Updated October 11, 2019

 

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.
  • Provide high-dose trivalent inactivated vaccine (HD-TIV) for adults 65 years and older, without contraindications as it provides better protection against influenza A (H3N2), compared to standard dose quadrivalent inactivated vaccine (QIV) vaccine.
  • Quadrivalent-live attenuated influenza vaccine (Q-LAIV) nasal spray is not available in Canada for this influenza season.

2019/2020 Universal Influenza Immunization Program (UIIP) Vaccines

Influenza Vaccines QIVs (Quadrivalent Inactivated Vaccines) QIVs (Quadrivalent Inactivated Vaccines) High-Dose TIV (Trivalent Inactivated Vaccine)
Trade Names FluLaval Tetra, Fluzone® Afluria® Tetra High-Dose Fluzone®
Age Eligibility 6 months and older 5 years and older 65 years and older
Dosage 0.5 mL 0.5 mL 0.5 mL
Route IM injection IM injection IM injection
Common Allergens Thimerosal (multi-dose vial)
  • neomycin
  • polymyxin B sulfate

Influenza vaccine strains

  • A/Brisbane/02/2018 (H1N1)
  • A/Kansas/14/2017 (H3N2)
  • B/Colorado/6/2017
  • B/Phuket/2073/2013 (not in the trivalent vaccine)

Vaccine Ordering

  • Order vaccine from Ontario Government. Pharmaceutical and Medical Supply Service (OGPMSS) using the UIIP Vaccine Order Form after Oct. 28, 2019
  • Questions about vaccine orders, call 416-327-0837 or email OGPMSS.moh@ontario.ca.

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.