Winter vaccine update

As we head towards winter it’s a great time to remind your clients about the importance of vaccination. Influenza is the most common vaccine-preventable disease in Australia and free influenza vaccines are available through the Australian Government’s National Immunisation Program for people living with diabetes.

Living with diabetes can weaken the immune system, making it harder to fight off viruses and vaccination is especially important for older adults and First Nations people, who are more likely to face serious illness. Vaccination is one of the best ways to reduce the risk of complications.

Donna Itzstein, Pharmacist and Credentialled Diabetes Educator, shares the latest data and commentary on vaccinations and respiratory viral infections.

Lower respiratory tract infections

Deaths due to lower respiratory tract infections are on the rise. Our clients living with diabetes often have comorbidities that increase their risk of contracting infections and their subsequent impact. Isolating practices implemented in 2020 temporarily reduced deaths. However, people have become overwhelmed by the number and variety of immunisations recommended.

Figure 1: Total number of patients (children and adults) admitted with a severe acute respiratory infection to sentinel hospitals by disease and week of admission in Australia, 1 January to 9 February 2025. ⁽¹⁾

Figure 2: Rate of influenza-like illness per 1,000 consultations per week with sentinel general practice sites compared with the five-year average by year and week of consultation, Australia.

The facts

• Lower respiratory infection is the leading cause of death from infections. Many of the causes of hospitalisations from lower respiratory tract infections are vaccine-preventable diseases.⁽²⁾
• The three main causes of acute respiratory infections leading to hospitalisation are Influenza, RSV and COVID-19 (Figure 1).
• Viral respiratory illness generally follows seasonal patterns, and this year follows previous patterns (Figure 2).  We can expect an increase during May.
• Analysis of > 500,000 UK Biobank participants showed that diabetes was associated with 1.5-fold and 1.8-fold greater COVID mortality in women and men, respectively, and 2.2-fold and 1.9-fold greater influenza/pneumonia mortality in women and men.⁽²⁾
• Vaccines take three weeks to provide sufficient immune responses.

The risk of severe disease outcomes

The risk of severe disease outcomes from notifiable and non-notifiable infections is increased among:

• older adults (with the risk increasing with age)
• adults with medical risk conditions 
• First Nations adults.

The risk is greater for non-First Nations adults from age 75, while it is greater for First Nations adults and adults with risk conditions from age 60. 

Examples of medical risk conditions for severe RSV disease:

• chronic cardiac, respiratory, neurological and liver conditions
• immunocompromising conditions
• chronic metabolic disorders (diabetes)
• chronic kidney disease
• obesity.

Influenza

There were 810 deaths involving influenza between January and August 2024. ⁽⁴⁾ Even though influenza vaccines are available through the National immunisation program for our vulnerable group ≥ 65 years, the vaccination rate is 60.5%, and in First Nations people ≥ 65 years, 59.4%. Influenza is a notifiable disease in Australia; however, it may present as a minor illness in younger people and may not be confirmed. There have been 41,684 notifications of laboratory-confirmed influenza reported to the National Notifiable Diseases Surveillance System (NNDSS) in the year to 24 March 2025. ⁽⁵⁾

The influenza vaccines are free under the National Immunisation Program for:

• Aboriginal and Torres Strait Islander people aged six months and over
• Children aged six months to under five years (VaxiGrip Tetra, FluQuadri). During the first year of administration, two vaccines given 4 weeks apart are recommended.
• Pregnant women at any stage of pregnancy
• People aged 65 years or over (Fluad Quad)
• People aged six months or over who have medical conditions that mean they have a higher risk of getting a severe disease. (Flucelvax Quad, VaxiGrip Tetra).

The highest level of protection happens in the first three to four months following vaccination. As shown in the above graph (Figure 2), April onwards is the best time to be vaccinated. A booster dose is recommended each year.

About the vaccines

• All vaccines are quadrivalent as they contain four influenza virus strains: two influenza A subtypes and two influenza B lineages.
• Standard-dose egg- or cell-based influenza vaccines contain 15 µg of haemagglutinin per strain per dose with no adjuvant.
• The available adjuvanted influenza vaccine is egg-based and contains the standard 15 µg of haemagglutinin per strain per dose, with MF59 as the adjuvant. The adjuvanted influenza vaccine is formulated to induce a greater immune response than standard-dose influenza vaccines. (Fluad Quad)
• High-dose (egg-based) influenza vaccines contain 60 µg of haemagglutinin per strain per dose with no adjuvant. (Fluzone High-Dose Quadrivalent)
• All the influenza vaccines available in Australia are split virion or subunit. Parts of the virus that stimulate an immune response are produced; however, they are incapable of causing disease. These vaccines are safe for immunocompromised people.
•  They are prepared from purified inactivated influenza virus cultivated in embryonated hens or propagated in Madin-Darby canine kidney (MDCK) cells (cell-based influenza vaccine).
• None of the available influenza vaccines contain >1 µg of ovalbumin. People with egg allergy, including a history of anaphylaxis, can be safely vaccinated with any influenza vaccines (including egg-based  and cell-based vaccines) unless they have reported a severe adverse reaction to influenza vaccines.⁽⁶⁾

The Queensland government has rolled out a free flu vaccination program for all Queensland residents through local pharmacies, including people ineligible for the National Immunization Program vaccination.

Respiratory syncytial virus (RSV)

People aged 60 and over, Aboriginal and Torres Strait Islander people aged 60 and over, and people with medical risk conditions may consider purchasing RSV vaccines through the private market. However, these cannot be reimbursed through the NIP or state and territory programs. (7)

While there is currently limited data on the RSV disease burden in adults in Australia, between 2016 and 2019, the hospitalisation rate in adults aged 65 years and older was estimated at 123 per 100,000 population, and for adults aged 75 years and over 194 per 100,000 population.

The reported rate of RSV hospitalisations in older adults has been increasing with the growing awareness of RSV disease and more frequent laboratory testing. The RSV vaccine is a fragment of RSV (a protein or protein-encoding mRNA). This vaccine does not contain a live virus and can be given to immunocompromised adults.  

Clinical trials for Arexvy and Abrysvo showed good protection against severe RSV disease in adults aged 60 years and over, with around an 80–95% reduction in the risk of severe lower respiratory tract disease in vaccinated individuals. Post-market studies are ongoing.

GlaxoSmithKline Biologicals’ postmarket studies showed that a second seasonal dose did not increase immunogenicity. At this time, a single dose is recommended. ⁽²⁾

COVID-19

Deaths due to COVID-19 have reduced with the introduction of vaccines.

COVID-19 Vaccine Program in the last 12 months 12 march 2024-2025: ⁽⁹⁾

• More than half of COVID-19 vaccinations are administered through pharmacies.
• Adults with less risk of severe illness are underrepresented. Increased vaccinations in this group could lead to an immune herd effect that protects vulnerable people.
• At-risk groups (severely immunocompromised adults and people ≥ 75 years) are recommended to have six monthly boosters. Vaccination boosters for all other adults are recommended for 12 monthly intervals. Aged care residents have been well vaccinated.

Diabetes and viral infections

Individuals living with diabetes have an increased risk of developing respiratory viral infections, such as influenza and COVID-19. This susceptibility is often due to compromised immune function associated with diabetes, which can lead to more severe illness if these infections are contracted.

The weariness around vaccinations is a significant public health challenge. To effectively communicate the importance of vaccinations, particularly for vulnerable populations like those with diabetes, a multidisciplinary approach is essential.

References

1. Australian Centre for disease control. Australian Respiratory Surveillance Report. [Online] March 2025. https://www.health.gov.au/sites/default/files/2025-02/australian-respiratory-surveillance-report-27-january-to-23-february-2025.pdf.
2. Australian Government. Infectious and communicable diseases. Australian Institute of Health and Welfare. [Online] 2nd July 2024. https://www.aihw.gov.au/reports/australias-health/infectious-and-communicable-diseases.
3. Risks and benefits of vaccines in Diabetes. Bloomgarden, Zachary. New York, USA: Wiley, 23rd September 2023, Journal of Diabetes.
4. Australian Government. Deaths due to COVID-19, influenza and RSV in Australia- 2022 – September 2024. Australian Burea of Statistics. [Online] 29th October 2024. https://www.abs.gov.au/articles/deaths-due-covid-19-influenza-and-rsv-australia-2022-september-2024#:~:text=There%20were%20810%20deaths%20involving,of%20deaths%20due%20to%20flu.
5. Immunisation Coalition. Influenza Statistics. [Online] 24th March 2025. https://www.immunisationcoalition.org.au/news-data/influenza-statistics/.
6. Australian Government; Department of Health and Aged Care. Influenza (flu). Australian Immunisation Handbook. [Online] 24th March 2024. https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu#.
7. National Immunisation Program. National Immunisation Program. Respiratory syncytial virus (RSV) products Program advice for health professionals. [Online] 5th February 2025. https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked#:~:text=The%20National%20RSV%20Mother%20%26%20Infant,National%20Immunisation%20Program%20(NIP).
8. GlaxoSmithKline Pty Ltd. Full prescribing information: AREXVY. [Online] [Cited: 24th March 2025.] https://www.fda.gov/files/vaccines%2C%20blood%20%26%20biologics/published/Package-Insert-AREXVY.pdf.
9. Australian Government, Department of Health and Aging. COVID-19 Vaccine Program. Australia’s COVID-19 Vaccine Program. [Online] 14th March 2025. https://www.health.gov.au/sites/default/files/2025-03/covid-19-vaccine-rollout-update-14-march-2025.pdf.