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New influenza vaccines for a new year
Vaccination is the most effective means of protecting against influenza. Receiving an influenza vaccine annually is
important, as different strains are generally in circulation each year (which is reflected in the strains selected for
the vaccine) and because the immunity provided by influenza vaccination is only expected to last one to two years.1 This
loss of immunity is more rapid in older and immunocompromised people, and annual vaccination is therefore particularly
important in these groups, as well as in younger children (aged six months to five years) who are particularly vulnerable
to the complications of influenza.2 People at increased risk of being exposed to and spreading the infection,
such as healthcare workers and childcare providers, should also ideally be vaccinated.
There are two funded influenza vaccines in 2014: Influvac and Fluarix. Both are indicated for adults and children aged
six months and older. The vaccines should ideally be administered intramuscularly, although both can be used subcutaneously
if there is a contraindication to intramuscular administration, such as a bleeding disorder.
Administration to patients can begin as soon as the vaccine is available at the general practice. Subsidy for eligible
groups is available up until 31 July, 2014 (see: “The subsidised group has not changed from 2013”).
Funded vaccine claims need to be submitted within eight months from the date of administration. Vaccination is also available
from selected accredited Pharmacists, however, this is not subsidised.
New strains are included in the 2014 vaccine
This year the vaccine includes two new strains, plus one strain from previous years. The vaccine components for the
2014 influenza season in New Zealand and Australia are:3, 4
- A/California/7/2009 (H1N1)-like virus
- A/Texas/50/2012 (H3N2)-like virus
- B/Massachusetts/2/2012-like virus
The A/California/7/2009 (H1N1)-like virus component of the influenza vaccine has been unchanged since 2010. It should
provide good protection against this strain of influenza which has been prevalent in some Northern hemisphere countries
during the 2013/14 winter.3 Similarly, the A/Texas/50/2012(H3N2)-like virus component should provide good
protection against the H3N2 strains also circulating and which were the predominant virus during the Christchurch severe
influenza outbreak in 2012. B/Massachusetts/2/2012, which belong to the Yamagata lineage of B viruses, are now the dominant
influenza B virus circulating.
These strains were recommended by the World Health Organisation and accepted by the Australian Influenza Vaccine committee
as appropriate for New Zealand and Australia in 2014.3, 4
How many doses are required?
Adults and children aged over nine years require one dose of the vaccine to achieve immunity for the season.
Children aged between six months and nine years who have not previously received an influenza vaccine should be given
two doses, with the second dose given at least four weeks after the first. Children in this age group who have received
an influenza vaccine at any time in the past require only one dose.
Who should not receive an influenza vaccine
At present there is no influenza vaccine available for infants aged under six months. Protection of
young infants can be partially achieved through vaccinating the mother during pregnancy, and via “cocooning”, i.e. immunising
adults (e.g. parents and grandparents) and older children who will have contact with the infant in order to reduce the
likelihood of exposure to the viruses. For most people, these vaccinations will not be subsidised.
People with an acute illness or fever over 38°C should delay having the vaccine until they are well.
Fluarix pre-filled syringes have a needle shield that contains latex.1 As such, Fluarix is considered inappropriate
for people with a latex allergy; Influvac can be used.
The influenza vaccines used in New Zealand are produced using hens’ eggs and contain trace amounts of egg protein. People
who have a confirmed anaphylactic reaction to egg protein may still be given the vaccine, however, this
should be done under the supervision of an Allergy specialist or Paediatrician.5 This is generally only recommended
if the benefits of vaccination outweigh the increased risk of an adverse reaction.5 People who have had mild
reactions or hypersensitivity to egg protein may receive the vaccine with additional safety precautions, such as a 30
minute observation period following administration (the normal recommended observation period is 20 minutes).5
Claiming funding for the vaccine
The vaccine costs $9.00 (excluding GST) per dose. The cost of vaccines administered to patients who are eligible for
subsidy can be claimed in full by the practice. The cost of administration of the vaccine to the eligible group can also
be claimed, and the administration subsidy is set at $19.59 (excluding GST) per person.
The vaccine has been available for order since February. Orders are subject to a minimum order size, starting at a
minimum of 50 doses in February, and reducing to a minimum of ten doses over the course of the season.
A limited refund of unused vaccines is available up until 31 August, 2014. Only 10 stock units can be refunded from
any one account.
For further information on receiving the vaccine, submitting claims and returning
unused vaccines, see: http://influenza.org.nz/?t=888
The subsidy group has not changed from 2013
The groups of people that are eligible for subsidy for influenza vaccination are unchanged from 2013. Most people at
increased risk from the complications associated with influenza are able to receive a funded vaccine. The eligible groups
in 2014 are:
- People aged 65 years and over
- Women who are pregnant
- Children aged under five years with a previous history of hospitalisation or significant respiratory illness
- People aged under 65 years with long-term health conditions, such as:
- Coronary heart disease
- Chronic kidney disease
- Chronic respiratory conditions
- Diabetes, types 1 and 2
- Immune suppression
- Rheumatoid arthritis
Practices can provide subsidised doses of the influenza vaccination until July 31, 2014, after which time, patients
will have to pay the full cost of the vaccine and administration.
The full list of conditions that qualify a patient for subsidised vaccination
is available from: http://www.influenza.org.nz/eligibility-criteria
Healthcare providers should receive the influenza vaccine
It is recommended that all healthcare providers and non-clinical practice staff be immunised annually against influenza.
Influenza vaccination among healthcare providers improves patient safety,6, 7 and is consistent with professional
ethics. Vaccination should form part of an overall practice effort to reduce influenza transmission, which includes hand
washing and exclusion of all staff with influenza-like illness.
All District Health Boards in New Zealand offer free influenza vaccination to healthcare staff. Since 2010, data has
been available on the uptake of this free immunisation. In 2013, approximately 58% of all employees received an influenza
vaccination.8 This rate was a significant improvement from 2012 (48%), 2011 (46%) and 2010 (45%).8 Rates
were highest among doctors (64%) and lowest among midwives (46%).8 Nurses (55%), allied staff (56%) and other
employees (60%) all had similar rates of influenza vaccination.8 Immunisation rates also differed among DHBs,
with the highest rates achieved in 2013 in Tairawhiti and Canterbury DHBs (77% and 76% respectively) and the lowest rates
in West Coast DHB (36%).8
Healthcare workers have one of the highest exposure rates for influenza in the community, and a substantial proportion
become infected with the influenza virus each season.7 Once infected, the virus is shed before the onset of
symptoms, during subclinical or clinical illness and once symptoms have resolved, meaning that healthcare workers, even
when they appear well, can spread the influenza virus to patients.7
There is moderately strong evidence that immunisation in healthcare workers reduces patient mortality from influenza.7 Healthcare
worker immunisations are also likely to reduce the number of influenza cases in patients.7 Overall, the benefits
of healthcare worker influenza vaccination, which include reductions in morbidity and mortality among patients and reduction
in illness among the workers themselves, outweigh any potential harms.7
Thank you to Associate Professor Nikki Turner, Department of General Practice and Primary Health Care,
Director CONECTUS and the Immunisation Advisory Centre, University of Auckland and Associate Professor Lance
Jennings, Clinical Virologist, University of Otago, Christchurch and Canterbury Health Laboratories, Canterbury
DHB for expert review of this article.
- National Influenza Specialist Group. Influenza info for health professionals. Immunisation Advisory Centre (IMAC)
New Zealand. Available from: www.influenza.org.nz/?t=888 (Accessed
- Song J, Cheong H, Hwang I, et al. Long-term immunogenicity of influenza vaccine among the elderly: Risk factors for
poor immune response and persistence. Vaccine 2010;28:3929–35.
- World Health Organisation (WHO). Recommended composition of influenza virus vaccines for use in the 2014 Southern
Hemisphere influenza season. WHO, 2013. Available from: www.who.int/influenza/vaccines/virus/recommendations/201309_recommendation.pdf (Accessed
- Australian Influenza Vaccine Committee (AIVC). AIVC recommendations for the composition of influenza vaccine for
Australia in 2014. AIVC, 2013. Available from: www.tga.gov.au/about/committees-aivc.htm#.UsykvbQTBpg (Accessed
- Australian Society of Clinical Immunology and Allergy Inc. Guidelines for medical practitioners: Influenza vaccination
of the egg-allergic individual. 2010. Available from: www.allergy.org.au Accessed
- Jefferson T, Di Pietrantonj C, Rivetti A, et al. Vaccines to prevent influenza in healthy adults. Cochrane Database
Syst Rev 2010;7:CD001269.
- Ahmed F, Lindley M, Allred N, et al. Effect of influenza vaccination of healthcare personnel on morbidity and mortality
among patients: Systematic review and grading of evidence. Clin Infect Dis 2014;58:50–7.
- Ministry of Health (MOH). 2013 Workforce influenza immunisation coverage rates by District Health Board. MOH, 2013.
Available from: www.health.govt.nz (Accessed Mar, 2014).