Flu Shot Frequently Asked Questions

If you would like information about the High Dose Flu vaccine for someone over 65,  please click here.

There are a few key steps you can take to help prevent respiratory infections this season:

  • Maintaining a healthy lifestyle, eating a balanced diet, exercising regularly and getting adequate sleep are general practices for good health. 

  • Washing your hands often for at least 20 seconds is also an important part of staying healthy.

  • Getting your influenza vaccination is also a very important way to prevent complications that can arise from influenza.

Q: Who is the Influenza Vaccine recommended for this year?

A: Canada’s National Advisory Committee on Immunizations recommends that everyone 6 months of age and older get an influenza vaccine, with few exceptions.

Importantly, this year the BCCDC is making eligibility for government funded flu vaccines universal, meaning that anyone 6 months of age or older is eligible to receive a flu vaccine to lower their risk of influenza. 

Q: Who is at a higher risk of complications arising from influenza infection?

A: Some groups are considered at higher risk for more serious illness including hospitalization and complications from influenza. This includes:

·         Children 6 months to 5 years of age

·         Pregnant women

·         Those who are 65 years and older

Those with the following medication conditions:

·         Cardiac Disease

·         Respiratory Conditions

·         Diabetes Mellitus

·         Obesity

·         Renal Disease

·         Immunocompromised

·         Liver Disease

·         Frailty


Q: What are the complications that can arise from Influenza?

A: Influenza can impact multi-organ systems and in this way act as a trigger for Acute Myocardial Infarction, Ischemic Heart Disease, and Cerebrovascular Disease even after the infection has resolved.

Influenza infection can also have serious respiratory effects on patients with asthma or COPD, which can lead to viral or secondary bacterial pneumonia.  

Finally,  Influenza can cause exacerbations of hypertension, renal disorder, and diabetes. 

Q: What is the make up of the flu vaccines available this year?

Flu vaccines change each year in an effort to try to match the circulating virus strains. 

The strain components for the 2023/2024 Northern Hemisphere influenza vaccines are:

  • A/Victoria/4897/2022 (H1N1)pdm09-like virus (new this year). 

  • A/Darwin/9/2021 (H3N2)-like virus.

  • B/Austria/1359417/2021-like virus.

  • B/Phuket/3073/2013-like virus (in quadrivalent vaccines only) .

Q: What types of vaccine will be available this year?

A: There will be 4 different types of flu vaccine available this year:  Quadrivalent vaccines offer protection against all 4 of the above strains, whereas a trivalent vaccine protects against only 3 of the 4 strains. (two influenza A strains but only one influenza B strain)

This year, the following influenza formulations will be available:

  • FLUZONE® QUADRIVALENT - Quadrivalent Inactivated Influenza Vaccine (intended for those 6 months of age and older) 

  • FLUMIST® QUADRIVALENT – Quadrivalent Live Attenuated Influenza Nasal Spray Vaccine (intended for those 2 – 17 years of age)

  • FLUAD Trivalent Inactivated Influenza Vaccine: 65 years of age and older residing in the community

  • FLUZONE® HIGH DOSE QUADRIVALENT - Quadrivalent Inactivated Influenza Vaccine, intended for those 65 years of age and older, available for pre-order for private paying customers

  • FLULAVAL® TETRA QUADRIVALENT - Quadrivalent Inactivated Influenza Vaccine (intended for those 6 months of age and older) 

Source: https://immunizebc.ca/vaccines-by-disease/influenza

Q: What is the Regular Dose flu vaccine?

The Regular Dose flu vaccine is the injectable form of flu vaccine (as compared to the nasal spray and high dose forms). This vaccine is quadrivalent (protects against all 4 strains listed above), and is publicly funded for anyone 6 months and over who wishes to protect themselves from influenza. 

Q: Are there any contraindications?

A: Severe allergic reaction (anaphylaxis) to any component of the vaccine, or anaphylaxis after a previous dose of any influenza vaccine.

Q: Can COVID-19 vaccines be given at the same time as Influenza vaccines?

A: The National Advisory Committee on Immunization (NACI) NACI has stated that: “Administration of COVID-19 vaccines may occur at the same time as, or at any time before or after influenza immunization (including all seasonal influenza vaccines or LAIV) for those aged 12 years and older as of September 2021.”

Q: What if someone is afraid of needles but would still like protection from influenza this year?

A: Flumist is a nasal spray that is authorized to be given to children 2-17 years of age, however, in the case of needle phobia, Flumist may be given to anyone 18-59 years of age.

 Please note that flumist contains only 3 influenza strains (trivalent) and for those ages 18-59, there is better evidence for protection from influenza with the quadrivalent, injectable form. 

References:

Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2023–2024: https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/canadian-immunization-guide-statement-seasonal-influenza-vaccine-2022-2023.html#a2.5

Fluzone High-Dose Seasonal Influenza Vaccine: https://www.cdc.gov/flu/prevent/qa_fluzone.htm

Influenza vaccines for adults 65 years of age and older Question and Answer Document: http://www.bccdc.ca/resource-gallery/Documents/Guidelines%20and%20Forms/Guidelines%20and%20Manuals/Immunization/Vaccine%20Info/Influenza-vaccines-adults-65-older-QandA.pdf

2022/23 Seasonal Influenza Vaccine Eligibility: http://www.bccdc.ca/resource-gallery/Documents/Guidelines%20and%20Forms/Guidelines%20and%20Manuals/Epid/CD%20Manual/Chapter%202%20-%20Imms/Part4/Influenza_Eligibility.pdf

For individuals over 65:

Q : What are the risks of influenza infection in those age 65 and over?

A: For those who are over the age of 65, influenza infection is generally more severe. For this age group,  influenza infection increases the risk of a heart attack by 3-5X and more than doubles the risk of stroke. These risks remain elevated for several months after infection.

Those with other chronic illnesses, and those who are immune compromised are also at greater risk of suffering from these complications. This includes people with the following medical conditions: 


·         Cardiac Disease

·         Respiratory Conditions

·         Diabetes Mellitus

·         Obesity

·         Renal Disease

·         Immunocompromised

·         Liver Disease

·         Frailty

Q: What vaccines are recommended for individuals 65+

The FLUZONE® HIGH-DOSE QUADRIVALENT vaccine is a private pay vaccination option offering increased protection for adults 65 years of age and older. This vaccine contains a higher dose of antigen to help create a stronger immune response. 

 

Alternatively, the FLUAD® vaccine is free for all other adults 65 years of age and older. This vaccine is a trivalent influenza vaccine and contains an adjuvant that helps create a stronger immune response.

Q: What is different about the composition of the high dose flu vaccine?

A: The high dose flu vaccine this year is a quadrivalent vaccine which means that it protects from 2 influenza A strains and 2 influenza B lineages. The high dose vaccine contains four times the amount of antigen, which is the inactivated protein that allows the immune system to formulate an immune response. 

Q: Who is the High Dose Vaccine recommended for?

A: The High Dose Vaccine is recommended by the National Advisory Committee on Immunizations (NACI) in Canada and the wider medical community for anyone over the age of 65.

Q: Is the High Dose Vaccine more effective?

A: Yes, the high dose vaccine is more effective at protecting from the flu and reducing the risk of serious illness in the event that an individual contracts the flu.  A recent Randomized Controlled Trial, showed that the High-Dose Influenza vaccine provided 24% better protection from influenza infection over the standard dose influenza vaccine.

Q: Why is the High Dose Vaccine more effective?

A: As we age, the body undergoes a natural and progressive weakening of the immune system over time. This is a phenomenon known as Immunosenescence.  Consequently, older adults produce fewer B and T cells in bone marrow and thymus and have higher levels of B cell apoptosis compared to younger individuals. This leads to fewer lymphocytes found in lymphoid tissues like the spleen.

It is because of Immunosenescence that older adults are at a higher risk of more severe infection. In this age group, the body lacks the ability to mount an adequate immune response in terms of antibody titres thus leaving these individuals at increased risk of more severe disease and with less ability to generate a good immune response from traditional dosed vaccines.

It is believed that the increased levels of antigen found in the high dose formulation stimulate a stronger immune response which in turn leads to a higher degree of immunity from influenza.

Q: Will the High Dose Flu shot be visible in my immunization history?

A: Yes, within one month of your vaccination public records should reflect this years immunization, meaning your doctor and other health officials can see the details of this vaccine. Please note, however, that the province’s “Get Vaccinated” booking portal might not take into account these updated records, which means that some individuals that receive a high dose flu shot might still receive an invitation from the province to book a regular dose flu shot. In these cases, that individual is safe to ignore the invitation from the “Get Vaccinated” platform.

Q: What are the side effects from the High Dose formulation?

A: Side effects are similar to standard dose regimens, including reports of pain at the injection site, muscle aches, headache, fatigue, and rarely, fever. Current data suggests that injection site reactions and systemic adverse reactions were slightly more frequent after vaccination with Fluzone High-Dose compared with a standard-dose vaccine. 

Note: It is important to remember that these side effects are considered to be a normal result of vaccination and are an indication that the body is mounting an immune response that will protect the individual from future infection. On the other hand, the absence of these symptoms is not an indication of a lack of efficacy from the vaccine.

Q: Are there any contraindications?

A: Severe allergic reaction (anaphylaxis) to any component of the vaccine, or anaphylaxis after a previous dose of any influenza vaccine.

Q: Can COVID-19 vaccines be given at the same time as Influenza vaccines?

A: The National Advisory Committee on Immunization (NACI) NACI has stated that: “Administration of COVID-19 vaccines may occur at the same time as, or at any time before or after influenza immunization (including all seasonal influenza vaccines or LAIV) for those aged 12 years and older as of September 2021.”

Q: How can I ensure I will get the High Dose Vaccine this flu season?

A: The Fluzone High Dose Quadrivalent vaccine is available for pre-order for those individuals 65 years of age and older in limited quantities. Please register by clicking here.

The high dose formulation is publicly funded only for adults 65 years of age and older who are residents of long-term care, assisted living or First Nations communities.