This document, the National Advisory Committee on Immunization (NACI): Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2018–2019, updates NACI’s recommendations regarding the use of seasonal influenza vaccines.
New or updated information for 2018–2019
Individuals with Neurologic or Neurodevelopment Conditions
The findings of an updated review of the literature are consistent with the preliminary evidence indicating that children and adults with neurologic and neurodevelopmental conditions are groups at risk for influenza-related complications and hospitalization. Therefore, based upon current evidence and expert opinion, NACI reaffirms its recommendation that children and adults with neurologic and neurodevelopmental conditions are groups for whom influenza immunization is particularly recommended.
Efficacy and Effectiveness of High-Dose and Adjuvanted Inactivated Influenza Vaccines in Persons 65 Years of Age and Older
Based on updated reviews of the literature on the efficacy and effectiveness of high-dose and adjuvanted inactivated influenza vaccines in persons 65 years of age and older, NACI has concluded there is no substantial change in the conclusions to be drawn from the scientific literature. However, NACI has updated its recommendation on the choice of vaccine product for this age group by creating recommendations for the programmatic level (i.e., provinces and territories making decisions for publicly funded immunization programs) and individual level (i.e., individuals wishing to prevent a vaccine-preventable disease or a clinician wishing to advise individual patients).
At a programmatic level, NACI recommends that any of the four influenza vaccines available for use in adults 65 years of age and older should be used: standard-dose TIV, high-dose TIV, MF59-adjuvanted TIV, and QIV. High-dose TIV is expected to provide superior protection to standard-dose TIV; however, with cost-effectiveness assessments having been outside the scope of the evidence review and without data on the relative efficacy and effectiveness between high-dose TIV, MF59-adjuvanted TIV, and QIV, there is insufficient evidence to make a comparative recommendation on the use of these vaccines at the programmatic level (Grade I). At an individual level, NACI recommends that high-dose TIV should be offered over standard-dose TIV to persons 65 years of age and older. NACI concludes that, given the burden of disease associated with influenza A(H3N2) and the good evidence of better efficacy compared to standard-dose TIV in this age group, high-dose TIV should be offered over standard-dose TIV to persons 65 years of age and older (Grade A). There is insufficient evidence to make comparative recommendations on the use of MF59-adjuvanted TIV and QIV over standard-dose TIV (Grade I).