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Administration of influenza vaccine

Note: Also see Contraindications and precautions (includes other considerations) and Influenza vaccination during pregnancy

Vaccinating Workforce
For current guidance on who can administer the influenza vaccine, including to which consumer age groups, refer to the Immunisation Handbook 2020 Section 2.  

Pre-vaccination screen
A comprehensive pre-vaccination screen must be completed with the vaccine recipient.  

A new consumer A4 handout, What you need to know about the flu vaccination (HP8682), has been developed to assist with pre-vaccination screening and to provide post vaccination information. It can be downloaded to print from Dropbox: NIP - vaccine resources - Simplify your life (tinyurl.com/548knm9z) Hardcopies of this resource (and future 2023 influenza promotional resources) can be ordered via the Blue Star portal. To register with the Blue Star portal, email moh.support@ bluestargroup.co.nz and request ‘Vaccine resources access’; include your clinic/practice/pharmacy name and your contact details. 

Refer also to the section Contraindications and other precautions which includes other considerations. The full screening checklist can be found in the Immunisation Handbook 2020 Section 2.1.3 .
The IMAC pre-vaccination screening tool can be found here (tinyurl.com/2ufdtkua).

Informed consent
Informed consent must be obtained before a vaccine is administered. See Immunisation Handbook 2020 Section 2.1.2 for a full explanation of the informed consent process and who can give consent. The informed consent process includes advising consumers on what to expect following the vaccination and where to seek help if required.

Verbal versus written consent
Consent can be gained either verbally or using a written consent form and will depend on the providers' local systems and processes, but also on the vaccination setting. If consent is gained verbally, it must be documented as part of a permanent patient record.

If written consent is required, the 2023 Flu vaccination consent form file is available at Dropbox: NIP - vaccine resources- Simplify your life (tinyurl.com/548knm9z) and the resources section of influenza.org.nz.

Additional clinical information to support consent discussions is on this website including:
-  influenza vaccine safety and effectiveness for all ages (see Clinical Info tab)
-  the risks and burden of influenza for older people, pregnant people and children.  

Post-vaccination advice
The new What you need to know about the flu vaccination handout mentioned above includes post-vaccination advice. It is important that consumers know to keep this information handy. Instead of a paper copy, some consumers may prefer to take a photo of the post-vaccination information on the handout.

From 2023, influenza vaccinations will be monitored using Post Vaccine Symptom Check (PVSC). Consumers should be informed of PVSC and its value in monitoring the safety of the vaccine and encouraged to participate. For further information on PVSC see below.

Concomitant administration with the influenza vaccine
The influenza vaccine can be given concomitantly with all National Immunisation Schedule vaccines.

FLUAD QUAD, Shingrix and Nuvaxovid utilise novel adjuvants to gain a good immune response. Consumers should be informed of the possibility of a stronger post-vaccination response, where two or more of these are administered together.

Individuals (or parents/legal guardians/power of attorneys) should be informed of the small risk of febrile convulsions in concomitant delivery with PCV13 in children aged 6 months to under 5 years. If the individual has a history of febrile convulsions, separation of two days between vaccines is recommended.

Tamariki vaccines and dose chart

See here.

Minimum interval between an influenza vaccination at the end of 2022 and this year’s vaccination
No minimum interval is required between an influenza vaccination in 2022 and one in 2023.The 2023 influenza vaccination can be given as soon as the vaccine is available.

Preparation of vaccine
Manufacturers’ guidance:
-  AFLURIA QUAD and AFLURIA QUAD JUNIOR - Shake before use. After shaking, the vaccine should appear as a homogenous suspension.
-  FLUAD QUAD - Gently shake before use. After shaking, the normal appearance of the vaccineis a milky-white suspension.
-  FLUQUADRI – Before administering a dose of vaccine, shake the prefilled syringe.

Post-vaccination observation period after receiving an influenza vaccination
1. For influenza only vaccination: the post- vaccination observation period is 20 minutes but can be reduced to 5 minutes for people who meet ALL of the following criteria:
• are aged 13 years and over
• do not have a history of severe allergic reactions
• have been assessed for any immediate post-vaccination adverse reactions (5minutes)
• are aware of when they need to and how to seek post-vaccination advice
• will have another adult with them for the first 20 minutes post-vaccination
• will not drive, skate, scoot, ride a bike or operate machinery until 20 minutes post-vaccination
• have the ability to contact emergency services if required

2. For concomitant influenza & COVID-19 vaccination: the post-vaccination observation period for all ages is 20 minutes. This can be reduced to 15 minutes if all of the criteria in 1. immediately above are met.

3. For concomitant influenza vaccination & other non-COVID-19 vaccine: the post-vaccination observation period for all ages is 20 minutes.

While many people aged 13+ will have a reduced observation period following vaccination, they should only walk, take public transport or be driven by another person for 20 minutes after their vaccination. It is important that this message is given to those being released after a five-minute observation period. After 20 minutes, they can drive themselves, cycle or use other mobility devices. There remains a risk of syncope after any vaccination and thus consumers must not operate a vehicle or heavy machinery during this time.

Post Vaccine Symptom Check (PVSC)
Influenza vaccinations will be monitored this year using the Post Vaccine Symptom Check (PVSC). This is a survey used by the National Immunisation Programme to monitor the safety of the vaccines in Aotearoa New Zealand and, more specifically, understand how an individual’s health may have been affected after their vaccination (for example, whether any adverse events were experienced). Any consumer who has received an influenza vaccination can participate in the survey. The data collected will help monitor adverse events following vaccination and identify potential safety issues. Consumers can participate in the survey by scanning a QR code at the time of vaccination. QR codes will be available for sites to print and display and can be accessed from the National Immunisation Programme Dropbox. The QR code links to a web form to enable participants to register. Once registered, a SMS (txt) message will be sent from the National Immunisation Programme a few days following vaccination with a link to the survey. The PVSC was first used in Aotearoa New Zealand during the rollout of COVID-19 vaccinations. Data collected is de-identified and includes if an adverse event(s) was experienced and whether these events required medical treatment or impacted routine activities. Once sufficient PVSC influenza immunisation data is available, survey results will be published on the Te Whatu Ora website. PVSC does not replace the reporting of AEFI through the traditional channels and adverse events should also be reported directly to the Centre for Adverse Reactions Monitoring (CARM).

Reporting adverse events following influenza vaccination
Healthcare professionals and vaccinators are professionally and ethically responsible for reporting any serious or unexpected adverse events after the administration of all medicines, including the influenza vaccine, regardless of whether or not they consider the event to have been caused by the vaccination. CARM Reports can be completed online at nzphvc.otago.ac.nz/report/or the form can be printed, filled in and mailed.

Inactivated vaccines
These vaccines have been made from influenza viruses that have been concentrated, inactivated, and then broken apart. Neither AFLURIA QUAD, AFLURIA QUAD JUNIOR, FLUADQUAD or FLUQUADRI can cause influenza as the vaccines do not contain any live viruses. (5-7)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 that can lead to the suggestion that influenza vaccination is ineffective. These illnesses should not be confused with influenza. 

Influenza vaccination and international travel  
See here: International travel.

  • ZOSTAVAX is only given as a single dose – it IS NOT administered every year that an eligible adult receives their influenza vaccination.
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