2022/2023 Influenza Immunization Guidance for B.C. Pharmacies

Provincial online influenza courses have been updated for the 2022/23 season and are now available on LearningHub.

• Seasonal Influenza Updates 2022 – 2023
• Influenza Immunization Competency Course: Foundations of Influenza Disease & Vaccines

As per Part 4 – Biological Products – Influenza vaccine products, the table below summarizes the types of publicly funded influenza vaccine products expected for 2022/2023 and the intended age group(s) for each of the products:

^{*Flumist may be offered to 18-59 years of age who have needle phobia or unwilling to get another influenza vaccine, provided informed consent includes that QIIV provides better protection against influenza for this age group.
If Fluad® is unavailable, Afluria® Tetra, Flulaval® Tetra or Fluzone® Quadrivalent should be used.}

For detailed information see Intended Use of Influenza Vaccines.

The BCCDC has developed an Influenza vaccines for adults 65 years of age and older Question and Answer document for health care providers which includes information about both Fluad® and Fluzone® High-Dose.

The eligibility criteria for publicly funded influenza vaccine is universal, and therefore “Anyone else who wishes to reduce their risk of influenza” can be offered the publicly-funded flu vaccine.

See 2022/23 Seasonal Influenza Vaccine Eligibility.

ImmsBC system is used for the following functions:

• Scheduling and managing appointments
• Vaccine data entry
• Inventory and wastage 
• Reports

Influenza vaccine administration fee

The publicly funded influenza vaccine administration fee is $12.10 when given to an eligible B.C. resident. Pharmacies cannot charge individuals when administering publicly funded vaccines. 

For non-BC residents, they may be offered private stock or refer them to public health. Effective October 14, 2022, pharmacies can claim for the drug administration fee ($11.41) when administering private flu vaccines – see below Private Supply of Flu vaccines. 

Nurses: Pharmacies may contract nurses to administer influenza vaccinations. Nurses must be licensed by the B.C. College of Nurses and Midwives (BCCNM); i.e., they must be an active registrant of that college. Pharmacies can claim the vaccine administration fee of $12.10 when the vaccine is administered by a nurse. See Pharmacare Newsletter September 7, 2022.

Registered Pharmacy Technicians: Effective November 4, 2022, the new PHO order permits registered pharmacy technicians (RPhT) to prepare and administer influenza vaccines via IM injection or intranasal route. Pharmacies can claim the administration fee $12.10 when the vaccine is administered by a RPhT. Similar to the COVID-19 PHO order, these orders are time limited to the declared COVID-19 public health emergency and are not currently permanent changes to scope of practice.

Pharmacare resource: Pharmacare Policy Manual Section 8.10

PharmaNet data entry not required for publicly funded influenza vaccines

PharmaNet data entry is not required for publicly funded influenza vaccines. ImmsBC single entry will result in the automatic entry in PharmaNet and payment to pharmacies. As information entered in ImmsBC is then entered in PharmaNet, the Ministry expects that pharmacy entry of information in ImmsBC will comply with the same standards as any other entry in PharmaNet.

Note that the information in PharmaNet will not be visible or in the patient’s PharmaNet dispense history, and therefore not accessible for clinical purposes. The patient’s full clinical record can be viewed in ImmsBC or CareConnect. Ensure to check patient’s allergies and drug history before administering the vaccine and record any reaction in ImmsBC.

For non-publicly funded (private) influenza vaccines, continue to enter into PharmaNet only (do not enter in ImmsBC).

ImmsBC pharmacy profile – vaccine information

When you are ready to accept influenza appointments ensure you add the appropriate influenza vaccines to the “Vaccine Information” field in your pharmacy’s ImmsBC profile. This will ensure that the public can find your pharmacy when searching to book an influenza appointment through the Get Vaccinated provincial booking portal.

A new update has rolled out on the various "Vaccine Information" descriptors available. This will allow pharmacies to accept appointments for those ages 4+ for flu without allowing those under 12 to book for COVID-19 vaccinations.

It will also allow for pharmacies to remove vaccine booking options if you run out of a particular vaccine (e.g., if you run out of bivalent, but want to continue flu and monovalent or if you run out of Fluzone QIV and only have Fluad for those 65+). This will prevent further appointment bookings for those services going forward until you have more vaccines on hand.

This update will impact the visibility of your pharmacy's appointment availability immediately if you do not update your Vaccine Information selections on your pharmacy's profile on ImmsBC.

Please follow the steps below to update:

1. Log in to "ImmsBC"

2. Go to the "Clinic In a Box" area

3. Search for your pharmacy and open your pharmacy "Profile"

4. From the "Details" tab, click on the edit pencil beside "Vaccine Information"

5. New Options Available:

• "C19 mRNA bivalent vaccine 18+" for bivalent vaccines

• "C19 mRNA vaccine - 12+" for monovalent vaccines

• Do not select “C19 mRNA vaccine – 5 to 11” or “C19 mRNA vaccine – 6 months to 4 years” to prevent bookings for children

6. Leave old options, there is no need to edit or remove "COVID-19 mRNA vaccine (includes bivalent vaccine)" and "Influenza (Flu) - Regular dose".

7. Click on "Save"

8. Review the options selected in the "Vaccine Information" to ensure it has been saved.

Setting Flu vaccine options

To accept flu appointments, please update your “Vaccine Information” based on your flu vaccine supply and update the “Minimum Age” if appropriate. 

Fluad

• Vaccine Information option - “Influenza (Injectable) – 65+”

Fluzone Quad, Flulaval and Alfuria

• Vaccine Information option - “Influenza (Injectable) – 6 months to 64”
• Minimum Age = 4, if you plan to provide to young children
• Minimum Age = 12, if you do not plan to provide to children

FluMist

• Vaccine Information option – “Influenza (Nasal Spray) – 2 to 17”
• Minimum Age = 4, appointments for <4 would have to be booked manually

If you run out of a particular vaccine during the campaign, you can remove any of the Vaccine selections to prevent further appointment bookings for that vaccine going forward.

Account for co-administration when setting up your scheduler

The ImmsBC Scheduler does not currently allow users to create vaccine specific appointment types (e.g. flu only appointments, COVID-19 only appointments or COVID-19 and flu appointments). Therefore, users must account for the fact each appointment could be for co-administration.

For example:

If a pharmacy typically sets appointments every 10 minutes for COVID-19 vaccinations, they might want to consider setting it to every 15 minutes starting Oct 11 onwards as each appointment could potentially be for both COVID-19 and influenza. When appointments are only for one vaccine, you could consider using the unused time to offer vaccinations to walk-in clients.

Inventory management

Because each appointment could be for either or both COVID-19 and influenza you should pay close attention to your inventory of each vaccine type and may want to set appointments based on the vaccine which you have (or will have based on incoming supply) the least of.

If you temporarily run out of supply of either product, we recommend you update your “Vaccine Information” options as well (e.g. if you run out of Fluzone, please remove the influenza for 12-64 option).

You can review what vaccine the client has selected when booking the appointment in your “Clinic In a Box > Client List > “Client Reason for Visit” column. These selections do not account for eligibility, simply the intention of the client for their visit.

Enter vaccine record in ImmsBC after administration of vaccine

Do NOT create influenza vaccination administration records before the patient actually receives the vaccination

Do not complete the vaccine administration process in ImmsBC until after the vaccination administration has actually occurred. Unlike PharmaNet, you cannot reverse this record if a client changes their mind prior to being vaccinated. This will impact the PIR data and client ability to make another appointment until the issue is resolved.

Please contact immunizationsupport@bcpharmacy.ca if you need an erroneous record deleted. 

Backdated entries

Unlike PharmaNet, if a vaccine record was inadvertently entered into ImmsBC on the wrong date, this cannot be reversed. Please complete the downtime form with the correct vaccination details and submit to immunizationsupport@bcpharmacy.ca for manual entry and request for the incorrect vaccination record to be removed.

• Before vaccination, obtain informed consent as per Standards, Limits and Conditions for Drug Administration.
• In the ImmBC system, document that verbal consent was received.

• See BCPhA example consent forms for immunization (written consent is not mandatory).

  • Injectable Influenza Vaccine Consent Form (Written) 

  • Injectable Influenza Vaccine Consent Form (Verbal) 

  • FluMist® Vaccine Consent Form (Written)

  • FluMist® Vaccine Consent Form (Verbal)

  • General Consent for Immunization (Written)

• Tools to help with the informed consent process: HealthLink BC Files on inactivated influenza vaccines and live attenuated influenza vaccines for patients.
• Mature minor consent: Youth fall into the “mature minor” consent category if a healthcare provider supplies them with the information, gives them a chance to ask questions and believes they have the understanding to give consent. No written consent is required from the parent or guardian. Be sure to document the informed consent in ImmsBC. For more information see Mature Minor Consent and The Infants Act, Mature Minor Consent and Immunization.

Updated November 1, 2022

Pharmacies can now place orders directly with primary distributors for the remainder of the campaign. Please note that due to limited supply, weekly or daily order limits are in effect with all distributors. More vaccines are expected to be shipped into the province within the next few weeks, so please plan appointment bookings accordingly.

• Gamma, Imperial, K&F, Matrix and Unipharm – order from them directly for flu vaccines. 
• McKesson has unfortunately delayed their open ordering to Monday, November 7.  Deliveries are expected to arrive 1-3 business days after ordering.

Please do not make requests for vaccine from public health units. The only exception may be for pharmacies administering clinics for Long-Term Care or Assisted Living facilities, although typically it is the facilities themselves that will place the order for the influenza/COVID-19 vaccines.

Pre-filled syringe allocation
Many pharmacies have inquired about the quantity of pre-filled syringe (PFS) vaccines they will receive in their allocation. Only about 5% of the total supply of flu vaccines provided to community pharmacies this year are PFS, so not all pharmacies will receive PFS supply and those who do will only receive a limited quantity.

FluMist® Quadrivalent (Intranasal Spray)
Due to the delayed arrival of FluMist into the province, it will be available for open ordering through your distributor. 

Generally, pharmacies offering privately funded influenza vaccines should begin offering these vaccines around the same time as the public campaign start date (October 11, 2022). 

Patients choosing this option must be informed the supply is coming from private stock and a publicly funded option is also available to them at no cost. 

Privately funded influenza shots must be entered into PharmaNet and must not be documented on ImmsBC.  

PharmaNet entry requirements

For the 2022-23 season, three of the publicly funded products are also available for private supply. Where a flu product is uniquely a private supply product, enter the DIN in PharmaNet. For products that have both private and public supply, enter private supply using the PIN in PharmaNet. Do not record private supply vaccinations in ImmsBC.

If providing these products as private supply, enter the following PINs in PharmaNet, and your CPBC ID in the Prescriber ID field:

• Flumist® Quadrivalent - PIN 66128276
• Fluzone® Quadrivalent - PIN 66128073
• Fluzone® High-Dose Quadrivalent - PIN 66127356
• Afluria® Tetra – private supplies are prefilled syringes – use DIN 02473283 (Public supply comes in multi-dose vials only).

Effective October 14, 2022, pharmacies can submit the drug administration fee ($11.41) using PIN 66128366 for non-publicly funded vaccines. This is done separately to the drug claim. For details, see Pharmacare Policy Section 8.10 Pharmacist administration of drugs and vaccines - “Submitting a claim for administering drugs and non-publicly funded vaccines.”

Ancillary supplies and PPE

Pharmacies are to continue to source their own ancillary supplies and protective personnel equipment (PPE) e.g., medical masks.

Infection, Prevention and Control Measures

BCCDC guidance outlines the infection prevention and control measures required for the set-up and safe operation of immunizations in community settings (e.g., community pharmacies, community centres).

Immunizers, staff and volunteers in an immunization clinic must wear a medical mask. Eye protection may also be used based on a point-of care risk assessment, and per additional precautions, where indicated. Gloves should be worn when administering intranasal influenza vaccine. Refer to the Guidance for Influenza Vaccine Delivery in the Presence of COVID-19 for more information.

Further information can be found on BCCDC Infection Control webpage.

Vaccine Preparation and Administration Technique 

• Vaccine preparation and administration technique for intramuscular injections
• Landmarking for deltoid IM injections
• Immunizing Children -Suggested Best Practice Tips

Inventory must be managed within ImmsBC, which includes accepting received inventory, recording wastage and/or making adjustments for other reasons.

To learn more about how to handle this in ImmsBC, visit the Inventory page in ImmsBC Training and Resources section.

ImmsBC data entry

See Immunizations in Long-term Care and Assisted Living and Immunizations in Independent Living for information on data entry and payment in those settings.

Supplies

• Health Authorities will continue to manage influenza supply (Fluzone High-Dose) for long-term care (LTC) and assisted living facilities (AL) as they have in previous years.
• Influenza vaccine for these facilities should NOT be ordered from your pharmacy wholesaler.
• Some regions manage directly with LTC and AL facilities, who in turn will contact their pharmacy service providers to coordinate pick-up of vaccine (where necessary) as well as plans on administering doses for residents and staff.
• Some regions will continue to ask pharmacies to place orders on behalf of the facilities they service. Immunization for LTC and AL facilities will likely begin toward the end of September (exact dates TBD).
• The product being used for residents of LTC and AL facilities this year is Fluzone® High-Dose Quadrivalent.
• Pharmacies may start providing influenza vaccination services to residents and staff in LTC and AL facilities at the direction of the Health Authority including prior to the campaign launch date.
• Pharmacies planning to provide influenza clinics to residents of Independent Living facilities or other congregate living facilities should provide influenza vaccines no earlier than the official start date.
• Residents in these other facilities do not qualify for publicly funded Fluzone® High-Dose Quadrivalent vaccine.
• As a rule, if a pharmacy does not receive Fluzone® High-Dose Quadrivalent for a site from their Health Authority, then this site is not considered long-term care or assisted living. A pharmacy cannot begin administering influenza vaccines prior to the official start date to these sites.

For detailed instructions on transferring inventory for Long Term Care/Assisted Living facilities, please see Pharmacy Transfers.

Health Authorities are working with pharmacy providers to immunize health care workers (HCW). Staff at Health Authority (HA) facility clinics will coordinate the provision of influenza vaccine supply directly with pharmacies. Influenza vaccine for these clinics should NOT be ordered from your pharmacy wholesaler.

• Reporting Adverse Events Following Immunization – For BC Community Vaccine Providers.
• AEFI Reporting Procedure Flow chart
• Adverse Event Following Immunization (AEFI) Case Report Form

• PPP-68 Cold Chain Management
• BCCDC guidelines for dealing with equipment malfunctions and power failures.
• BCCDC’s Cold Chain Resources for Community Providers.
• Reporting a cold chain failure:  Complete BCCDC’s Cold Chain Incident Form and fax to the local health.
• Red dotting procedure (physically marking impacted vials): To ensure that all staff members that handle vaccine are made aware of vials that underwent a temperature excursion, the vials must be red-dotted or visibly marked to denote which vials have been impacted. This is especially critical in the event that subsequent temperature excursions occur to the affected vials which could impact the usability of the vaccine.
• Redistributing impacted vials: Redistributing impacted vaccines to new sites is considered very high risk.
  • Sub-lots are used in health authorities to track vaccine that have undergone temperature excursions and are being redistributed. Creating a sub-lot in ImmsBC is not required at the pharmacy level.
  • if impacted vials are transported to another clinic for use, all related CCI documentation must travel along with the vaccines (i.e., date and summary of incident, total time of temperature excursion, maximum excursion temperature and outcome).

Since influenza vaccine records are entered into ImmsBC and extracted into the Provincial Registration System (PIR), reporting of influenza vaccinations to public health is no longer required.

Pharmacies in NHA only: please continue to report influenza vaccines for those ≤ 8 years of age (TBD).

Co-administration of COVID-19 vaccine and influenza vaccine: As per BCCDC Part 4- Biological page COVID-19 vaccines, COVID-19 vaccines can be administered concomitantly or at any time before or after the administration of another inactivated or live vaccine.

Updated Jun. 13, 2023

Pharmacies may now dispose of any remaining influenza vaccine from the 2022/23 campaign.
 
Vaccine can be disposed of through the pharmacy’s regular biomedical waste disposal process. 

It is required that your pharmacy’s ImmsBC supply location vaccine inventory is up-to-date to be able to participate with next season’s campaign, so please take the time to update your inventory immediately.

• Ensure you only make changes to your pharmacy’s supply location inventory. Do not make any changes to your pharmacy distributor or other pharmacies’ inventory. 
• Be sure to carefully distinguish between “Wastage” and “Adjustment” as well as the difference of “Quantity” and “Doses”: 
  • Only record doses as “Wastage” for inventory that you have disposed of, or previously returned via your pharmacy distributor as part of the influenza vaccine return program.
  • To reconcile your ImmsBC inventory where your ImmsBC inventory does not reflect your physical inventory use the “Adjustment” function. Enter a negative sign in front of the quantity of doses if reducing inventory.  
• For further instruction, please refer to slides 10-14 of the manual. 

Refer to Part 4 of HPA Bylaws Schedule F – Certified Practice – Drug Administration by Injection and Intranasal Route Standards, Limits and Conditions for guidance on legal and professional duties when providing immunizations.

For Pharmacists

• BCPhA Flu Vaccine Booking Posters (NEW)
• BCCDC Immunization Manual – Part 3 Management of Anaphylaxis in a Non-Hospital Setting
• BCCDC Immunization Manual – Part 4 Biological Products (Vaccines & Immune Globulins)
• BCCDC Immunization Manual – Part 5 Adverse Events Following Immunization
• Influenza vaccines for adults 65 years of age and older QA document. ·
• NACI Statement on Seasonal Influenza Vaccine for 2022-2023.
• Strategies to Prevent COVID-19 and Influenza Vaccine Errors
• Guidance for Influenza Vaccine Delivery in the Presence of COVID-19
• Continuity of Immunization Services During COVID-19

For Patients

• BCPhA FAQs “2022 Flu Vaccines in B.C. Pharmacies”
• HealthlinkBC Files:
  • Why Seniors Should Get the Inactivated Influenza (Flu) Vaccine #12a
  • Facts about Influenza (the Flu) #12b
  • Influenza (Flu) Immunization: Myths and Facts #12c 
  • Inactivated Influenza (Flu) Vaccine #12d
  • Live Attenuated Influenza (Flu) Vaccine #12e

Health Authority Specific Influenza Resources & Tools

The following provides links to BC Health Authorities information on influenza services (clinics, products etc):

First Nations Health

http://www.fnha.ca/what-we-do/communicable-disease-control/influenza-information

Fraser Health

https://www.fraserhealth.ca/health-topics-a-to-z#topictags=Influenza&e=0

Interior Health

http://www.interiorhealth.ca/sites/Partners/ImmunizationResourcesTools/Pages/default.aspx

Island Health

www.islandhealth.ca/flu

Northern Health

https://www.northernhealth.ca/for-health-professionals/immunization-resources-tools#current-issue

PHSA

http://www.phsa.ca/health-info/staying-healthy/preventing-infection/immunization/influenza

Vancouver Coastal

http://www.vch.ca/public-health/communicable-diseases-immunizations/flu-shots-flu-clinics