H1N1 and Seasonal Influenza Vaccine Practices across Canadian Jurisdictions

From CADTH Technology Overviews, Volume 1, Issue 3, September 2010

• Introduction
• Objective
• Methods
• Results
• Limitations
• Conclusions
• References

[Adapted from Morrison, A. H1N1 and Seasonal Influenza Vaccine Practices across Canadian Jurisdictions. (Environmental Scan issue 6). Ottawa: Canadian Agency for Drugs and Technologies in Health; 2009.]

Introduction

The delivery of influenza vaccination programs in 2009 required rapid planning and implementation. Considerable uncertainty arose regarding the timing of administering H1N1 and seasonal influenza vaccines when, in mid-October 2009, the preliminary release of unpublished Canadian research indicated that people who received the seasonal flu vaccine the previous year were twice as likely to get the H1N1 virus.¹ In response, many Canadian jurisdictions modified their seasonal flu vaccination strategies.

At the beginning of November 2009, Canada’s National Advisory Committee on Immunization published the recommendation that immunization for seasonal flu should be offered as soon as possible, and that both the seasonal and H1N1 vaccines could be administered concurrently.⁴

The Public Health Agency of Canada commissioned independent researchers to look at the data, and the World Health Organization is consulting international experts who are investigating their own data for any similarities. Currently, data from the US, Australia, and Europe have not supported the Canadian research results. Conversely, a retrospective Mexican study, published in BMJ (formerly known as the British Medical Journal), found that the seasonal flu vaccine may help protect individuals against H1N1.² Another recent US study also noted the value of exposure to the seasonal flu vaccine or seasonal flu infection in providing protection from the H1N1 virus.³

Objective

The purpose of this report is to provide information regarding the seasonal and H1N1 vaccination programs currently offered in Canadian jurisdictions. The following question was addressed:

What are the strategies employed by Canadian jurisdictions with regard to the deployment of seasonal and H1N1 flu vaccination programs?

Methods

This report was produced by the Canadian Agency for Drugs and Technologies in Health (CADTH) through its Environmental Scanning Service, an information service for those involved in planning and providing health care in Canada. It is based on a limited literature search rather than a comprehensive, systematic review. Therefore, this report should be considered along with other types of information and health care considerations.

Results

The H1N1 flu vaccine is available to everyone who needs and wants it in each province and territory. Almost all provinces and territories opened up their H1N1 flu vaccination programs to the general public after first completing the vaccination of high-risk groups. 

Most jurisdictions initiated their seasonal flu vaccination programs in October, mainly administering the vaccine to elderly people but also to some other high-risk groups. Some jurisdictions intended to open their seasonal flu immunization programs to the general public after the H1N1 vaccination program was completed. In one province (Quebec), the seasonal flu vaccine was introduced after the H1N1 vaccination program had been fully delivered. Table 1 provides a summary of jurisdictional programs.

Eight provinces and territories permitted the concurrent administration of both the seasonal and H1N1 flu vaccines: British Columbia,⁵ Alberta,⁶ Manitoba,⁷ Ontario,⁸ Nova Scotia,⁹ Newfoundland and Labrador, Nunavut,¹⁰ and Yukon.¹¹ The seasonal flu vaccination programs were delivered in each of these jurisdictions in October before the availability of the H1N1 flu vaccine. At the time of the release of the H1N1 flu vaccine, some of these jurisdictions temporarily suspended the delivery of their seasonal flu vaccination programs but subsequently resumed the service. In Ontario, the seasonal flu vaccination program was temporarily disrupted while the H1N1 vaccine was administered to high-risk groups.¹²

As of December 3, 2009, the seasonal and H1N1 flu vaccines were being administered concurrently in Ontario.⁸

Although Newfoundland and Labrador permitted the concurrent administration of both the seasonal and H1N1 vaccination programs, this has not yet been adopted as the practice in this province.

Three jurisdictions introduced the seasonal flu vaccine in October 2009 to individuals identified as being most at risk of serious complications: Saskatchewan,¹³ Prince Edward Island,¹⁴ and the Northwest Territories.¹⁵ Following the completion of the H1N1 mass vaccination program, the seasonal flu vaccination programs resumed for remaining high-risk groups. Some of these jurisdictions expanded their seasonal flu programs to include the general public.

New Brunswick began delivering its seasonal flu vaccination program in October 2009 to individuals identified by the province to be most at risk of serious complications.¹⁶ The province exhausted its supply of the seasonal flu vaccine in October¹⁷ and, subsequently, had not planned to resume the program after the completion of the H1N1 mass vaccination program.¹⁸

Quebec is the only jurisdiction that postponed the administration of the seasonal flu vaccine until January 2010, following the complete delivery of the H1N1 mass vaccination program.¹⁹

Table 1: Seasonal Flu Vaccination Programs

Limitations

The results of this report are based on a limited literature search and on personal communications with Canadian health care officials. As such, the comprehensiveness of this report cannot be guaranteed. This report is based on information gathered as of December 3, 2009, and may not reflect the most current information.

Conclusions

The H1N1 flu vaccine is available to all Canadians and is administered in each jurisdiction. High-priority groups are receiving the vaccine first, followed by the general public.

The seasonal flu vaccine is available in most, but not all, jurisdictions. Some provinces are immunizing only high-risk groups. British Columbia, Alberta, Manitoba, Ontario, Nova Scotia, Newfoundland and Labrador, Nunavut, and Yukon have permitted the concurrent delivery of both the seasonal and H1N1 flu vaccines. Saskatchewan, Prince Edward Island, and the Northwest Territories interrupted the delivery of their seasonal flu vaccines during the implementation of the H1N1 vaccination program. These provinces intended to resume delivery of the seasonal flu vaccination program once the H1N1 vaccine schedule was completed. New Brunswick was not planning to resume its program, because it had already exhausted its supply of the vaccine.

Quebec postponed its seasonal flu vaccination program until the H1N1 program had been fully delivered.

References

1.      White P. Study prompts provinces to rethink flu plan. Globe and Mail [Internet].  2009 Sep 27 [cited 2009 22 Dec]. Available from: http://www.theglobeandmail.com/news/technology/science/study-prompts-provinces-to-rethink-flu-plan/article1303330/

   2.   Garcia-Garcia L, Valdespino-Gomez JL, Lazcano-Ponce E, Jimenez-Corona A, Higuera-Iglesias A, Cruz-Hervert P, et al. Partial protection of seasonal trivalent inactivated vaccine against novel pandemic influenza A/H1N1 2009: case-control study in Mexico City. BMJ. 2009;339(3928).

   3.   People who have had repeated flu infections or repeated flu vaccines may have some protection against the new pandemic swine influenza, U.S. researchers said on Monday. Reuters [Internet]. 2009 Nov 17 [cited 2009 Dec22]. Available from: http://in.reuters.com/article/health/idINTRE5AF5EO20091117

   4.   Statement on seasonal trivalent inactivated influenza vaccine (TIV) for 2009-2010. Can Commun Dis Rep [Internet]. 2009 [cited 2009 Dec 22];35(ACS-6). Available from: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/09vol35/acs-dcc-6/index-eng.php

   5.   Targeted vaccine campaign will protect those at risk [news release on the Internet]. Vancouver: British Columbia Centre for Disease Control; 2009 [cited 2009 Dec 22]. Available from: http://www.gov.bc.ca/h1n1/attachments/2009HLS0023-000414.pdf.

   6.   Questions and answers: 2009 influenza immunization program [Internet]. Edmonton: Alberta Health Services; 2009 [cited 2009 Dec 22]. Available from: http://www.albertahealthservices.ca/files/ns-qa-flu-immunization.pdf

   7.   Flu bulletin #2 [news release on the Internet]. Winnipeg: Government of Manitoba; 2009 [cited 2009 Dec 22]. Available from: http://www.gov.mb.ca/chc/press/top/2009/10/2009-10-21-141700-7026.html

   8.   Tam P. Seasonal flu shot offered with H1N1: Both available today to residents six months and up. Ottawa Citizen. 2009. 

   9.   H1N1 immunization starts next week in Nova Scotia. NovaNewsNow [Internet]; 2009 [cited 2009 Dec 22]. Available from: http://www.novanewsnow.com/article-391494-H1N1-immunization-starts-next-week-in-Nova-Scotia.html

10.   Windeyer C. HSS announces H1N1 & seasonal influenza vaccine roll-out [news release on the Internet]. Iqaluit: Nunavut Department of Health and Social Services; [cited 2009 Dec 22] 2009.  Available from: http://www.flunu.ca/PDFs/oct22_ENG.pdf

11.   H1N1 (human swine flu) and seasonal vaccine and clinic information [Internet]. Whitehorse: Yukon Health and Social Services; 2009 [cited 2009 Dec 22].  Available from: http://www.hss.gov.yk.ca/programs/health_officer/h1n1_vaccine_info/#vaccine_questions

12.   Ontario announces flu shot rollout for seasonal and H1N1 vaccines [news release on the Internet]. Toronto: Ontario Ministry of Health and Long-Term Care; 2009 [cited 2009 Dec 22]. Available from: http://www.news.ontario.ca/mohltc/en/2009/09/ontario-announces-flu-shot-rollout-for-seasonal-and-h1n1-vaccines.html

13.   H1N1 influenza update: province outlines immunization plans [news release on the Internet]. Saskatoon: Government of Saskatchewan; 2009 [cited 2009 Dec 22]. Available from: http://www.gov.sk.ca/news?newsId=96b0757b-c725-4f6d-9b2a-d40e18b55f92

14.   Seasonal influenza vaccine now available for those over 65 [news release]. Charlottetown: Prince Edward Island Department of Health; 2009.

15.   Northwest Territories Health and Social Services. Get the flu shot/not the flu [news release on the Internet]; 2009 [cited 2009 Dec 22]. Available from: http://www.yhssa.org/news/newsposting.asp?id=119

16.   Province launches seasonal flu vaccination campaign [news release on the Internet]. Fredericton: Government of New Brunswick; 2009 [cited 2009 Dec 22]. Available from: http://www.gnb.ca/cnb/news/he/2009e1470he.htm

17.   Fitzpatrick M. Seasonal flu could be lurking until H1N1 abates. National Post [Internet]. 2009 Nov 19 [cited 2009 Dec 22].  Available from: http://www.nationalpost.com/news/story.html?id=2246593

18.   H1N1 vaccine priority groups [news release]. Fredericton: Government of New Brunswick; 2009.

19.   Vaccines against the flu [Internet]. Montreal: Sante et Services sociaux Quebec; 2009 [cited 2009 Dec 22]. Available from: http://www.msss.gouv.qc.ca/sujets/prob_sante/influenza/index.php?accueil_en