2022 IMAC Influenza powerpoint 23032022_LA final

2022 Seasonal Influenza Programme (as at 23 March 2022) Refer to Flu kit booklet (when available) or influenza.org.nz for current information

Karakia Whakataka te hau ki te uru Whakataka te hau ki te tonga Kia mākinakina ki uta Kia mātaratara ki tai E hī ake ana te atakura He tio, he huka, he hau hū Tihei mauri ora!

Cease the winds from the west Cease the winds from the south Let the breeze blow over the land Let the breeze blow over the ocean Let the red tipped dawn come with a sharpened air.

A touch of frost, a promise of a glorious day.

Programme today • 5.30pm Influenza and influenza vaccine - Lisbeth Alley, IMAC • 6.10pm Recording 2022 influenza vaccines – Loren Shand, MOH • 6.20pm 2022 Influenza promotional campaign – Rachel Lorimer, MOH • 6.30pm Questions

Influenza-like illness reported 2019–2022

Influenza vs. common cold vs COVID-19 Influenza

Common cold

COVID-19

• Sudden onset • High fever • Severe headache • Dry cough becomes moist • Muscle ache • Bed rest necessary • Can suffer serious complications (eg, secondary pneumonia)

• Mild illness

• Fever

• Mild fever

• Sore throat

• Mild headache – sinuses

• Breathlessness • Headache

• Occasional cough

• Dry cough

• Muscle ache

• Body ache

• Runny nose

• Fatigue • Runny nose

Influenza complications • Pneumonia (secondary and bacterial) o Respiratory failure • Myositis • Encephalopathy • Myocarditis • Reye’s syndrome • Bronchitis • Pericarditis

• Otitis media • Death from overwhelming sepsis can progress rapidly • Exacerbates underlying medical conditions (eg, pulmonary, cardiac or metabolic disease)

Influenza and cardiovascular disease • Inflammatory response to disease causes changes to blood vessels around the heart and tachycardia • Accelerates plaque generation • Thrombi can then form in vessels • Obstructed blood supply can trigger an AMI • Secondary infections such as pneumococcal pneumonia, have been linked to increased CVD risk

Prevention of CVD

• Cardiac complications of influenza infection e.g. myocarditis, are well recognised • 6-10 times higher risk of AMI/stroke for up to 1-week post influenza

• Vaccinated older people less likely to develop severe illness, be hospitalised, admitted to ICU • Vaccination as effective as interventions such as statins, antihypertensive drugs and smoking cessation • Increasing evidence that regular annual influenza vaccination increases protection J.C. Kwong, et al. Acute myocardial infarction after laboratory-confirmed influenza infection N Engl J Med, 378 (4) (2018), pp. 345-353, C. Warren-Gash, et al. Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: a systematic reviewLancet Infect Dis, 9 (10) (2009), pp. 601-610, A.K. Boehme, et al. Influenza-like illness as a trigger for ischemic stroke Ann Clin Transl Neurol, 5 (4) (2018), pp. 456-463.

.

Turner N, et al. The effectiveness of seasonal trivalent inactivated influenza vaccine in preventing laboratory confirmed influenza hospitalisations in Auckland, New Zealand in 2012. Vaccine. 2014;32(29):3687-93

Risks for hapū māmā and babies • Physiological changes: o

Decreased lung capacity

o

Increased cardiac output

o

Altered cell-mediated immunity

• An influenza infection can have serious consequences including premature birth, miscarriage/stillbirth, low birth weight and perinatal death.

• 5x more likely to be hospitalised with influenza compared with non-pregnant (SHIVERS data, Auckland 2012-2014)

Co-circulation and co-infection with COVID-19 • Co-infection with ILI and COVID-19 increases risk for severe disease • Data from the UK’s winter of 2019–2020 suggest that COVID-19 and influenza co-infections have resulted in higher mortality rates compared to those who only tested positive for COVID • Age specific mortality rates were higher among older people with coinfection Fujita DM ,et al. COVID-19 and Influenza coinfection: The rise of Ômicron and H3N2 in Brazil - 2022. Travel medicine and infectious disease. 2022;46:102262.

Stowe J, et al. Interactions between SARS-CoV-2 and influenza, and the impact of coinfection on disease severity: a test-negative design. International Journal of Epidemiology. 2021; 50(4):1124-1133.

Dadashi M, et al. COVID-19 and Influenza Co-infection: A Systematic Review and Meta-Analysis. Frontiers in Medicine. 2021, 8:681469

Potential for 2022 flu season resurgence • Reduced influenza incidence has been observed in NZ, Au, UK, US and Europe • Minimal respiratory illnesses reported during the 2020–2021 Northern Hemisphere winter season • Large compensatory influenza seasons are predicted to follow the 2019–2021 light seasons due to: • Reduced residual immunity from 2020 & 2021 • Re-opening of borders (Lee, et al 2022)

Flu Kit 2022 to come • Content and references updated • See www.influenza.org.nz/resources • Flu kit references will be available at: www.influenza.org.nz

Summary of 2022 Influenza Vaccines – available now

https://www.influenza.org.nz/

Influenza vaccine strains 2022 2022 influenza vaccines contain 4 strains • • • •

A/Victoria/2570/2019 (H1N1)pdm09-like virus A/Darwin/9/2021 (H3N2)-like virus* B/Austria/1359417/2021-like virus* B/Phuket/3073/2013-like virus *new strains 2022

Influenza programme 2022 Start date: 1 April 2022 Updated information: www.influenza.org.nz • vaccine details • vaccine supply • eligible groups • Flu Kit • resources.

All vaccines are ordered through HCL.

Two funded vaccines (for eligible groups) available for 2022 AFLURIA® QUAD JUNIOR

AFLURIA® QUAD

• Children aged <3 years, ie, 6–35 months

• Children* from 3 years and adults

• 1 or 2 doses • Funded for those who meet eligibility criteria • Available to purchase

• Funded for those who meet eligibility criteria • Available to purchase *3 to under 9 years (1 or 2 doses)

Two unfunded vaccines available for 2022 FLUAD® QUAD

FLUQUADRI™

• For ≥65 years

From > 6 months of age and older

• Adjuvanted vaccine (MF59)

• 1 or 2 doses

• Stimulates an immune response to get similar effectiveness as for younger people

• Unfunded only - purchase through GPs, many pharmacies (aged 13+)

• Unfunded only - purchase through GPs, pharmacies

Ordering – order ALL influenza vaccines through HCL Vaccine

Age group

6–35 months AFLURIA® QUAD JUNIOR

Dose per pack 1

AFLURIA® QUAD 3 years and over 10 FLUAD® QUAD 65 years and over 10 FLUQUADRI™ 6 months and older 5

Available to order

Vaccination start date

7 March

1 April 2022

You will be advised when your order has been dispatched out of HCL and you will be able to track and trace it as usual.

2022 influenza vaccines - needles Funded: • AFLURIA® QUAD JUNIOR – pre-filled syringe with fixed needle

• AFLURIA® QUAD – pre-filled syringe with fixed needle Unfunded: • 2022 FLUAD® QUAD – pre-filled syringe – no needle.

• FLUQUADRI® – pre-filled syringe – needle supplied unattached.

Eligibility 2022 TBC Influenza immunisation is recommended and FREE for those most likely to get very sick, go to hospital or die from influenza: 1. pregnant women/ hapū māmā (any trimester) 2. people aged 65 years or older 3. people aged under 65 years with diabetes, most heart or lung conditions and some other illnesses 4. children aged 4 years or under who have been hospitalised for respiratory illness or have history of significant respiratory illness TBC: Pharmac consultation underway re Māori and Pacific peoples aged between 55 and 64 years of age inclusive.

Influenza vaccines for children Age

Vaccine brand

Dose

Number of doses

6–35 months

AFLURIA® QUAD JUNIOR

0.25 mL

1 or 2*

6 months+

0.5 mL

1 or 2*

3–8 years

FLUQUADRI™ (unfunded) AFLURIA® QUAD

0.5 mL

1 or 2*

≥9 years

AFLURIA® QUAD

0.5 mL

1 dose

*Two doses separated by at least four weeks, if influenza vaccine is being used for the first time.

Influenza and PCV13 • Increased risk of fever when influenza vaccine given with PREVENAR 13® in children aged 6–23 months • Advise parents/guardians whose children are recommended to receive both influenza vaccine and PCV13 • Offer to separate by two days, but not essential

Precautions and contraindications All vaccinations • Anaphylaxis to previous dose or component of the vaccine • Defer if: o

Acutely unwell with fever (>38oC)

o

Other systemically unwell illness

Precautions and contraindications Egg allergy or anaphylaxis • All influenza vaccines can be given to people with history of egg allergy or anaphylaxis.

• Influenza vaccines with up to 1 microgram of ovalbumin do not trigger anaphylaxis in sensitive individuals.

• The residual ovalbumin in one dose of influenza vaccine is below this limit.

Immune checkpoint inhibitors and vaccination 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 6 months can receive any non-live vaccine.

LIVE vaccines are contraindicated

Spacing of Influenza and COVID-19 vaccines Current advice is: • The influenza vaccine can be given concomitantly with Pfizer and AstraZeneca COVID-19 vaccines.

• FLUAD® QUAD and Nuvaxovid (Novavax) or Shingrix – 3-day gap recommended (all adjuvanted vaccines) • Pregnant women are recommended to have influenza and mRNA-CV (Pfizer) COVID-19 vaccine at any stage of pregnancy (can be given the same time) Note: there is no set gap between COVID-19 disease and having your influenza vaccine – just when you are well again.

Do Influenza vaccines contain antibiotics?

• FLUAD® QUAD contains traces of kanamycin and neomycin due to their use during production.

• AFLURIA® QUAD and AFLURIA® QUAD JUNIOR contain traces of neomycin and polymyxin B. • These influenza vaccines should be used with caution in people with known anaphylaxis to any of these antibiotics.

• No antibiotics are used in the manufacture of FLUQUADRI™.

2022 influenza vaccines All 2022 influenza vaccines available in NZ are: • inactivated and cannot cause influenza • do not contain latex • do not contain preservatives AFLURIA® QUAD, AFLURIA® QUAD JUNIOR and FLUQUADRI™ do not contain an adjuvant FLUAD® QUAD contains an adjuvant MF59 which is squalene based – from fish. Squalene is also produced naturally in the human body.

Vaccines and anticoagulants Influenza vaccines can be administered to people on anticoagulants, including aspirin, dabigatran (PRADAXA®), enoxaparin (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.

Safety of influenza vaccination Common immune responses include: • Pain, itching and redness at site (1 in 3 adults) • Ache and pains (1 in 10 adults) • Fever, unwell, tired Note: maybe more common with adjuvanted influenza vaccine

• Most significant serious reaction is anaphylaxis (1.5 per million) • Fever common in children Note: AN INACTIVATED VACCINE CANNOT GIVE YOU INFLUENZA!

Documenting influenza vaccines 2022 • Ensure all vaccinators are notified to the NIR team and have completed an AUA - includes pharmacists.

• Notify all influenza vaccinations given (including to pregnant women) to the NIR/NIS - with consent • Remember to opt adults onto NIR before entering vaccination details or at same time, depending on PMS requirements • The provider should be noted as the GP in the ‘provider’ box and whoever administers the vaccine as the ‘vaccinator’ • FLUAD® QUAD and FLUQUADRI™ are recorded under normal 65+ selection

How long does a person have to wait after receiving an influenza vaccination?

NOTE: post-vaccination wait time for 'influenza only' vaccination is being reviewed - further advice may follow.

Vaccination during pregnancy • Trans-placental transfer of influenza-specific antibodies may provide protection for up to 6 months • Influenza vaccine used in hapū māmā since 1960s with considerable safety data • Influenza vaccination in early pregnancy is safe with no increase in major malformations • Vaccination is associated with a decrease in stillbirth rate

Eick AA, et al. Maternal influenza vaccination and effect on influenza virus infection in young infants. Arch Pediatr Adolesc Med. 2011;165(2):104-11

Discuss and recommend to hapū māmā and their whānau • WHO recommends that hapū māmā be given HIGHEST PRIORITY for influenza vaccination at ANY stage of pregnancy.

• Risk of influenza and complications for both • Vaccine is effective for woman and her baby during pregnancy and after birth.

• Influenza vaccine has an excellent safety record during pregnancy.

• Make a clear recommendation for woman to receive influenza vaccination during pregnancy.

Influenza vaccine coverage for pregnant women

By ethnicity – some groups are less protected 70 60

Percentage

50 40 30 20 10 0

2017

2018

2019

Delivery Year Māori

Pacific Peoples

Asian

Qlik data downloaded and analysed to July 2021

NZEO

2020

Vaccination and breastfeeding

• The influenza vaccine can be given when breastfeeding • Protecting the mother can help prevent her becoming infected and transmitting influenza to baby

Influenza immunisation coverage 2021

Should healthcare workers be vaccinated? YES • Protect patients at greater risk of developing complications • Improved patient and employee safety; decreased healthcare expenditure • Staff have a duty of care to protect vulnerable patients from threat of influenza illness.

• Relying on patients being vaccinated is not enough; many vulnerable people have poor immune response to vaccine or may not have been vaccinated this year.

Avoiding shoulder injury related to vaccine administration (SIRVA) Landmarking the deltoid injection site • Find the acromion process • Find the deltoid tuberosity • Injection site is halfway between the two • Give vaccine in bulkiest part of the muscleusually in line with the axilla

Questions??

Phone: 0800 466863/0800 immune Email: 0800immune@auckland.ac.nz

IMAC Flu Webinar National Immunisation Solution

Loren Shand - Programme Manager for National Immunisation Programme technology

23.03.2022

National Immunisation Solution (NIS) – supporting FLU 2022 campaign Below outlines the key messages on the NIS and how it will utilised during the 2022 Flu campaign

The NIS is different from both

The NIS will continue to evolve

the current National

and develop throughout 2022.

Immunisation Register (which it will replace) and the Covid Immunisation Register (which it will eventually supersede).

Critical is the learning derived from both systems to inform the development.

The first sector experience of the NIS will be supporting the Flu Vaccination 2022 campaign.

Whereby ALL flu vaccinations will be captured in the NIS as of the 1st April 2022.

Flu immunisation providers will choose how to record flu by utilising either; •

the CIR (hosting a form)

•

Using existing integrated electronic systems that already reports onto the NIR

Both options will then have inputs mapped into the NIS

MVP – 3 Key Scenarios

What is the ask of the sector:

Current Model For those that currently do not use a system (paper based or electronic) that can submit information to the NIR to record flu vaccination For those that currently use ImmuniseNow to record flu vaccinations direct into NIR

Future state 1 April You will be asked to start using direct entry into NIS via the ‘Flu form’ which will be hosted on the CIR

For those that have an electronic system (mainly Patient Management Systems) that directly submit information to NIR

You will have the option of moving to direct entry into NIS via the ‘Flu form’ which will be hosted on the CIR, but will not be required to do so.

We understand this to mainly be related to GP systems.

If you continue to submit data to NIR directly from electronic systems for flu we will pick this data up from NIR and place this into NIS.

Determining your NIS onboarding needs Are we planning to vaccinate for Flu in 2022?

NO

This does not apply to you

USE THIS DIAGRAM TO DETERMINE WHAT YOUR ONBOARDING NEEDS ARE

YES Are we vaccinating COVID?

NO

YES

Complete onboarding steps in blue on next page

Do we hope to use CIR to capture Flu vaccinations?

YES

NO

Does our PMS connect directly to the NIR?

NO

YES

For Flu, do we use Immunise Now ?

YES

Continue to record flu vaccinations in your PMS

NO

For Flu, do we capture vaccination details on a paper based form?

YES NO

Record flu vaccinations in the CIR. Complete onboarding steps in orange on next page

Your NIS Onboarding Journey

Select Pathway

Determine next steps based on your current processes

EXISITING COVID VACCINATING SITES Adding Flu capability

NEW TO NATIONAL IMMUNISATION SOLUTION Planning to deliver Flu vaccinations

Site setup

Ensure site is set up to vaccinate for Flu 2022

User setup

Provide users with access to NIS and onboard workforce

No action required

For existing vaccinators: No action required

You may be contacted by your DHB lead to confirm your intent to provide flu vaccinations

For new vaccinators: complete a new user setup form. Await confirmation and email regarding training

Complete site setup form

Receive user set up form

Return completed form to NIS.engagement@health.govt.nz Await confirmation and user setup request

Complete with all vaccinator details and return form NIS.engagement@health.govt.nz Await confirmation and email regarding training

Training

Getting users upskilled to document flu vaccinations

All existing users will receive an invitation to complete flu related training and drop in sessions

Reporting

Reporting requirements setup

A reporting workshop will be available to outline the flu specific reporting functionality

Help & Support Providing a ‘one front door’ approach to our service desk

One door support system help@imms.health.govt.nz

New users will complete training as noted in orange stream below

All new user will receive an email inviting them to: • Complete initial Elearning module • Register for a Zoom webinar by providing their email/name

A reporting workshop will be available to onboard new users to enable use of the reporting functionality in NIS

One door support system help@imms.health.govt.nz

What you can do to prepare?

• Use the decision tree to understand your onboarding requirements – choose your lane BLUE LANE

ORANGE LANE

THIS DOES NOT APPLY

Existing Vaccinator using CIR – Training Only

New to CIR – register your site and

As I am not delivering flu or I have a PMS

vaccinators and training

system linked to the NIR

• Prepare to report all funded and unfunded flu vaccinations • Commence your onboarding journey!

• Please email questions to NIS.engagement@health.govt.nz • Plan for workforce to complete training the week commencing 25th March 2022 – estimated 60 min elearning

2022 Influenza Promotional Campaign Rachel Lorimer – Group Manager, Communications & Engagement, National Immunisation Programme

Campaign Overview •

Maximise the uptake of the influenza vaccine with a specific emphasis on priority equity groups.

•

Campaign messaging, tone, visuals will prioritise and connect with key equity groups - Māori, Pasifika and disabled people.

•

Grounded in research and insights.

•

Leverage the learnings from the COVID-19 vaccination campaign.

•

This year’s campaign will run from 1 April to 30 June and will have two phases.

Campaign Phases Phase One – Priority Groups •

•

•

•

From 1 April marketing activity will target those aged 65 and over and pregnant people.

Will include targeted advertising (local press, niche publications, digital, social) and stakeholder engagement (e.g. Age Concern, Plunket) Additional activity targeting Māori, Pacific and disabled communities with whānau approach.

Provide DHBs, GPs and Pharmacies with resources e.g. posters, flyers to have conversations with their patients.

Phase Two – All of New Zealand •

From May higher profile campaign to raise awareness of flu vaccination and including workplace vaccination using broader channel media mix.​

•

Continued focus on priority equity groups.

Flu Campaign Webpage

Channels and Resources Resources

Media Channels

Flyers

Radio

Posters

Print e.g local newspapers, niche publications

Newsletter content

Out-of-home

Social tiles

Social

Teardrop banners

TV

Website

Digital

Questions

Thank you

Questions?

Closing Karakia Unuhia, unuhia Unuhia ki te uru tapu nui Kia waatea, kia maamaa te ngaakau, Te tinana,te wairua I te ara tangata Koia raa e Rongo, whakairia ake ki runga Kia tina! Tina!

Hui e! Taaiki E!

Useful contacts The Immunisation Advisory Centre (IMAC) Ph: 0800 IMMUNE (0800 466 863) Email: 0800immune@auckland.ac.nz National Influenza Campaign coordination Email: influenza@auckland.ac.nz Website: www.influenza.org.nz Healthcare Logistics (HCL) Phone: 0508 425 358 Ordering: www.hcl.co.nz or TOLL-FREE fax: 0508 408 358 ($10 fee) Seqirus (vaccine manufacturer) Phone: 0800 502 757