No 39 - 2023

This autumn’s influenza and COVID-19 vaccination programme, 2023/2024

This autumn’s influenza and COVID-19 vaccination programme, 2023/2024

As from 1 October, selected target groups will be offered influenza and COVID-19 vaccination. The two vaccinations may be given concurrently.

Invitation for influenza and COVID-19 vaccination

Persons who are offered vaccination based on their age will receive an invitation as Digital Post or by snail mail if they are exempted from Digital Post. After receiving the invitation, these citizens may schedule an appointment at a vaccination centre or chemist via the website www.vacciner.dk or by contacting a regional hotline. This service is available only at some chemists. The other target groups may also schedule their appointment via vacciner.dk but will be required to complete a sworn statement when doing so.

Influenza vaccination

Target group and period

Influenza vaccinations will be in place as from 1 October. As in previous years, this year’s vaccination is offered free of charge to everyone belonging to the following groups:

  1. Persons aged 65 years* or more.
  2. Persons below 65 years with some chronic conditions, including:
    a. Persons with chronic pulmonary conditions
    b. Persons with cardiovascular diseases (barring isolated, well-regulated high blood pressure)
    c. Persons with diabetes 1 or 2
    d. Persons with congenital or acquired immunodeficiency, e.g., persons with immunoglobulin deficiency, organ or stem cell transplantation, ongoing cancer treatment by chemotherapy and persons receiving other immunosuppressant therapy
    e. Persons whose respiration is affected due to muscular weakness
    f. Persons with chronic liver or kidney failure
    g. Persons with other chronic conditions whose conditions mean that influenza or COVID-19 constitute a serious health risk, e.g., persons with severe rheumatologic syndrome, serious neurologic disease or short bowel syndrome
  3. Persons with severe obesity (BMI>35)
  4. Persons with other serious disease or conditions due to which influenza or COVID-19 constitutes a serious health risk, e.g., persons with severe mental illness, Down’s syndrome or severe abuse
  5. Pregnant women in their 2nd or 3rd trimester**
  6. Persons in the household of persons with congenital or acquired immunodeficiency and children at an increased risk of severe influenza or COVID-19
  7. Early retirement pensioners
  8. Children aged 2 to 6 years***

    *64-year-olds may be vaccinated provided they will turn 65 years old no later than on 15 January 2024.
    **Pregnant women are recommended vaccination in their first trimester if other risk factors exist for a serious influenza disease course.
    ***Children who turn 7 years old before receiving their second dose of influenza vaccine may conclude their vaccination course.

As usual, the SSI purchases the influenza vaccines. However, this year, vaccinations are given at vaccination centres and at some chemists. The SSI is still responsible for supplying the vaccines to the agreed vaccination sites. Influenza vaccination may be given concurrently with COVID-19 vaccination.

The vaccination period will remain active through 15 January 2024.

Influenza vaccines in this season

This year, VaxigripTetra® and InfluvacTetra® will once again be used for adults. The two vaccines are equally effective. For children aged 2-6 years, Fluenz Tetra® (nasal spray) is used as was previously the case. For information about the vaccines, please see the Vaccine Encyclopaedia (in Danish language).

This year’s vaccination programme comprises no high-dose vaccine (Fluzone®) for the oldest citizens.

This year, a total of 1,200 cell-based vaccines, Supemtek®, were acquired. These vaccines were produced without use of egg and antibiotics and may therefore be used for persons who have serious allergies to egg, neomycin or gentamicin.

Excipients and allergies

Both VaxigripTetra® and InfluvacTetra® may contain small amounts of egg protein and formaldehyde. Vaxigriptetra® may contain small amounts of neomycin, whereas InfluvacTetra® may contain small amounts of gentamicin.

Allergy to formaldehyde will most frequently present as contact dermatitis. However, in these cases, contact dermatitis does not constitute a contraindication. We recommend giving the vaccine as a deep intramuscular injection.

Persons who are allergic to egg, but where the patient reacts exclusively by developing urticaria, may be vaccinated using VaxigripTetra® or InfluvacTetra®, after which the recommended observation period is 30 min. Persons with serious allergy to egg , neomycin or gentamycin should this year be vaccinated with Supemtek®. These persons need to contact the region by phone to learn at which vaccination site they may be vaccinated. Read more about Supemtek®.

For more information, please see Allergies and vaccination.

Specifics about vaccination of children

Children 2-6 years:
This is the third consecutive year that children aged 2 through 6 years are offered influenza vaccination in the form of a live attenuated vaccine given as a nasal spray administered as a single puff to each nostril. Children in the target age group who have previously received influenza vaccination are given only one vaccine, regardless of which vaccine was given previously and when the vaccine was given. Children who have not previously received influenza vaccination are given two vaccines at a four-week interval; the first dose must be given no later than on 18 December 2023.

Read more under Children and influenza vaccination (In Danish language: Børn og influenzavaccination).

Contraindications to Fluenz Tetra®:
Please be aware of the following contraindication to vaccination with Fluenz Tetra®, based on recommendations from the Danish Paediatric Society:

  • Age below two years or above 18 years
  • Previous anaphylaxis to influenza vaccine or a vaccine component, including gentamicin.
  • Systemic allergic reaction to egg that requires admission to hospital
  • Immunodeficiency caused by conditions like acute or chronic leukaemia, lymphoma, symptomatic HIV infection and asplenia
  • Primary immunodeficiency
  • Acquired immunodeficiency due to high-dose immunosupressive therapy
  • Severe or uncontrolled asthma, including asthma requiring admission to hospital in the past three months
  • Asthmatic bronchitis within the past 72 hours
  • Salicylate treatment (due to the connection between Reyes’ syndrome and salicylates and wildtype influenza infection). Salicylates may not be used in children and young people in the four weeks following the vaccination.
  • Children with non-operated craniofacial malformations or with cochlear implant (due to lacking data)

Furthermore, it should be noted that household members to severely immunocompromised people are not recommended vaccination with FluenzTetra® (nasal spray) as this is a live attenuated vaccine, and the influenza virus may therefore potentially be transmitted by contact.

The above-mentioned children should instead be vaccinated with VaxigripTetra® or InfluvacTetra® which are authorised for use as from six months of age.

Please note that as Fluenz Tetra® is a live attenuated vaccine. Other live attenuated vaccines, e.g., MMR vaccines or chicken pox vaccine, must either be given on the same day or at a minimum four-week interval.

Generally for children, if the child being vaccinated is younger than eight years of age and has not previously been vaccinated, two vaccines are given at a four-week interval. If the child has previously received influenza vaccination or is older than eight years of age, a single vaccine is given.

Influenza vaccination paid by the patient

Vaccines defrayed by the patient may be ordered with the SSI as from week 40/41.

For further information about influenza vaccination in the upcoming season, please see Influenza vaccination (in Danish language).

COVID-19 vaccination

Target group and period

As from 1 October, COVID-19 vaccination is offered free of charge for the same target groups as influenza vaccination, apart from children aged 2-6 years and early retirement pensioners.
Pregnant women are offered COVID-19 vaccination as from their first trimester if they have not previously received COVID-19 vaccination or carry other risk factors for a serious COVID-19 disease course.

The vaccination period will remain active through 15 January 2024.

COVID-19 vaccines used in this season

In this season, the vaccine given is Comirnaty Omicron XBB.1.5. from Pfizer/BioNTech. A single dose is given regardless of previous vaccination status. The vaccine is given no less than three months after the patient’s previous COVID-19 vaccination.

In this season, persons with a severely weakened immune response may also be offered a second dose following specific medical judgement. If given, the extra dose must be administered at a minimum three-month interval.

Persons who have received a stem cell transplantation should be offered two doses of Comirnaty Omicron XBB.1.5 given at a minimum interval of three weeks, followed by seasonal vaccination (a third dose) no less than eight weeks after the second dose was given. Vaccination is given following specific medical judgement approx. 2-3 months after the transplant.

Vaccination of children below 18 years of age at special risk is done only following specific medical judgement by a pediatrician.

The vaccine is provided in multiple-dose vials as one of three different posologies/dosages for adults and children aged more than 12 years (gray lid), children aged 5-11 years (blue lid) and children from six months to four years (maroon lid).

Excipients and allergies

Comirnaty Omicron XBB.1.5 contains macrogol as the previously used Comirnaty vaccines did. Allergy to macrogol is very rare, but vaccination is contraindicated in these patients.
Previous anaphylactic reaction in connection with vaccination or administration of pharmaceuticals or repeated serious stress reactions/anaphylaxis in connection with oral pharmaceuticals should be assessed by a physician prior to vaccination.

Correct registration in the Danish Vaccination Register of influenza and COVID-19 vaccinations

Persons aged 65 years or more have their influenza vaccination courses planned with InfluvacTetra® when the invitations are sent out. For influenza vaccination, the influenza currently on stock is used (InfluvacTetra/VaxigripTetra).

When registering a vaccination, it is important to ensure that the batch number and type of influenza vaccine match the vaccine administered.

If you (as a physician) plan a COVID-19 vaccination course for a patient, it is important to select Comirnaty Omikron XBB.1.5 (uninvited). The dosage depends on age as the vaccine comes in three different doses for either adults and children aged more than 12 years, children aged 5-11 years and children aged from six months to four years of age. Assessment of indication for COVID-19 vaccination for children and young people aged less than 18 years is based on specific medical judgment by a pediatrician.

(C. Munkstrup, L.K. Knudsen, J. Grau, L.S. Vestergaard, H.-D. Emborg, Department of Infectious Disease Epidemiology and Prevention)