Monday, October 15, 2018

Flu Season is Coming ... with Some Updates

"When are flu shots coming in?" is the most frequently asked question at every community pharmacy counter once Thanksgiving weekend rolls around. Although pharmacies will have to brace themselves for the increased workload and disruption to normal prescription workflow, it's great to see that so many patients understand the importance of protecting themselves and the people around them against the flu and its complications.

While flu shots are slowly making their way into community pharmacies, pharmacy students are also preparing for the extra volume of patients flu season brings. For some of us, including myself, this year's influenza vaccine will be the first vaccination we've ever administered.

On top of remembering documentation requirements, the correct process for land-marking an injection site, and procedures for anaphylactic reactions, we should also keep in mind the important update for those 65 years and older as we're handing out influenza vaccination questionnaires to patients.

What's the update? 

The Canadian Immunization Guide created by the National Advisory Committee on Immunization (NACI) details current evidence-based recommendations on the use of vaccines for disease prevention in different populations. In an update for the 2018 flu season, NACI acknowledges evidence that the high-dose trivalent inactivated vaccine (TIV) provides better protection than the standard-dose TIV against flu-related complications and hospitalizations in those aged 65 and older.1

When considering the evidence for provincial and territorial funding, NACI recommends that any of the four influenza vaccines indicated of those 65 years and older - standard-dose TIV, high-dose TIV, adjuvanted TIV, and quadrivalent inactivated vaccine (QIV) - can be used.On the other hand for individuals 65 years and older seeking to get vaccinated and clinicians who are advising individual patients, NACI recommends the high-dose TIV be offered over the standard-dose TIV.3

How will this impact community pharmacy?

Currently in Canada, Ontario is the only province to publicly fund the high-dose TIV for all adults 65 years of age or older, while Nova Scotia, Manitoba, Saskatchewan, and Prince Edward Island are only funding the vaccine for elderly people living in long-term care facilities.Ontario pharmacies will not be receiving high-dose TIV as a part of the Universal Influenza Immunization Program (UIIP) and so the vaccination will only be publicly funded if received at a physician or nurse practitioner's office, retirement home, long-term care facility, or hospital.

While sharing the demands of flu season with other healthcare providers may relieve some of the burden on Ontario pharmacies, it leaves us with a question - what should we be doing with patients 65 years and older? There isn't enough evidence to make a comparative recommendation between the high-dose TIV, adjuvanted TIV, and QIV.So should we be vaccinating patients over 65 in community pharmacies or send them straight to their doctor's office? We can't possibly expect physicians and nurses to vaccinate all Ontarians aged 65 and older, so how do we decide which patients to refer? Would turning patients away significantly delay vaccination or even discourage them from getting vaccinated?

How will you apply NACI's recommendations to patients over 65 wishing to get vaccinated in your pharmacy? Please send me your comments and experiences using the form to the right.

For more information on influenza vaccinations in older adults and how to approach vaccine hesitancy, see the Influenza in Older Adults - Ensuring Optimal Protection course offered on rxBriefCase.

I look forward to reading your comments!



  1. Government of Canada. (2018, May 1). Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2018-2019. Accessed October 9, 2018:
  2. Sanofi. (2018, October 1). Sanofi aims to topple the flu as it marks National Seniors Day with a Guinness World Record attempt. Accessed October 9, 2018:
  3. Ontario Ministry of Health and Long-Term Care. (Updated 2018, September 19). Universal Influenza Immunization Program (UIIP). Accessed October 9, 2018: