Universal Influenza Immunization Program: Preparing for Flu Season

Universal Influenza Immunization Program: Preparing for Flu Season Update to York Region health care providers - September 26, 2018 Ontario s Universal Influenza Immunization Program (UIIP) is getting ready for the 2018-19 flu season. s for high risk individuals will be available to order from York Region Public Health (YRPH) on September 28, with vaccination for the general population expected to start in late October. See below for details on who is considered high risk. Influenza is ranked among the top 10 leading causes of death among the Canadian population and presents a significant burden to the health care system. According to Canada s National Advisory Committee on Immunization (NACI), 12,200 influenza-related hospitalizations occur on average in Canada each year. The influenza vaccine is recommended for everyone six months of age and over without contraindications. NEW FOR THE 2018-2019 FLU SEASON This year, all individuals aged six months or older are eligible for a quadrivalent inactivated vaccine (QIV), protecting individuals against four strains of influenza (two A strains and two B strains.) In previous years, individuals from 18 years old to 64 years old received trivalent vaccines, which protected against only three strains (two A strains and one B strain). In addition, the intranasal quadrivalent live attenuated influenza vaccine (Q-LAIV) is available to immunize individuals two to 17 years of age. For children without contraindications specific to Q-LAIV, either Q-LAIV or QIV can be used. Publicly funded Q-LAIV (FluMist ) is anticipated to be available to order in late October. A high-dose trivalent inactivated vaccine (high-dose TIV) for individuals 65 years of age and older is available for order by primary care providers (e.g., physicians and nurse practitioners), participating retirement homes, long-term care homes and hospitals. High dose TIV is preferentially recommended over standard dose TIV for people over 65. Additional information on publicly funded vaccine availability and eligibility can be found on the second page of this message. ORDERING AND RETURNING INFLUENZA VACCINES Pharmacies YRPH will not be distributing publicly funded influenza vaccine to approved participating pharmacies. Pharmacies will be ordering and receiving influenza vaccines directly from their wholesale distributor. As part of the UIIP, pharmacies are required to submit vaccine refrigerator temperature logs to YRPH on a weekly basis every Wednesday. Failure to submit a temperature log will result in suspension for a minimum of seven days of vaccine ordering until the required documentation is received and reviewed by YRPH. Health Care Providers Influenza vaccine orders can be submitted using York Region Public Health s publicly funded vaccine order form available at york.ca/vaccineinventory under Order Forms. A copy of the vaccine order form and the vaccine wastage form follow this message. Returning Influenza s Pharmacies and Health Care Providers As per the Ministry s vaccine storage and handling protocol, non-reusable influenza vaccine should be returned to YRPH using the attached wastage form. Any adverse storage conditions, such as cold chain failures, should be reported to YRPH at 1-877-464-9675 ext. 74065 as soon as possible. For more information, contact the Inventory program via phone at 1-877-464-9675 ext. 74033, via email at vaccineinventory@york.ca, or visit york.ca/vaccineinventory. 1-877-464-9675 Fax: 905-895-6066 york.ca/healthprofessionals

Publicly funded influenza vaccines available through the 2018/2019 UIIP Quadrivalent Inactivated s (QIVs) FluLaval Tetra Fluzone Quadrivalent Dosage 0.5 ml 0.5 ml Format(s) Administration Route Age Indications as per product monograph (UIIP eligibility table 2) Most Common Allergens Post-Puncture Shelf Life Available through pharmacies or health care providers? Multi-dose vial Intramuscular injection Multi-dose vial (MDV) Prefilled syringe (PFS) Intramuscular injection Quadrivalent - Live Attenuated (Q-LAIV) FluMist Quadrivalent 0.2 ml (0.1mL in each nostril) Prefilled single use sprayer Intranasal spray High-Dose Trivalent Inactivated (High-Dose TIV) Fluzone High-Dose 0.5 ml Prefilled syringe Intramuscular injection 6 months 6 months 2 to 59 years 65 years Egg Protein* Thimerosal 28 days MDV: PFS: MDV: PFS: Egg Protein* Thimerosal Egg Protein* 28 days N/A Arginine Egg Protein* Gelatin Gentamicin N/A Both Both Both Egg Protein* N/A Primary care providers, LTC/retirement homes, and hospitals only Which publicly funded vaccines are individuals eligible to receive? Age Group QIV Q-LAIV High-Dose TIV 6 to 23 months 2 to17 years 18 to 64 years 65 years Important Notes: Fluzone Quadrivalent and Fluzone High-Dose are different products. Fluzone High-Dose is only authorized for those 65 years of age and over. Please use caution when administering Fluzone products to ensure that the right vaccine is being administered to the right person. Trained pharmacists may only administer publicly funded influenza vaccine to individuals 5 years of age and older. All regulated health professionals authorized to immunize must ensure they are following vaccine storage and handling guidelines. Details can be found at york.ca/vaccineinventory, under Storage and Handling. Children less than nine years of age who are receiving the influenza vaccine (QIV or Q-LAIV) for the first time require two doses given at least four weeks apart.

Who is considered high risk for influenza? Groups for which immunization should occur as soon as influenza vaccine is available include: (1) People who are more likely to experience influenza-related complications (including hospitalization): o Pregnant women o People who are residents of nursing homes or other chronic care facilities o People 65 years of age o All children 6 to 59 months of age o Indigenous peoples o Adults or children with chronic health conditions such as: cardiac or pulmonary disorders diabetes mellitus or other metabolic disease cancer conditions which compromise the immune system (due to underlying disease, therapy or both) 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 (2) People who may transmit influenza to those at high risk: o Health care workers and other care providers in facilities and community settings o Household contacts (adults and children) of individuals at high risk of influenza related complications o Persons who provide care to children 59 months of age. o Those who provide services within a closed or relatively closed setting to persons at high risk (e.g., crew on a ship) (3) Swine and poultry industry workers o The Ministry of Health and Long-Term Care recommends swine and poultry industry workers receive influenza immunization as early as possible Additional resources for immunizers Ministry of Health and Long-Term Care Universal Influenza Immunization Program: http://www.health.gov.on.ca/en/pro/programs/publichealth/flu/uiip/default.aspx Public Health Ontario Influenza https://www.publichealthontario.ca/en/browsebytopic/infectiousdiseases/pages/idlandingpages/influenza.aspx NACI Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza for 2018-2019 https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-statementseasonal-influenza-vaccine-2018-2019.html#app UIIP operational information, a Q&A, and fact sheets for immunizing patients six months - 17 years, 18-64 years, and 65+ years of age can be found at http://www.york.ca/vaccineinventory 3

Publicly Funded Order Form SECTION 1 INSTRUCTIONS FOR HEALTHCARE PROVIDER 1. Complete all mandatory fields (*) missing information will result in delays to your order. 2. Maintain no more than one month supply of any vaccine. Do not overstock your fridge. 3. Entire current fridge inventory amount must be entered. Please enter 0 if there is no vaccine. 4. Orders must include the most current seven business days of refrigeration temperature logs. 5. Complete orders will be processed in approximately three to four business days. 6. Send both pages to avoid delays in processing to 905-830-0578 or vaccineinventory@york.ca SECTION 2 HEALTHCARE PROVIDER INFORMATION *Healthcare provider/practice name FOR OFFICE USE ONLY Holding Point Code: YOR_NW Requisition number: *Order date (mm/dd/yyyy) *Number of immunizer(s) *Type of practice: General practice Pediatrician Other: *Number of fridge(s) *Type(s) of fridge: Bar Domestic Purpose-built *Contact person *Phone number *Fax *Email Unit number *Street number *Street address *City/Town *Postal code SECTION 3 PICK UP LOCATIONS * Pick up location - All office pick up hours are Monday to Friday 8:30 a.m. to 4:30 p.m. except Georgina Office (Monday and Wednesday 12:30 p.m. to 4:00 p.m.) Newmarket 520 Cane Parkway Vaughan 9060 Jane Street Richmond Hill 50 High Tech Road Markham 4261 Highway 7 East Georgina 24262 Woodbine Avenue SECTION 4 ACCOUNTABILITY STATEMENT By submitting this order, I verify on behalf of the practice that the refrigerator storing publicly-funded vaccines, at the location listed above, maintains temperatures between +2.0 C to +8.0 C; meets MOHLTC Storage and Handling Protocols and Guidelines; maximum, minimum, and current temperatures are recorded at least twice daily. Furthermore, I verify that no more than one month supply of vaccine is stored at the location listed above; red-dotted and short-dated vaccines are used first; expired vaccines are never administered and are returned as wastage; a review of vaccine inventory and checking for expired vaccines has been completed before placing orders; and all due diligence has been taken to prevent the wastage of publicly-funded vaccines. I understand that I am required to maintain accurate temperature logs that must be kept onsite for a minimum of two years and made accessible to York Region Public Health upon request. Upon vaccine pick-up, I will have the necessary materials for the safe transport of publicly-funded vaccines including properly conditioned hard sided, insulated container, digital temperature monitoring device, and appropriate packaging material. *Print Name *Signature *Date (mm/dd/yy) Complete and submit pages 1 and 2 18-5454 Page 1 of 2

SECTION 5 VACCINE INVENTORY AND ORDER FORM Trade Name(s) (Subject to availability) Pediacel DTaP-IPV-Hib Hiberix Act-Hib Hib Disease(s) and/or Eligibility Information Diphtheria, Tetanus, Pertussis, Polio, Haemophilus influenzae type b Haemophilus influenzae type b Imovax polio IPV Inactivated Polio (Limit 2 doses) Menjugate Liquid Neisvac-C Men-C-C Meningococcal Conjugate C Priorix MMR II MMR Measles, Mumps, Rubella Priorix-Tetra ProQuad MMRV Measles, Mumps, Rubella, Varicella Prevnar 13 Pneu-C-13 Pneumococcal Conjugate 13 Pneumovax 23 Pneu-P-23 Pneumococcal Polysaccharide 23 Tubersol TB Mantoux RotaTeq Rot-5 Rotavirus Tuberculin Purified Protein Derivative (Limit 20 doses) Td ADSORBED Td Tetanus, Diphtheria Adacel Boostrix Tdap Tetanus, Diphtheria, Acellular pertussis Adacel IPV Boostrix Adacel-Polio Tdap-IPV Tetanus, Diphtheria, Acellular pertussis, Polio Varivax III Varilrix Var Varicella Zostavax II Shingles Eligible for 65 to 70 years of age Publicly Funded Order Form Entire Current Inventory number in Doses Number of Doses Required Contact York Region Public Health Ext. 74033 SECTION 6 INFLUENZA VACCINE INVENTORY AND ORDER Trade Name(s) (Subject to availability) UIIP Eligibility Age Group Format Multidose Vial and/or FluLaval Tetra Fluzone Quadrivalent QIV 6 months Prefilled Syringe (depending on availability) FluMist Quadrivalent Fluzone High-Dose Q-LAIV High Dose TIV 2 years to 17 years Prefilled single use intranasal spray 65 years Prefilled Syringe Entire Current Inventory number in Doses Note: NACI has not identified any preference between Q-LAIV and QIV products nor high-dose TIV and QIV products. FOR OFFICE USE ONLY Number of Doses Required Entered by/date: (RPh)T final check: 18-5454 Page 2 of 2

SECTION 1 INSTRUCTIONS FOR HEALTHCARE PROVIDER 1. Complete all mandatory fields (*). Non-Reusable Wastage Form 2. York Region Public Health will only accept wastage of publicly-funded vaccines from our vaccine order forms. Do not drop off other drug products. 3. Please contact us at 1-877-464-9675 ext. 74033 or email vaccineinventory@york.ca for more information. SECTION 2 HEALTHCARE PROVIDER INFORMATION *Holding Point Code (HPC): YOR_NW_ *Address SECTION 3 DROP OFF LOCATIONS *Premise/Provider Name *Phone number *Drop off location - All office drop off hours are Monday to Friday 8:30 a.m. to 4:30 p.m. except Georgina Office (Monday and Wednesday 12:30 p.m. to 4:00 p.m.) Newmarket 520 Cane Parkway Vaughan 9060 Jane Street Richmond Hill 50 High Tech Road Markham 4261 Highway 7 East Georgina 24262 Woodbine Avenue SECTION 4 ACCOUNTABILITY STATEMENT By submitting this form, I verify on behalf of the premise/provider that I am only returning publicly-funded vaccines received from York Region Public Health and that all due diligence has been taken to prevent unnecessary wastage. *Print Name *Signature *Date (mm/dd/yy) Complete and submit pages 1 and 2 18-5298 Page 1 of 2

Non-Reusable Wastage Form SECTION 5 WASTAGE CODES CCE Cold Chain: Emergency/Natural Disaster CCH Cold Chain: Human Error CCM Cold Chain: Equipment Malfunction CCP Cold Chain: Power Outage CTP Cold Chain: Breach in Transit DE Defective Product DI Discontinued Product DP Damaged Product EQ Excessive Quantity EX Expired Product FC Facility Closure RP Recalled Product SV Suspected Contamination * Name *LOT Number *Expiry Date *No. of Doses *Wastage Code Office Use Only Example: Adacel 1A2B3C March 2018 4 EX FOR OFFICE USE ONLY IBSB Received By Sorted By/Date Return ID IBSB Date Received Entered to Panorama By/Date Return Authorization Number Panorama Ship Status Updated By/Date 18-5298 Page 2 of 2