Influenza Information for Health Professionals

Updated November 21, 2022

For a summary of influenza, COVID-19 and other respiratory virus activity in Toronto, see the Integrated Respiratory Diseases Dashboard.

 

The publicly funded influenza vaccines available for the 2022/2023 Universal Influenza Immunization Program (UIIP) include:

  • Quadrivalent Inactivated Vaccine (QIV) for ≥6 months of age (See Table 1)
  • High-Dose Quadrivalent Inactivated Vaccine (QIV-HD) for ≥65 years only (See Table 2)
  • Adjuvanted Trivalent Inactivated Vaccine (TIV-adj) for ≥65 years only (See 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:

NOTE: On July 26, 2021, PHO Laboratory implemented changes to eligibility of multiplex respiratory virus PCR (MRVP) testing for children <18 years old seen in the Emergency Department, hospitalized patients, outbreak-associated patients, and patients in institutions not in outbreak with acute respiratory illness (ARI).

Starting July 26, 2021, PHO Laboratory made the following changes to MRVP testing:

  • To support enhanced respiratory virus surveillance, MRVP testing will be available for symptomatic children (<18 years) seen in the Emergency Department (ED).
  • MRVP testing will be available for all symptomatic hospitalized patients (ward and ICU/CCU).
  • Specimens from the first four symptomatic patients in an outbreak that request respiratory virus testing will be tested by MRVP.
  • Symptomatic patients tested in institutional settings (non-outbreak) will be eligible for MRVP testing when ordered on the PHO Laboratory requisition.
  • Influenza testing is not currently available through the Public Health Ontario (PHO) Laboratory for patients >18 years of age in ambulatory/outpatient settings, assessment centres, including ambulatory influenza high risk patients (these patients will be offered SARS-CoV-2 testing only).

MRVP testing requests for patients with ARI in the settings described above should be clearly indicated on the requisition by selecting “Respiratory Viruses” or “COVID-19 Virus AND Respiratory Viruses” as appropriate in section 5 – “Test(s) Requested”. Only mark one of the three test request options. In addition, the patient’s setting and symptoms should be indicated on the requisition.

Publicly Funded Influenza Vaccines for the 2022/2023 Flu Season

Table 1. Publicly funded influenza vaccine available through the 2022/2023 UIIP for individuals 6 months of age and older

Quadrivalent Inactivated Vaccine
UIPP Abbreviation QIV
NACI Abbreviation IIV4-SD – –
Vaccine product FluLaval Tetra Fluzone® Quadrivalent Afluria® Tetra
Manufacturer GSK Sanofi Pasteur Seqirus
Age indication ≥6 months ≥6 months ≥5 years
Vaccine type Egg-based Egg-based Egg-based
Micrograms of hemagglutinin 15 µg 15 µg 15 µg
Dosage 0.5 mL 0.5 mL 0.5 mL
Format MDV
  1. MDV
  2. PFS
  1. MDV
  2. PFS
Route IM IM IM
Most common allergens1
  • Egg protein2
  • Thimerosal3
  • Egg protein2
  • Thimerosal3
  • Egg protein2
  • Neomycin
  • Polymyxin B
  • Thimerosal3
Post-puncture shelf life 28 days4 MDV: 28 days4
PFS: Not applicable		 MDV: 28 days4
PFS: 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
  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.
  3. Multi-dose vial presentation only
  4. Report all vaccine wastage and return only unopened vials/syringes/ampoules to PHU or OGPMSS (for Toronto clients) as wastage. Discard opened vials/syringes/ampoules through biohazard waste.

Table 2. Publicly funded influenza vaccine available through the 2022/2023 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 Fluad®
Manufacturer Sanofi Pasteur Seqirus
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 allergens1
  • 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.

2022/2023 Vaccine Ordering

The deadline to apply to order vaccine for the 2022/2023 season has passed.

The deadline to apply for the 2023/2024 UIIP will be announced in the coming months.

Organizations interested in becoming a vaccine provider for the Universal Influenza Immunization Program (UIIP) are required to complete an annual application process for approval to store, handle, and administer publicly funded influenza vaccine unless they are in receipt of other publicly funded vaccines (excluding COVID-19 vaccine).

More information:

Since the beginning of the COVID-19 pandemic, there has been very little influenza or other respiratory virus activity which is thought to be due to public health measures implemented to reduce COVID-19 transmission. In the southern hemisphere, an early surge in influenza cases was associated with the relaxation of public health measures during their recent influenza season (summer 2022). Situational assessment and epidemiological information from the southern hemisphere suggests Toronto is likely to see a notable increase in influenza activity after a 2-year lull, in addition to continued COVID-19 circulation.

As a result, when caring for people with “influenza-like illness,” which may include COVID-19, follow PHO’s Interim Infection Prevention and Control Measures based on COVID-19 Transmission Risks in Health Care Settings.

When caring for people with lab confirmed influenza, 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 casecontinued precautions for five days after lab confirmed influenza
  • Advise patients to stay home from work or school while ill, and to practise frequent hand washing and cough etiquette.

For more information about COVID-19, including isolation requirements, see TPH’s COVID-19 Information for Health Professionals.

  • 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.