Universal Influenza Immunization Program (UIIP)

The following provides information about the Ontario Ministry of Health and Long-Term Care’s (the ministry’s) Universal Influenza Immunization Program (UIIP) for the 2017-2018 influenza season. The official launch of the UIIP will occur on October 23rd, 2017. Influenza immunization for the general population through community-based influenza immunization clinics will begin on or after the UIIP launch date. As in previous years, immunization of high priority groups should begin as soon as influenza vaccine is available.

Recommended Influenza Vaccine Recipients

All individuals aged 6 months or older who live, work or attend school in Ontario are eligible and  are recommended to receive the publicly funded influenza vaccine in Ontario (provided that they have no contraindications to the vaccine).

Individuals at high risk of influenza-related complications or more likely to require hospitalization:

• All pregnant women
• People who are residents of nursing homes or other chronic care facilities
• People ≥65 years of age
• All children 6-59 months of age
• Indigenous peoples

Adults or children with chronic health conditions as follows:

• cardiac or pulmonary disorders
• diabetes mellitus or other metabolic disease
• cancer
• conditions which compromise the immune system
• renal disease
• anemia or hemoglobinopathy
• neurologic or neurodevelopmental conditions
• morbid obesity (body mass index of ≥40
• children and adolescents (6 months to 18 years) undergoing treatment with acetylsalicylic acid for long periods

Individuals capable of transmitting influenza to those at high risk:

• Health care workers and other care providers in facilities and community settings
• Household contacts (adults and children) of individuals at high risk of influenza related complications
• Persons who provide care to children ≤59 months of age.
• Those who provide services within a closed or relatively closed setting to persons at high risk (e.g., crew on a ship)

In addition, the ministry strongly recommends that swine and poultry industry workers receive influenza immunization as early as possible.

The publicly funded influenza vaccines available through the 2017/18 UIIP are listed in the table below:

<sup>Note: Additional information is available in the product monograph
* Unless specifically requested, the TIVs are primarily targeted to adults 18 years of age and older.
**The National Advisory Committee on Immunization (NACI) has removed the preferential recommendation for the use of live attenuated vaccine in children 2 to under 6 years of age
^ NACI has concluded that egg allergic individuals may be vaccinated against influenza using live attenuated influenza vaccine (see ADDENDUM – LAIV Use in Egg Allergic Individuals-Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2017-18.
~Fluzone ® Quadrivalent and Fluzone High Dose ® are two different products. Please see product monographs for further information.</sup>

Important Notes:

• All influenza vaccines must be administered by a regulated health care professional
• Trained pharmacists may only administer publicly funded vaccine to individuals 5 years of age and older
  
  

Vaccines for Specific Age Groups:

Note:

• NACI recommends that, given the burden of influenza B disease, QIV should be used for those 2 to 17 years of age. If QIV is not available, TIV should be used.
• NACI has not identified any preference among TIV products
• NACI has not identified any preference among QIV products

*Influvac is indicated for those 3 years of age and older in the product monograph

Influenza Vaccine Ordering

The TIV products (Influvac^®, Agriflu^® and Fluviral^®) and QIV products (FluLaval Tetra^® and Fluzone^® Quadrivalent^®) will be distributed based on availability (requests for specific TIV products or QIV products are not permitted). Each TIV product and each QIV product are considered equivalent with respect to their approved indications for use. Please consult your local public health unit to determine vaccine availability for your clinic.

Influenza vaccine is received in Ontario intermittently throughout late September and October, and distributed throughout influenza season. As in previous years, vaccine distribution for the 2017/2018 influenza season will begin around late September to late October for the immunization of high priority groups . Community-based influenza immunization clinics for the general population will begin when the UIIP is officially launched in late-October:

• Prior to as the UIIP launch in late-October, vaccine orders will be filled primarily for facilities that care for, and/or immunize, high priority groups, including long-term care homes, public hospitals, physicians’ offices, retirement homes and health unit clinics that are held specifically for persons in the high priority groups.
• Starting in mid to late October, depending on availability of supply, vaccine orders will start being filled more generally for health care providers including pharmacies, health care agencies, workplaces, etc. to prepare them for the administration of influenza vaccine to the general population beginning on the UIIP launch date in late October.

All required fields of the Influenza Vaccine Order Form for the UIIP must be completed to ensure orders are filled.

Important Notes:

• Vaccine wastage due to spoilage or expiry is a concern for all immunization programs, including the Universal Influenza Immunization Program. The Vaccine Storage and Handling Guidelines have been developed to facilitate proper storage and handling of publicly funded vaccines and minimize vaccine wastage as well as promote vaccine safety and efficacy.
• When minimum cold chain requirements are not met by a health care provider, the public health unit has the authority to withhold vaccines until compliance issues have been resolved or until completion of other follow-up deemed necessary to ensure appropriate vaccine storage and handling.

Program Specific Information for the Various UIIP Participants

• Fee-For-Service Providers and Family Health Teams
• Pharmacies with Trained Pharmacists
• Pharmacists with Health Care Agencies
• Prequalified Organizations (e.g., Health Care Agencies and Other Organizations)
• Long-Term Care Homes and Public Hospitals

Additional Resources and Information

• NACI Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2017-2018 is available on the Government of Canada’s website.
• Canadian Immunization Guide, Early vaccine reactions including anaphylaxis (includes details on the management of anaphylaxis).
• Adverse Events Following Immunization (AEFIs) must be reported to your public health unit.
• Vaccine Storage and Handling Guidelines describes the provincial requirements that must be followed by all healthcare providers who handle publicly funded vaccines.
• Promotional materials and publications for the UIIP will be available from Service Ontario.
• Program materials such as the vaccine order form and UIIP Manual are available on the ministry’s website.
• Health Care Provider Qs & As for 2017-2018 Universal Influenza Immunization Program
• Quadrivalent Influenza Vaccine Fact Sheet: For individuals 6 months up to and including 17 years of age
• Quadrivalent LAIV (FluMist) Provider Fact Sheet
• Trivalent Influenza Vaccines: For individuals aged 18 years and older

Questions

• For questions regarding the 2017-2018 UIIP, email the ministry at UIIP.MOH@ontario.ca.
• For questions regarding vaccine storage and handling, or vaccine ordering, contact your local public health unit.