Administration and answers to some frequently asked questions about influenza vaccination

1. How long does a person have to wait at the clinic after receiving an influenza vaccination?

The 20-minute waiting period continues to be the best option when the waiting area is adequate and safe.

Adolescents aged 13 years or older and adults receiving only an influenza vaccination:

  • If the risk of exposure to infectious disease in a crowded waiting rooms is higher than the low risk of anaphylactic events; adolescents and adults who meet ALL the following criteria may not need to wait for 20 minutes post-vaccination:
  1. do not have a history of severe allergic reactions,
  2. have been assessed for any immediate post vaccination adverse reactions (5 minutes),
  3. are aware of when they need to and how to seek post-vaccination advice,
  4. will have another adolescent or adult with them for the first 20 minutes post vaccination, and
  5. have the ability to contact emergency services if required.

Adolescents aged 13 years or older and adults receiving any other vaccination, and all children aged under 13 years need to remain under observation for the 20-minutes post-vaccination.

2. Administration of influenza vaccine and other vaccines

2a. Spacing of influenza vaccination and the COVID-19 vaccine (COMIRNATY™)

All National Immunisation Schedule vaccines (except shingles vaccine) can now be given at the same time or immediately before or after the COVID-19 vaccine. 

Pregnant women are recommended influenza vaccine and COVID-19 vaccine at any stage of pregnancy and whooping cough vaccine from 16 weeks gestation. They can be given at the same time or separately.

2b. Spacing of influenza vaccination and non-COVID-19 vaccines

The influenza vaccine can be administered concurrently with all non-COVID-19 vaccines, including the herpes zoster (shingles) vaccine, pneumococcal vaccines and Tdap, and the National Immunisation Schedule vaccines. Separate syringes and different injection sites should be used.

2c. Coadministration of influenza and pneumococcal vaccines

In one study, children aged 6–23 months are two to three times more likely to develop a fever of 38°C–39°C during the first 24 hours after receiving influenza and PCV13 (PREVENAR13®) vaccines at the same visit compared with children who received the vaccines on separate days.

  • Around one in 10 adults have an increased risk of experiencing fatigue, headache and/or body aches and pains during the 14 days after receiving influenza and PCV13 vaccines at the same visit.
  • Around two in 10 adults have an increase risk of redness or pain at the site of one or both injection sites when receiving influenza and 23PPV (PNEUMOVAX®23) vaccines concurrently.
  • Separating administration of these vaccines by two days can be offered, but is not essential.

Please refer to the Medsafe website www.medsafe.govt.nz for the PREVENAR 13 and PNEUMOVAX 23 data sheets.

2d. ZOSTAVAX® and annual influenza vaccination

Annual influenza immunisation is recommended and funded for adults aged 65 years or over.

One ZOSTAVAX is recommended for adults aged 65 years to under 80 years. This dose is also funded.

  • ZOSTAVAX and influenza vaccine can be administered at the same visit.
  • ZOSTAVAX is only given as a single dose – it IS NOT administered every year that an eligible adult receives their influenza vaccination.

3. Do we have to use the needles sourced by Seqirus to administer AFLURIA QUAD or FLUAD QUAD?

No. At the time of vaccination, the choice of needle gauge and length will be based on the vaccinator’s clinical judgment to ensure needle length is appropriate to reach muscle. Table 2.8 in the online Immunisation Handbook 2020 provides guidance on the needle gauge and length by site and age:

Age Site Needle guage and length Rationale

5–6 years

Deltoid

23–25 G x 16 mm

A 16 mm needle should be sufficient to effect deep IM deposition in the deltoid in most children.

7–64 years
65 years or older

Deltoid

23–25 G x 16 mm
23–25 G x 25 mm
21–22 G x 38 mm

Most adolescents and adults will require a 25 mm needle to effect deep IM deposition.
Very large or obese person Deltoid 21–22 G x 38 mm Use clinical judgment to ensure needle length is appropriate to reach muscle.

4. Can people receiving immune checkpoint inhibitors have an influenza vaccination?

Yes. A person who is currently receiving any of the immune checkpoint inhibitor treatments, atezolizumab (TECENTRIQ®), ipilimumab (YERVOY®), nivolumab (OPDIVO®) and pembrolizumab (KEYTRUDA®), or who has received any of these in the previous six months can receive any non-live vaccine, e.g., influenza or COVID-19, without consulting their specialist prior to vaccination. The administration of live vaccines (MMR, VV, HZV) is contraindicated.

5. Can influenza vaccines be administered to people receiving anticoagulant mediation?

Yes. FLUAD QUAD, AFLURIA QUAD, INFLUVAC TETRA or AFLURIA QUAD JUNIOR can be administered to people on anticoagulants, including aspirin, dabigatran (PRADAXA®), enexoparin (CLEXANE®), heparin, rivaroxaban (XARELTO®), ticagrelor (BRILINTA®), and warfarin. 

After vaccination, apply firm pressure over the injection site without rubbing for 10 minutes to reduce the risk of bruising. Please refer to the Medsafe website www.medsafe.govt.nz for the PRADAXA, CLEXANE, XARELTO and BRILINTA data sheets.

6. Can influenza vaccines be given to people with egg allergy or anaphylaxis?

Yes. FLUAD QUAD, AFLURIA QUAD, INFLUVAC TETRA or AFLURIA QUAD JUNIOR can be safely administered to people with a history of egg allergy or egg anaphylaxis at general practices, pharmacies or at the workplace, although the data sheet advises caution in people who have a history of egg anaphylaxis. Studies have shown that influenza vaccines containing one microgram or less of ovalbumin do not trigger anaphylaxis in sensitive individuals. 

7. Can the influenza vaccines be given to people with a sulfonamide (sulfer) allergy?

Yes. Sulfonamide (sulfur) antibiotics, such as cotrimoxazole, sulfasalazine, and sulfite preservatives used in food, are different to medicines containing the words sulfate or sulphate, e.g. neomycin sulphate. 

8. Do the influenza vaccines contain antibiotics?

Yes.

  • FLUAD QUAD vaccines contain traces of kanamycin and neomycin.
  • INFLUVAC TETRA vaccines contain traces of gentamicin.AFLURIA QUAD and AFLURIA QUAD JUNIOR vaccines contain traces of neomycin and polymixin B due to their use during production.

The vaccines should be used with caution in people with known anaphylaxis to these respective antibiotics.

9. Seafood, shellfish or other food allergy or anaphylaxis

  • People with a seafood or shellfish allergy or anaphylaxis can receive influenza vaccine, including FLUAD QUAD that contains the MF-59 adjuvant derived from shark liver.
  • A person with confirmed allergy or anaphylaxis to chicken meat or chicken protein should discuss whether to receive an influenza vaccine with their immunologist. In making the decision with the person, the immunologist will balance the potential for residual chicken protein and the person's individual sensitivity with the risks of influenza and potential benefits of influenza vaccination.
  • Allergy or anaphylaxis to other foods are not a contraindication for influenza vaccination.

9. Are the influenza vaccines latex free?

  • FLUAD QUAD, AFLURIA QUAD and AFLURIA QUAD JUNIOR syringes do not have any components made using natural rubber latex.
  • INFLUVAC TETRA syringes do not contain any latex components. However, the manufacturer (Mylan) is unable to confirm that the product did not come in contact with any latex materials during the manufacturing and packaging process.
    • If no latex-free influenza vaccine is available, please call 0800 IMMUNE (0800 466 863) before vaccinating a person who is highly sensitive to latex with a history of severe hypersensitivity response.

10. Do the influenza vaccines contain blood products?

No. No blood products are used in the manufacturing processes of FLUAD QUAD, AFLURIA QUAD, INFLUVAC TETRA and AFLURIA QUAD JUNIOR.

11. Do the inflluenza vaccines contain thiomersal?

No. FLUAD QUAD, AFLURIA QUAD, INFLUVAC TETRA and AFLURIA QUAD JUNIOR are preservative free. They do not contain thiomersal.

12. Why is an influenza vaccination recommended every year?

Yearly vaccination is recommended for two reasons: first, because protection from the previous vaccination lessens over time; and second, because the circulating influenza viruses can change and the strains in the vaccine usually change each year in response to the changing virus pattern.

13. When should people be vaccinated?

It is possible to come in contact with influenza viruses all year round. However, the likelihood of influenza viruses circulating in the community significantly increases during winter.

For most people, the best time to be vaccinated against influenza is before the start of the winter season. It can take up to two weeks for the vaccine to provide the best influenza protection. However, influenza vaccinations can be given when influenza virus activity has been identified as protective antibody levels have been observed to develop rapidly from four days after vaccination.

It is recommended that women who become pregnant after winter and have not received the current influenza vaccination are offered influenza vaccination up to and including 31 December.

14. Is there a minimum interval between an influenza vaccination at the end of 2020 and this year's vaccination?

No minimum interval is required between an influenza vaccination in 2020 and one in 2021. The 2021 influenza vaccination can be given as soon as the vaccine is available.

15. Can you get influenza from the influenza vaccine?

No. FLUAD QUAD, AFLURIA QUAD, INFLUVAC TETRA and AFLURIA QUAD JUNIOR have been made from influenza viruses that have been concentrated, inactivated, and then broken apart. Inactivated influenza vaccines cannot cause influenza as the vaccines do not contain any live viruses.

Sometimes influenza vaccination is accused of causing the disease. There are two possible reasons for this. First, when vaccinated, the body responds to vaccination by producing an immune response. This can include systemic symptoms such as fever, headache or fatigue, which may mistakenly be assumed to be early signs of influenza but are the body responding to the vaccination. Second, other respiratory viruses and bacteria circulate during the winter months and influenza vaccination does not protect against these.

Most of these other viruses cause milder infections. However, some viruses and bacteria may produce influenza-like symptoms and/or quite severe illness which can lead to the suggestion that influenza vaccination is ineffective. These illnesses should not be confused with influenza.