Influenza Information for Health Professionals

Influenza occurs globally with an annual attack rate estimated at five to 10 per cent in adults and 20 to 30 per cent in children. In Canada, influenza generally occurs each year in the late fall or winter months.

The tabs below offer health professionals key information about influenza vaccination, infection prevention and control, diagnosis, and treatment of seasonal influenza.

  • 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 October 8, 2020

Publicly Funded Influenza Vaccines for the 2020/2021 Flu Season

Influenza Vaccines QIVs (Quadrivalent Inactivated Vaccines) QIVs (Quadrivalent Inactivated Vaccines) High-Dose TIV (Trivalent Inactivated Vaccine)
Trade Names FluLaval Tetra, Fluzone® Quad Flucelvax® Quad High-Dose Fluzone®
Vaccine type Egg-based Cell culture-based Cell culture-based
Age Eligibility ≥ 6 months ≥ 9 years ≥ 65 years
Dosage 0.5 mL 0.5 mL 0.5 mL
Route IM injection IM injection IM injection
Hemagglutinin (HA) dose 15 µg HA per strain 15 µg HA per strain 60 µg HA per strain
Allergens thimerosal in multi-dose vial thimerosal in multi-dose vial
Common side effects redness, swelling, pain at injection site; malaise, myalgia redness, swelling, pain at injection site; headache, myalgia redness, swelling, pain at injection site; malaise, myalgia, fever up to three days

FluMist® Q-LAIV nasal spray is not publicly funded this year.

Egg-based Influenza Vaccine Strains

*updated from last year’s influenza vaccine.

  • A/Guangdong-Maonan/SWL1536/2019 (H1N1) pdm09-like virus*
  • A/Hong Kong/2671/2019 (H3N2)-like virus*
  • B/Washington/02/2019 (B/Victoria lineage)-like virus*
  • B/Phuket/3073/2013 (B/Yamagata lineage)-like virus [not in the trivalent vaccine]

New this year, Flucelvax® Quad is a mammalian cell culture-based inactivated, influenza vaccine authorized for use in Canada in November 2019. It is considered effective, immunogenic, and safe in adults and children ≥ nine years of age, and has a comparable immunogenicity and safety profile to traditional egg-based influenza vaccines already licensed in Canada. For more information, see  NACI Supplemental Statement on Mammalian Cell Culture-Based Influenza Vaccines.

Vaccine Ordering

Order vaccines using the Universal Influenza Immunization Program (UIIP) Vaccine Order Form, after October 19, 2020. Call 416-327-0837 or email OGPMSS.moh@ontario.ca about vaccine orders.

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.