Influenza Information for Health Professionals

The publicly funded influenza vaccines available for the 2021/2022 UIIP include:

  • Quadrivalent Inactivated Vaccine (QIV) for ≥6 months of age (table 1)
  • High-Dose Quadrivalent Inactivated Vaccine (QIV-HD) for ≥65 years only (table 2)
  • Adjuvanted Trivalent Inactivated Vaccine (TIV-adj) for ≥65 years only (table 2)
  • sudden onset of high fever, chills, cough and muscle aches
  • other common symptoms include:
    • headache
    • chills
    • loss of appetite
    • fatigue
    • sore throat
  • nausea, vomiting and diarrhea may also occur, especially in children

For local, provincial and national influenza surveillance information:

  • Obtain laboratory testing (nasopharyngeal swab collected in a respiratory virus collection kit) in all persons with suspected influenza who are admitted to hospital.
  • Influenza testing is not currently available through the Public Health Ontario (PHO) Laboratory for patients in ambulatory settings, including those at high risk for influenza complications or patients in emergency department settings who will not be admitted to hospital.
  • Follow PHO’s current Respiratory Viral Testing Algorithm available on PHO’s Labstracts.

Updated September 27, 2021

Publicly Funded Influenza Vaccines for the 2021/2022 Flu Season

Table 1. Publicly funded influenza vaccine available through the 2021/2022 UIIP for individuals 6 months of age and older

Quadrivalent Inactivated Vaccine
UIPP Abbreviation
 QIV
NACI Abbreviation
 IIV4-SD – – IIV4-cc
Vaccine product
 FluLaval Tetra Fluzone® Quadrivalent Afluria® Tetra Flucelvax® Quad
Manufacturer
 GSK Sanofi Pasteur Seqirus Seqirus
Age indication
 ≥6 months ≥6 months ≥5 years ≥2 years
Vaccine type
 Egg-based Egg-based Egg-based Cell culture-based1
Micrograms of hemagglutinin
 15 µg 15 µg 15 µg 15 µg
Dosage
 0.5 mL 0.5 mL 0.5 mL 0.5 mL
Format
 MDV
  1. MDV
  2. PFS
  1. MDV
  2. PFS
 PFS
Route
 IM IM IM IM
Most common allergens2
  • Egg protein3
  • Thimerosal4
  • Egg protein3
  • Thimerosal4
  • Egg protein3
  • Neomycin
  • Polymyxin B
  • Thimerosal4
 Does not contain egg protein
Post-puncture shelf life
 28 days5 MDV: 28 days5
PFS: Not applicable		 MDV: 28 days5
PFS: Not applicable		 Not applicable
Product dimensions (cm)
 2.7 x 2.7 x 6.9 MDV: 3 x 2.9 x 6.2
PFS: 10.4 x 9.9 x 3.8		 MDV: 6.1x 6.0 x 3.1
PFS: 12.5 x 6.1 x 9.4		 15.4 x 13.02 x 2.38
  1. ‘Cell culture-based’ refers to how the influenza vaccine is made. Flucelvax® Quad is a mammalian cell culture-based QIV. Both egg-based and cell culture-based QIVs provide protection against four strains of influenza and are available in the UIIP for 2021/2022. Any of the available products can be used in the age group for which they are indicated.
  2. Any component in a vaccine may be a potential allergen. This table identifies the most common allergens.
  3. The National Advisory Committee on Immunization (NACI) indicates that egg allergy is not a contraindication for influenza vaccination and that egg-allergic individuals may be vaccinated against influenza using the full dose of any age-appropriate product.
  4. Multi-dose vial presentation only
  5. Return vials with remaining doses to PHU or OGPMSS (for Toronto clients) as wastage.

Table 2. Publicly funded influenza vaccine available through the 2021/2022 UIIP for individuals 65 years of age and older

High-Dose Quadrivalent Inactivated Vaccine

Adjuvanted Trivalent Inactivated Vaccine
UIPP Abbreviation
 QIV-HD TIV-adj
NACI Abbreviation
 IIV4-HD IIV3-Adj
Vaccine product
 Fluzone® High-Dose Quadrivalent Seqirus
Manufacturer
 Sanofi Pasteur Sanofi Pasteur
Age indication
 ≥65 years ≥65 years
Vaccine type
 Egg-based Egg-based
Micrograms of hemagglutinin
 60 µg 15 µg
Dosage
 0.7 mL 0.5 mL
Adjuvant
 No Yes
Format
 PFS PFS
Route
 IM IM
Most common allergens2
  • Egg protein2
  • Egg protein2
  • Kanamycin
  • Neomycin
Post-puncture shelf life
 Not applicable Not applicable
Product dimensions (cm)
 9.9 x 10.4 x 2.3 12.7 x 6.35 x 9.4
  1. Any component in a vaccine may be a potential allergen. This table identifies the most common allergens.
  2. The National Advisory Committee on Immunization (NACI) indicates that egg allergy is not a contraindication for influenza vaccination and that egg-allergic individuals may be vaccinated against influenza using the full dose of any age-appropriate product.

Vaccine Ordering

Order vaccines using the Universal Influenza Immunization Program (UIIP) Vaccine Order Form , from October 18, 2021 onward. Call 416-327-0837 or email OGPMSS.moh@ontario.ca about vaccine orders.

More Information

When caring for people with influenza or influenza-like illness, follow Provincial Infectious Diseases Advisory Committee’s Routine Practices and Additional Precautions in all Health Care Settings including:

  • droplet and contact precautions
  • facial protection (which may include a mask in conjunction with eye protection, or a face shield that covers eyes, nose and mouth) within two metres of a patient on droplet precautions
  • isolation in a single room or cohorted with another lab-confirmed case
  • continued precautions for five days after onset of illness

In addition, advise patients with influenza-like illness to stay home from work or school while ill, and to practise frequent hand washing and cough etiquette.

  • Report confirmed cases of influenza to Toronto Public Health.
  • Report respiratory infection outbreaks in institutions and public hospitals to Toronto Public Health.
  • To report call 416-392-7411 during business hours and 3-1-1 on evenings and weekends.

The Ministry of Health recommends the following in preparation for an increased demand for health care services and outbreaks:

Acute Care

  • Prepare for an increase in emergency room visits, hospital admissions and need for intensive care beds.
  • Prepare for use of antiviral medications when influenza is circulating in the community:
    • Antiviral medications should be used for emergency room and outpatient clinic patients with influenza-like illness (ILI) and risk factors for influenza complications, and patients being admitted with ILI.
    • In addition, planning should be undertaken to rapidly detect nosocomial outbreaks of influenza and initiate antiviral treatment for patients with ILI, as well as initiating antiviral prophylaxis for all other patients on the affected unit.
    • Unvaccinated staff members and those vaccinated in the preceding two weeks who are required to work on the affected unit should also receive antiviral prophylaxis.

Primary Care

  • If possible, keep your offices open during the holiday season to accommodate the anticipated increase in influenza activity.
    • If your office will be closed make efforts to inform your patients about alternate clinics in your community where they can go to seek care in case they develop ILI and require medical attention and/or are candidates for antiviral treatment because of risk factors for complications.
    • Examples include:
      • messaging on your office voicemail system
      • information on your office website
      • email information to patient
      • direct patients to contact TeleHealth
  • Follow best practices/examples related to influenza infection prevention and control (e.g., staff immunization, personal protective equipment indications, environmental cleaning, healthy workplace policies) and advise patients of measures to prevent acquisition and transmission of respiratory infections via signage at reception (e.g., hand hygiene, cover your cough, self-screening).

Long-term care:

  • Prepare to detect and respond to outbreaks over the influenza season, including the rapid provision of antiviral medications to all residents and staff as appropriate.
  • Ensure that you have protocols in place for managing influenza and other respiratory outbreaks at your home, which include protocols to communicate with your Toronto Public Health liaison (call 3-1-1 after hours) should an outbreak be suspected.
  • Processes should also be in place to rapidly obtain antiviral medications for treatment of residents with ILI and for prophylaxis of other residents in the outbreak affected area of the home.
    • The sooner antiviral medications are initiated in an influenza outbreak, the quicker the outbreak will be controlled, limiting the risk for residents.
    • Antiviral medications are also recommended for unvaccinated staff members and for those vaccinated in the preceding two weeks.
    • Contact your Toronto Public Health liaison (call 3-1-1 after hours) for more information regarding antiviral prophylaxis recommendations for staff and reimbursement processes.