The 2023 fall season is fast approaching, and pharmacies are preparing to meet the healthcare and vaccination needs of their communities. This year, pharmacy professionals across Ontario will face a different type of challenge, with the triple threat of an upcoming influenza season, RSV, and the ongoing wave of COVID-19. As vaccines remain one of the most important public health tools for protecting patients, it is crucial that pharmacists feel well-prepared to educate patients on the importance of flu vaccination, the available flu vaccines, and who should receive them.

Providing Patient Education on Influenza

Influenza, commonly known as the flu, is a contagious respiratory disease caused by the influenza A and influenza B viruses. In Canada, seasonal influenza epidemics typically occur during the late fall and winter months, causing an estimated 12,200 hospital stays and 3,500 deaths annually.1,2


While many people recover within 7 to 10 days, certain demographics, including those with chronic illnesses, the elderly, young children, pregnant individuals, and Indigenous populations, are at greater risk of severe complications such as pneumonia, exacerbated cardiovascular disease, and the worsening of underlying chronic health conditions.


Since the COVID-19 pandemic, pharmacy professionals may find an increase in “vaccine fatigue”, a phenomenon that describes a patient’s inaction or apathy towards vaccine information or instruction due to perceived burden and burnout.3 However, since new influenza strains circulate each year, the most vulnerable patients in communities require annual flu immunization for protection against influenza.


Vaccine fatigue and hesitancy present a major obstacle to achieving herd immunity, which occurs when a high percentage of a community is immune to a disease, making the spread of this disease from person to person unlikely.4 Pharmacists have an important role in communicating that vaccination offers protection not only to the individual receiving the vaccine, but also to those who cannot receive the vaccine, and vulnerable populations such as infants, elderly individuals, or individuals with specific medical conditions.

Overview of Canadian Influenza Vaccines

In Canada, three categories of influenza vaccines are authorized for use: inactivated influenza vaccines (IIV), recombinant influenza vaccines (RIV), and live attenuated influenza vaccines (LAIV). A summary of the different influenza vaccines available in Canada during the 2023–2024 influenza season can be found in Appendix B: Characteristics of influenza vaccines available for use in Canada, 2023–2024 on Health Canada’s website.


Within these 3 categories, influenza vaccines are classified as trivalent or quadrivalent formulations. Trivalent influenza vaccines protect against three distinct influenza virus strains, typically consisting of two influenza A strains and one influenza B strain. On the other hand, quadrivalent influenza vaccines protect against four different influenza virus strains, typically comprising two influenza A strains and two influenza B strains.


Influenza vaccines are further categorized as standard-dose or high-dose, and whether they are adjuvanted. High-dose influenza vaccines contain four times the amount of antigen than the amount contained in standard-dose influenza vaccines. Adjuvanted influenza vaccines contain an adjuvant, an ingredient added to some vaccines to help produce a stronger immune response in vaccine recipients.

Age-Based Recommendations

Pharmacy professionals can provide influenza vaccines to individuals 2 years of age and older through the Universal Influenza Immunization Program. This fall, the UIIP program will open to the general public on October 30th, 2023.

Healthcare, covid vaccine injection and woman with doctor with surgical gloves in hospital or clinic. Healthcare, medical insurance and vaccination innovation, global infection safety in medicine.


Pharmacy professionals should familiarize themselves with the different products available and recommended products in each age category. 

  • FluLaval Tetra and Fluzone® Quadrivalent are indicated for patients 6 months of age and older.
  • Fluad and Fluzone® High-Dose Quadrivalent are indicated for patients 65 years of age and older.

Patients often request that their pharmacy provide them with a “high dose” flu shot in order to receive better protection. Immunizers should be aware that this is really referring to higher-potency influenza vaccines specifically design for seniors. Both influenza vaccine options in seniors, Fluad® and Fluzone® High-Dose Quadrivalent, elicit a stronger immune response in patients 65 years of age and older (making them an attractive option for this age group), but accomplish this in different ways. 


The Fluzone® HD-QIV formulation contains a higher antigen content per dose than a standard influenza vaccine to create a more robust immune response. Fluad® contains the same antigen content per strain but contains an adjuvant which helps to create a stronger immune response. As both Fluzone® HD-QIV and Fluad® enhance the immune response in senior patients, and are publicly funded under the UIIP, the two formulations, designed specifically for seniors, offer increased protection from influenza.

Co-Administration of Influenza and COVID-19 Vaccines

One common question that pharmacists may encounter is if influenza vaccines can be given at the same time as other vaccines, such as the COVID-19 vaccine. The Canadian Immunization Guide recommends that influenza vaccines, including LAIV4, can be administered simultaneously with other vaccines (live or inactivated) as well as at any time before or after a previous vaccination.


In addition, the current COVID-19 guidance from the Ministry of Health states that individuals 6 months and older, may receive a COVID-19 vaccine on the same day, or at any time before or after, non-COVID-19 vaccines.


When administering vaccines simultaneously, pharmacists should consider administering the different vaccines at separate injection sites to minimize localized adverse reactions. If this is not possible, injections given in the same area should be separated by a distance of at least 2.5cm (1 inch). In all cases, a separate needle and syringe should be used for each injection.


As the fall respiratory illness season approaches, pharmacy teams will be vital in educating patients to prioritize vaccination, utilizing their unique knowledge and training. By dispelling common myths about vaccines and helping patients make informed decisions about their health, pharmacy professionals can continue to help keep their communities safe this fall.


Disclaimer: The content for this article was created by OPA and sponsored by Seqirus.

  1. Schanzer DL, Mcgeer A, Morris K. Statistical Estimates of Respiratory Admissions Attributable to Seasonal and Pandemic Influenza for Canada. Influenza Other Respir Viruses. 2013;7(5):799-808.

  2. Schanzer DL, Sevenhuysen C, Winchester B, et al. Estimating Influenza Deaths in Canada, 1992-2009. Plos One. 2013;8(11):E80481.

  3. Su, Zhaohui et al. “Mind the “Vaccine Fatigue”.” Frontiers in immunology 13 839433. 10 Mar. 2022, doi:10.3389/fimmu.2022.83943

  4. Desai AN, Majumder MS. What Is Herd Immunity? JAMA. 2020;324(20):2113. doi:10.1001/jama.2020.20895