Community pharmacy continues to play a vital role in the national influenza vaccination programme, with over 70% of pharmacies taking part in the 2022/23 season. In this article, Susan O’Donnell, Professional Services Pharmacist with the IPU, provides an overview of the 2022/23 influenza season, and associated vaccination programme, and looks at the upcoming season.
From September 2022 through January 2023, the World Health Organisation (WHO) noted that influenza activity was reported in all regions, with many regions seeing influenza activity return to levels typical of pre-COVID-19 pandemic years. During this period, influenza A(H1N1)pdm09, A(H3N2) and influenza B viruses circulated, although the proportions of viruses circulating varied between reporting countries. In most countries, influenza A virus detections outnumbered those of influenza B.
In Ireland during the 2022/23 influenza season 16,0841 laboratory-confirmed influenza cases were notified to the Health Protection Surveillance Centre (HPSC) by 21 May 2023. This was a significant increase on the previous influenza season (2021/22) when 2,197 laboratory-confirmed influenza were reported, with the easing of COVID-19 restrictions a possible contributory factor.
A total of 4,604 of the cases reported during the 2022/23 season were reported as hospital inpatients, including 185 confirmed influenza cases admitted to critical care units. Age-specific rates were highest in those aged 65 years and older. Between the start of October 2022 and 21 May 2023, 161 cases of laboratory-confirmed influenza ICU cases with known influenza vaccination status were reported, 108 (67%) of these cases not having received the 2022/23 influenza vaccine. During the season, 198 deaths were attributed to influenza.
Influenza A was the predominant influenza virus circulating in Ireland during the 2022/23 season; 13,511 cases were notified to the HPSC.
The recommended groups for the 2022/23 season who were eligible to receive the free influenza vaccine through the HSE national programme were those who were:
There were three seasonal influenza vaccines available free of charge in community pharmacies for eligible individuals through the programme:
Private stock of the Quadrivalent Influenza Vaccine and the Influvac Tetra vaccine were also available through community pharmacy for those persons not eligible for a vaccine under the HSE national programme.
Vaccines supplied for use as part of the HSE national programme were supplied by the National Cold Chain Service with deliveries commencing the week beginning 19 September 2022. Deliveries were fortnightly for this influenza season and were aligned with the COVID-19 vaccine delivery schedule.
The National Immunisation Advisory Committee (NIAC) advised co-administration of the seasonal influenza vaccines and COVID-19 vaccines to maximise uptake. As such a joint COVID-19 and Seasonal Influenza Vaccination Programme for Winter 2022/23 was formally launched on 3 October 2022 and continued until 30 April.
During the 2022/23 season over 1,344 community pharmacies (71% of community pharmacies) signed up to offer an adult influenza vaccination service, while 1,214 community pharmacies offered a nasal influenza vaccine service to those aged 2 to 17 years. This shows the commitment of community pharmacists in Ireland to expand their role, promote the national vaccination programmes and support their local populations.
According to HSE PharmaVax data a total of 1,247,209 influenza vaccinations (QIV, LAIV) were administered across all sites (community pharmacies, GPs, hospitals, and other sites) in Ireland during the 2022/23 influenza season, with 361,184 (29%) influenza vaccinations (QIV, LAIV) being administered by community pharmacists.
Vaccination uptake information for the Irish population is available for two cohorts — namely those aged 2 to 17 years and those aged 65 years and older. Figure 1 shows the uptake rates across these cohorts for both the 2021/22 and the 2022/23 seasons. The 2022/23 influenza season saw 15.4% of the population aged 2 to 17 years vaccinated, and 75.8% of those aged ≥65 years.
Figure 1: Influenza vaccination uptake, by age group, 2022*-2023 season vs same period 2021-2022. Source: HPSC
Nearly 95,000 of the individuals who presented for vaccination against influenza in community pharmacies were those aged 65 years and over, while 70,000 vaccines were administered by community pharmacists to those classified as medically at risk. The top four medical risk factors were chronic respiratory disease, immunocompromised, chronic heart disease and diabetes mellitus. Interestingly, 2,488 individuals who presented to community pharmacy were eligible for a free influenza vaccine under the category of an individual in regular contact with pigs, poultry or waterfowl.
When community pharmacies were initially included in the influenza vaccination programme in 2011, they accounted for only 4.2% of the vaccines distributed. The number of vaccinations administered by community pharmacists has grown steadily year-on-year, with the largest number of individuals being vaccinated in the last two years. 29% of all vaccines administered during the 2022/23 influenza season were administered by community pharmacists.
Community pharmacists’ administration of nasal influenza vaccinations to children aged 2 to 17 years performed extremely well. Figures indicate that 45% of LAIV administered to children aged between the age of 2 to 17 years old were completed by community pharmacists. This is up from 40% in the 2021/22 season.
Figure 2: Flu Vaccination Uptake Over Time. Source: IIS Flu vaccination dashboard (HSE)
The HSE advised that those recommended to receive the flu vaccine do so early in the season. Figure 2 shows that the numbers presenting for flu vaccination were highest during the months of October and November with demand slowing considerably after the New Year.
The PCRS portal, used to claim and record influenza and pneumococcal PPV23 community pharmacist delivered vaccines, was retired in September 2022. The HSE PharmaVax system was enhanced to record COVID-19, influenza and PPV23 vaccination events in October of 2022 and was used in place of the PCRS portal through the 2022/23 season. This helped to reduce the administrative burden, improved operational functionality and increased the visibility of payments. However, GP notification remains an additional manual task completed outside the vaccination recording system. Stakeholders are reviewing this GP notification to establish if the functionality of HSE PharmaVax may be adapted to better facilitate this and assist community pharmacists to comply with legislation.
The composition of the 2023/2024 vaccine has been determined. The WHO recommends that trivalent vaccines are used in the 2023-2024 Northern Hemisphere influenza season, containing the following strains:
No confirmation of the vaccines that will be used in the upcoming influenza season is available as of yet. The HSE has not released any information in relation to the 2023/2024 risk groups who will be eligible for the free influenza vaccine through the HSE national programme. The IPU Flu Hub available at ipu.ie > Pharmacy services > Vaccines and Injectables > Flu vaccination hub, will be updated as information becomes available for the season ahead.
References available on request.
Susan O Donnell
Professional Services Pharmacist, IPU
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