Influenza is one of the most common vaccine-preventable diseases in Australia. While reported cases are significantly higher than what they were this time last year, vaccination rates are slipping.

There were 30,404 reported cases of influenza from January–March this year, compared to 18,584 during the same time period last year. With 39,230 cases reported to date in 2024, there has been a significant spike in cases over the last few weeks.

As we approach World Immunisation Week (24–30 April 2024), here’s how pharmacists can help to protect the community this season. 

Children are undervaccinated and frequently hospitalised. How can this cohort be reached?

In 2023, influenza notifications were highest in children aged 5–9 years old, with hospitalisations peaking in those 15 years of age or younger. Yet the 5–15 age group is the most under-vaccinated cohort, with vaccination rates sitting at only 16% for 2023.

Vaccination rates among children aged 6 months to 5 years of age have been startlingly low post-COVID pandemic (28.3% in 2023), despite the considerable risk to this age group, said Dr Eden Mifsud, Medical Science Liaison, Influenza Vaccines Medical Affairs, at CSL Seqirus in the PSA webinar Influenza 2024 – The Right Vaccine for the Right Patient, held on 17 April 2024.

So how can pharmacists approach this conversation with parents and carers? Firstly, you can remind them that the influenza vaccine is covered under the NIP for children aged 6 months to 5 years because they are susceptible to severe disease associated with influenza, and death. 

Making vaccination more accessible for patients aged 5–15 can be achieved by scheduling and promoting after-school vaccination, said webinar co-host Peter Guthrey MPS, PSA Senior Pharmacist, Strategic Policy.

While parents may be hesitant to administer vaccines on a school night due to concern about adverse effects, pharmacists can reassure them that adverse events from influenza vaccines are relatively low compared to other vaccines, said Mr Guthrey.

‘Booking the whole family for the flu vaccine, school holiday or after-school appointments can be a powerful way to help people engage in vaccination,’ he said. ‘Parents are looking to protect the health of their children in a way that doesn’t disrupt the routine.’

What are the new ATAGI recommendations in 2024?

There have been a number of updates included in the Australian Technical Advisory Group on Immunisation (ATAGI) advice regarding the administration of 2024 seasonal influenza vaccines.

This year, ATAGI recommends pregnant women who received an influenza vaccine in 2023 receive the 2024 influenza vaccine if available before the end of their pregnancy, said Dr Mifsud.

‘We know antibodies can be passed through the placenta, and these antibodies can also be passed on if the woman chooses to breastfeed,’ she said. ‘That means those maternal antibodies can protect the infant for the first 6 months of its life.’

Another change to the ATAGI recommendations this year is the inclusion of conditions that increase the risk of severe influenza that are not attached to NIP funding eligibility, including:

• chronic liver disease
• obesity
• chromosomal abnormality (Trisomy 21)
• harmful use of alcohol.

‘This recommendation puts [these patients] at higher risk which is something that can be  discussed,’ said Mr Guthrey. 

Does the NIPVIP program extend to aged and disability care?

Yes. As of 29 April 2024, pharmacists will be funded to deliver NIP vaccines to some of Australia’s most vulnerable priority population groups, with NIPVIP payments also indexed in line with Medicare Benefits Schedule (MBS) indexation from 1 July 2024.

‘The expansion of the NIPVIP program to include pharmacists practising in residential aged care facilities and in disability care will drastically improve the specialised care pharmacists provide to these patients,” said PSA Chief Executive Officer, Adjunct Associate Professor Steve Morris.

Can the influenza vaccine be co-administered with newer vaccines on the market?

Fluad Quad, an adjuvanted influenza vaccine, is funded under the NIP for patients aged 65 years of age and older, designed to kickstart the immune system to provide extra protection to this vulnerable cohort.

With new vaccines released or covered under the NIP in 2024, including Shingrix, Arexvy and the pneumococcal vaccine for older Australians, ATAGI’s co-administration advice includes:

• co–administration of Fluad Quad and Shingrix, has not been studied. While co-administration can be done  if necessary, separating by a few days is preferable.
• studies on co-administration of Fluad Quad and Arexvy revealed a reduced immune response to one of the four influenza strains and increased likelihood of local and systemic adverse events.

When it comes to Arexvy, the benefits of co-administration with Fluad Quad should be weighed against the potential increase of local and systemic adverse events, advised Dr Mifsud.

‘If your patients don’t want to come back and want the vaccine on the same day, it’s imperative you explain that they may experience increased local and systemic adverse events,’ said Dr Mifsud. ‘Make them aware of what can happen and ultimately the decision is theirs.’ 

What do I need to know about NIPVIP claims for influenza vaccines?

Changes to the Australian Immunisation Register (AIR) Act 2015 require all vaccine providers to record information about the funding source for NIP vaccines in AIR, said Mr Guthrey.

While in most cases, pharmacists can choose the funding source in clinical software, there are some exceptions.

‘[For example], the Act requires that if anyone is pregnant at the time of vaccination, the antenatal category must be chosen rather than the funding source,’ he said.

‘While that might take care of the AIR upload compliance requirement, it doesn’t necessarily translate to [receiving] NIPVIP payments for administering vaccines to eligible people.’ 

Until this issue is ironed out, pharmacists must select the ‘antenatal’ category in their clinical software and manually adjust NIP payment claims with the Pharmacy Programs Administrator (PPA). 

Final tips for boosting vaccine uptake

A positive recommendation from a trusted healthcare professional is the strongest predictor of vaccine uptake, said Mr Guthrey.

Use language that conveys the importance of vaccination, such as: ‘I recommend influenza vaccination for you this season’.

Making the process as smooth as possible will also help to ensure uptake. For example, if you have an online booking system and a patient rings up to inquire about a vaccination  appointment, offer to make the booking or encourage walk-ins.

‘Making that appointment then and there rather than suggesting they make an appointment later is much more powerful,’ he said.

For more information, tune into the recorded Influenza 2024 – The Right Vaccine for the Right Patient webinar.