INFLUENZA VACCINE FOR 2008/09 AND HOW TO GET IT
The publicly funded Influenza Program will again consist of Fluviral S/F® 08/09 for the general public and Vaxigrip® 08/09 (Thimerosal reduced) for pregnant women. This year’s influenza vaccine contains:
- A/Brisbane/59/2007 (H1N1)- like virus
- A/Uruguay /716/2007 (H3N2)- like virus
- B/Florida/4/2006-like virus
The NACI 2008/09 Influenza Statement is available online.
Please date each multi-dose vial of vaccine when first opened:
- Fluviral® may be used up to 28 days from first use , after which the vial should be discarded.
- Vaxigrip ®, is lower in thimerosal, so the vial is good for only 7 days from first use , after which the vial should be discarded. If you don’t vaccinate enough pregnant women to use up a vial of Vaxigrip® within 7 days of opening it, please use it for other patients of any age for whom publicly funded vaccine is indicated so it doesn’t go to waste .
- Please note: influenza vaccine needs to be given IM using a 7/8 - 1 ½” needle
HOW TO GET VACCINE: Available from your local Health Unit from the week of October 27, 2008
If your office is expecting to deliver about the same amount of influenza vaccine as last year, you do NOT need to put in an order – you will receive the same amount as last year.
If your office expects a major change in the amount of influenza vaccine you will use this year compared to last year, please call your local Health Unit and let us know.
When picking up vaccine, please bring an ice pack and a cooler (see attached sheet on maintaining cold chain).
Only those eligible for publicly-funded vaccine (seebelow) should be immunized with this supply.
NEW FOR THE 2008/09 SEASON (Background information available on request):
Any risk to pregnant women from thimerosal containing vacccines is theoretical as there is insufficient evidence on this issue. Vaxigrip may be offered preferentially to pregnant women.
In the past, vaxigrip was also offered preferentially to infants aged 6-23 months; this is no longer felt to be necessary.
As a reminder , the elderly (including those in residential care facilities) should be vaccinated as soon as vaccine for the season is available. A previous recommendation that seniors not be vaccinated early has been withdrawn; it is not that their immunity wanes quickly, but that they have a weaker response to influenza immunization.
GROUPS ELIGIBLE FOR PUBLICLY- FUNDED INFLUENZA VACCINE
In British Columbia, influenza vaccine is provided free of charge to people in the following groups:
People older than 6 months of age who are at high risk of complications from influenza:
People of any age who are residents of nursing homes or other chronic care facilities
People 65 years of age and over
Anyone with the following chronic health conditions: (including pregnant women and children)
Cardiac or pulmonary disorders (including bronchopulmonary dysplasia, cystic fibrosis, asthma)
Diabetes and other metabolic diseases
Cancer, immunodeficiency (including HIV infection), immunosuppression due to underlying disease or therapy( e.g. severe rheumatoid arthritis requiring immunosuppressive therapies)
Chronic kidney disease, anemia and hemoglobinopathy
Conditions that compromise the management of respiratory secretions and are associated with an increased risk of aspiration (e.g., cognitive dysfunction, spinal cord injury, seizure disorder, neuromuscular disorder)
Children and adolescents (age 6 months to 18 years) treated for long periods with acetylsalicylic acid
Healthy children aged 6 to 23 months – (Note: influenza vaccine is not effective under 6 months of age)
Pregnant women who will be in their 3rd trimester during influenza season (Nov – April) - Vaxigrip® may be offered (Note that influenza vaccine is recommended for women in high risk groups at any stage of pregnancy or while breastfeeding.)
People working with live poultry and /or swine
Inmates of correctional facilities
People capable of transmitting influenza to those at high risk of complications from influenza:
Healthcare workers and other workers (including students, trainees, volunteers, etc.) who have significant contact with people in the high risk groups listed above. This includes you as doctors and your staff; midwives, etc.
Household contacts (including children) of people in the high risk groups above, whether vaccinated or not
Household contacts of children aged 0 to 23 months
Those providing regular child care to children aged 0 to 23 months, whether in or out of the home
Those who provide care or service in potential outbreak settings housing high risk persons (e.g. crew on ships)
People providing essential community services requiring frequent close contact with people at risk:
Others not listed above are encouraged to be vaccinated, but must buy vaccine. Vaccine for purchase for 2008/09 is available from pharmacies. Vaccine for purchase is not available from Public Health.
CONTRAINDICATIONS:
The only absolute contraindication to influenza vaccination is known anaphylactic hypersensitivity to egg, previous influenza immunization or any of the components of influenza vaccine.
History of Guillain Barre syndrome within 8 weeks of receipt of a previous dose of influenza vaccine.
Influenza vaccine is not effective under six months of age.
Not Contraindications:
Although influenza vaccination can inhibit clearance of warfarin and theophylline, clinical studies have not shown any adverse effects attributable to this interaction.
Beta-blockers
Allergy to anything that is not a component of influenza vaccine
FRASER HEALTH COMMUNITY INFLUENZA IMMUNIZATION CLINICS
Fraser Health will continue to provide mass immunization clinics for those eligible for publicly-funded vaccine, both in the community and in health units. Clinic times and locations will be published in local newspapers, and be available at www.fraserhealth.ca , then click on the link under "Flu Clinics.") PUBLIC HEALTH CLINICS WILL START THE WEEK OF NOVEMBER 3, 2008
REPORTING VACCINE-ASSOCIATED ADVERSE EVENTS AND OCULO-RESPIRATORY SYNDROME
Please report suspected vaccine adverse events or ORS post-immunization to your local health unit. Physicians should feel free to call a medical health officer if consultation about vaccination following ORS is needed. Information can be found in this year’s Influenza NACI statement on page 23 (see above for link to the NACI statement) or if you require more detailed information see the 2002 ORS NACI statement .
IMPORTANT: SENTINEL PHYSICIANS NEEDED
There is a continued shortage of sentinel physicians and a lack of good geographic representation in the Lower Mainland and Fraser Valley. In this vital program, Sentinel Physicians report and swab patients who present with influenza-like illness and alert public health of higher levels or unusual presentations of such disease. The contributions of Sentinel Physicians are essential for monitoring influenza-like illness and determining the effectiveness of interventions, including the influenza immunization program. Sentinel Physicians receive some financial compensation for their efforts. For more information please contact Ms. Louise Hoogewerf at 604-255-0711 or 1-888-255-5561.
PNEUMOCOCCAL VACCINE
Pneumococcal vaccine (23-valent polysaccharide) is provided free to those age 65 years and over and individuals age 2 through 64 with specific health conditions . Influenza season is a good time to offer patients pneumococcal vaccine, although it is available throughout the year. Pneumococcal vaccine can be given at the same time as the influenza vaccine, using separate syringes/needles at separate sites. It is given only once, except in defined, special circumstances. Refer to the Canadian Immunization Guide at http://www.phac-aspc.gc.ca/publicat/cig-gci/pdf/cig-gci-2006_e.pdf for further information.
How to Keep Vaccine Cold
When transporting vaccine, it is essential that the vaccine is always kept cold, but not frozen. Most vaccines currently used in Canada are best when stored between 2° and 8° C.
When you transport your own vaccine you need to bring: 
A hard-sided cooler with insulation at least 30 - 80 mm (= 3-8 cm or 1.2-3.2 inches) thick
Freezer gel pack(s) or other cooling pack(s), completely frozen.
Cardboard, bubble wrap, or Styrofoam, to keep the vaccine from touching the ice pack(s).
Preparing the Cooler
Pre-chill the cooler, either by putting it into a fridge with its lid open, or by putting ice pack(s) in it. It is chilled enough when it measures 2°-8° C using a thermometer that started out at room temperature.
If you pre-chilled the cooler by using ice packs, take them out.
Take fresh, completely frozen cooling pack(s) from the freezer and put them in the pre-chilled cooler, until the cooler is about 1/10 full of frozen ice packs. Close the cooler lid tightly.
When you pick up the vaccine, wrap it in the cardboard, bubble wrap, or Styrofoam, and put it in the cooler alongside the ice pack(s). Again, make sure the cooler lid closes tightly.
How to store vaccine 
Use a big fridge, NOT a bar-size fridge , because the temperature of small fridges varies too much. Your vaccine fridge should be:
at least 10 cm (= 4 inches) away from the wall, or as recommended by the manufacturer
on its own electrical circuit, with signs on BOTH the plug AND the circuit breaker (fuse box) which state: Vaccine Refrigerator: Do NOT Discconnect, Do NOT Switch Off
In an area kept clean and free of dust, away from direct sunlight
In good repair
Every year, seals should be checked and fixed if brittle or torn, and coils cleaned
Defrost when ice or frost is 1 cm (= 0.4 inches) thick
Use thermal mass (e.g., several jugs full of water) to help keep the temperature steady.
Keep a good quality minimum/maximum thermometer in the middle of the middle shelf of the refrigerator.
Make sure the thermometer always reads between 2° and 8° C.
Keep the vaccine at the back of the middle of the fridge, beside thermal mass, NOT in the door, so the vaccine won’t be warmed up every time the fridge door is opened. Space the packages of vaccine so that the cold air can circulate between them.
If you have a power failure or a problem with your fridge or cooler please call your local health unit.
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