity aged ≥ 50 years
• Aged ≥ 16 years who live in aged residential care or disability facilities
• Aged ≥ 12 years with severe immunocompromise who were eligible to receive three primary doses, or with a medical condition that increases their risk of severe illness from COVID-19 (including people who are pregnant)

It is recommended that additional doses are given at least six months apart, or six months after a positive COVID-19 test.² Clinical discretion, however, can be applied for some patients, e.g. an interval of three months may be appropriate for patients at high risk of severe disease from COVID-19.² N.B. A spacing of fewer than three months between doses requires a prescription.²

For further information of groups recommended to receive additional COVID-19 doses, see: info.health.nz/immunisations/vaccines-aotearoa/covid-19-vaccines/getting-covid-19-vaccines/, and Table 5.6 in the Immunisation Handbook, available from: www.tewhatuora.govt.nz/for-the-health-sector/vaccine-information/immunisation-handbook-2024-version-1/

For further information on COVID-19 vaccines, see: www.immune.org.nz/vaccines-and-diseases/vaccines