What pharmacists can do for Flu 2022
After two years of atypically low flu seasons due to COVID public health measures, we may be in for a tough fall.
Pre-COVID, flu was one of the top 10 causes of death in Canada, with an estimated 12,200 hospitalizations and 3,500 deaths annually.1 As influenza transmission/exposure was low in the community over the last 2 years, there is concern over the reduction in natural immunity to influenza. Signs point to a severe flu season, with growing fears around a potential “twindemic”, referring to a surge in both COVID and influenza.
Looking at surveillance data from Australia’s 2022 flu season earlier this year, often used as a predictor for the northern hemisphere, there was a stark increase in laboratory confirmed influenza cases, with a significantly higher peak number of cases this year compared to each of the last 5 years (both before and during COVID).2 Another concerning statistic is the prediction for low flu shot uptake this year, with only half of Canadians indicating that they intend to get vaccinated against the flu.3
After these last 2 seasons, pharmacies are well-versed in adapting to the latest recommendations to provide flu, COVID, and other recommended vaccines. Keep reading for some key updates and reminders to help pharmacy teams protect your patients!
What’s new for flu?
- A new product this year is the recombinant influenza vaccine (SupemtekTM), which contains purified hemagglutinin (HA) proteins that are an exact match to the recommended flu strains by the World Health Organization and three times the dose per strain (45mcg) compared to standard dose vaccines (15mcg). SupemtekTM and the other non-egg-based vaccine (Flucelvax®, standard dose, cell-based) are not included in any provincial/territorial programs. Patients may access these products from pharmacies privately, although pharmacists in ON will require a direct order to administer them.
- BC is providing the adjuvanted trivalent vaccine (Fluad®) for all patients 65+ this year; SK and MB are providing the high dose quadrivalent vaccine (Fluzone® High Dose) for all patients 65+ this year.
- Pharmacists in Nova Scotia will be able to administer flu vaccines to patients 6 months and up. Manitoba recently updated minimum age for pharmacy administration of flu shots to 2+ (note: only for publicly funded flu vaccines, otherwise the minimum age is 7+). In other provinces the minimum age for flu remains 2+ (ON, NB), 4+ (BC, can administer Flumist® for ages 2+), and 5+ (AB, NFL, PEI, SK, YK).
Co-administration with COVID-19 & other vaccines?
Flu vaccines can be co-administered with other vaccines (including live vaccines and COVID-19 vaccines in ages 5+). With all the different types of vaccine messaging they receive, patients may not recognize that bivalent COVID boosters don’t offer any protection against flu, clarification from pharmacy staff with strong affirmations that both vaccines are necessary can aid with uptake. Surveys show that Canadians would be open to getting vaccines co-administered if presented the option to schedule them together.3
Many high-risk patients for flu should also be recommended pneumococcal (age 50+ or patients with chronic conditions) and herpes zoster (age 50+ or immunocompromised 18+) vaccines. When possible, scheduling multiple vaccines on the same day may optimize workflow and reduce down-time for patients, and is recommended by NACI.4 When administering multiple vaccines, use different limbs if possible, or separate injection sites by at least 1 inch.4
What is the best option for my patient’s flu vaccine?
The key message continues to be: “the best vaccine is the one you get today”. Patients should be advised not to delay their flu shot, as all products are safe and effective for their indicated ages.
If you are in a province with multiple vaccine options available, or if the patient would like to receive a non-publicly funded vaccine, there are some considerations between products.
- For patients aged 2-17 who are needle averse, Flumist® (intranasal), the only live-attenuated flu vaccine available in Canada, may be offered (publicly funded in BC, PEI, YK). As a reminder, children less than 9 years of age receiving their very first flu vaccine require a second dose at a minimum interval of 4 weeks.
- For older adults aged 50-64 or those with comorbidities who are not yet eligible for the High-Dose quadrivalent vaccine (indicated for ages 65+), you may consider recommending the new recombinant vaccine (SupemtekTM) or a cell-based vaccine (Flucelvax®) to provide a better match to circulating flu strains than traditional egg-based vaccines. Please note neither of these options are publicly funded.
- For ages 65+, NACI recommends high dose (Fluzone® High Dose) over standard dose quadrivalent vaccines (multiple products). Fluzone® High Dose contains the highest dose of antigen available (60mcg per strain), especially important with influenza A, the strain that causes most severe disease for older adults. Other options include the trivalent vaccine (Fluad®), which contains an adjuvant to help boost immune response. Similarly, SupemtekTM may be recommended to provide an exact antigen match and higher dose (45 mcg per strain). If none of these high dose, non-egg-based or adjuvanted vaccines are available options, standard dose quadrivalent vaccines are still recommended, immunogenic, and safe.
How do we integrate other recommendations into the flu vaccine workflow?
When possible, utilize booking systems to screen for relevant vaccines (flu, COVID, adult immunizations). Passive screening with signage in waiting areas/drop off and adding vaccine screening (meningitis B, HPV, pneumonia, shingles) within consent forms can help patients self-identify based on age and/or medical conditions. Pharmacies may also consider implementing programs to prompt patients to schedule a follow up appointment for other recommended vaccines as the initial rush for flu subsides.
Are there strategies to improve the vaccine experience for patients and families?
A study conducted in 5 independent Wholehealth pharmacy locations found that implementing the CARD (Comfort, Ask, Relax, Distract) system improved the vaccination experience for children, parents, and pharmacy staff.5 Children reported that CARD reduced their pain and fear, while parents reported that CARD helped ‘a lot’ in getting their children vaccinated.5 Although studied in pediatric patients, the main approaches used in CARD (patient centredness, supporting autonomy, reducing fear triggers, distractions etc.) are useful for all ages. For more information on CARD, watch this webinar!
Community pharmacies have established themselves as key vaccination service providers. Last year, the majority of flu vaccines in Canada were administered in pharmacies, with many of these patients planning on returning to pharmacy for their flu shot this year.4 With the possibility of a severe flu season, pharmacists and pharmacy teams will have a significant role in guiding patients to get fully protected against vaccine preventable diseases, to protect our communities and support the capacity of our healthcare systems. For more information on the 2022-23 flu season and other COVID/adult immunization updates, watch our latest Flu + More! webinar HERE.
References:
- Government of Canada (2022, February). Flu (influenza): For health professionals. https://www.canada.ca/en/public-health/services/diseases/flu-influenza/health-professionals.html
- Australian Government (2022, September). Australian Influenza Surveillance Report. https://www1.health.gov.au/internet/main/publishing.nsf/Content/F3AA79F3C4C5AA53CA2588CD0000D6EF/$File/flu-13-2022.pdf
- Canadian Pharmacists Association (2022, August). Flu Shot Season & Pharmacies. https://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/CPhA-Flu-Shot-Survey_Aug-2022.pdf
- Canadian Immunization Guide (2022, June). Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2022–2023. https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/canadian-immunization-guide-statement-seasonal-influenza-vaccine-2022-2023.html
- Taddio, A et. al. Poster: Integrating CARD (Comfort, Ask, Relax, Distract) for improving COVID-19 pediatric vaccinations in community pharmacies: before and after study CARD (2022, June). Presented at CPhA Conference.
Molly Yang PharmD is Director of Pharmacy Innovation & Professional Affairs at Wholehealth Pharmacy Partners