Flu vaccine

Flu prevention is important to protect people and the health-care system

The goals for the 2023–2024 flu season are to protect the health of individuals and communities and mitigate impacts on the healthcare system, particularly with COVID-19 and respiratory syncytial virus (RSV) also circulating. There are four products available and six recommendations for administration in this season’s publicly funded influenza immunization program.

Products available for 2023-2024

The publicly funded vaccines available for the 2023-2024 season are:

Vaccine product & company

Age indication

FluLaval Tetra
Quadrivalent inactivated vaccine (QIV) egg-based

Six months and older

Fluzone® Quadrivalent
QIV egg-based
Sanofi Pasteur

Six months and older

Adjuvanted trivalent inactivated vaccine (TIV-adj) egg-based

65 years and older

Fluzone® High-Dose Quadrivalent
QIV-HD egg-based
Sanofi Pasteur

65 years and older

All products should be administered at a dose of 0.5 ml with the exception of Fluzone® high-dose quadrivalent (QIV-HD), which should be administered at a dose of 0.7 ml.

Other flu vaccines that are not publicly funded for the 2023-2024 season, including FluMist® Quadrivalent (intranasal spray) , Flucelvax® Quad (cell-based vaccine) and Supemtek™ (recombinant protein vaccine) may be purchased by patients at a pharmacy.

Recommendations for 2023-2024

Prioritize high risk patients to receive flu vaccines 

The provincial supply of vaccines will first be distributed to hospitals and long-term care homes at the end of September. Retirement homes and other settings with vulnerable populations, physicians, pharmacies, and all other providers/organization will then be provided with vaccine supply by mid- to late- October. 

Based on information provided by the National Advisory Committee on Immunization, the Ministry of Health recommends that the following individuals be prioritized for the flu vaccine as soon as it becomes available:

  • Health-care workers
  • First responders
  • Residents and staff of congregate living settings
  • People 65 years of age and older
  • Pregnant individuals
  • Children 6 months to 4 years of age
  • Individuals who are from First Nations, Inuit or Métis communities and/or self-identify as First Nation, Inuit or Métis, and their household members
  • Individuals from racialized and other equity-deserving communities
  • Individuals 6 months of age and older with certain underlying health conditions

The flu vaccine is recommended for all people aged six months and older without contraindication. Individuals in the following groups are particularly recommended to receive the flu vaccine when it becomes available to the public starting October 30, 2023:

  • Individuals capable of transmitting influenza to high-risk groups and/or to infants under six months old
  • People who provide essential community services
  • Poultry industry workers

Refer to the 2023/2024 Universal Influenza Immunization Program for a detailed list of patients who are recommended to get the flu vaccine.

Administer flu and COVID-19 vaccines at the same time 

Flu vaccines can be administered to patients six months of age or older at the same time as, or at any time before or after routine vaccines, including COVID-19 vaccines.

Consider offering flu and COVID-19 vaccines together during appointments or clinics.

Vaccines given during the same visit should be given at different injection sites on separate limbs. Alternatively, vaccines may be administered into the same muscle if separated by at least 2.5 cm/1 inch. Use a different needle and syringe for each vaccination.

Informed consent for co-administration should include a discussion of the benefits and potential risks given limited data available on administration of COVID-19 vaccines at the same time as, or shortly before or after, other vaccines.

Wait until November to run community flu vaccine clinics

Physicians should wait until November to run large-scale community clinics to ensure adequate flu vaccine supply for their clinic.

Do not book appointments prior to receiving flu vaccines in the event of unexpected delays or restrictions on vaccine availability.

Offer available flu vaccines to patients 65 years+

Patients 65 years of age and older should not delay flu vaccination to wait for a particular vaccine product.

Among the products indicated for those aged 65 and older, there is no preferential recommendation for using Fluzone® High-Dose Quadrivalent inactivated vaccine (QIV-HD) over Fluad® adjuvanted trivalent (TIV-adj) vaccine due to insufficient evidence.

Where available, offer Fluzone® QIV-HD or Fluad® TIV-adj over standard-dose QIV for adults 65 years of age and over.

Defer flu vaccines for patients who are ill or self-isolating

Patients who have any type of severe acute illness, with or without fever, should wait until their symptoms subside before getting the flu vaccine.

Patients with symptoms of acute illness, including minor symptoms such as sore throat, should take the COVID online self-assessment. Those who screen negative can get the flu vaccine.

Maintain the full post-vaccination observation period where appropriate

The National Advisory Committee on Immunization (NACI) recommends maintaining the full 15-minute post-vaccination observation for flu vaccine settings, including those offering the COVID-19 vaccine .

If there is a specific concern about a possible vaccine allergy, an observation period of 30 minutes is a safer interval.

To reduce crowding and the risk of COVID-19 transmission in waiting areas where physical distancing cannot be maintained, consider reducing the observation period to between five and 15 minutes for patients receiving the flu vaccine only, provided the following conditions are met (previous NACI recommendation): 

  • They have received the flu vaccine before
  • They have no known history of severe allergic reactions (including anaphylaxis) to any component of the flu vaccine
  • They have no history of other immediate post-vaccination reactions (for example, syncope with or without seizure)
  • They will not be operating a vehicle or other wheeled transportation or machinery for a minimum of 15 minutes after vaccination
  • They are accompanied by a responsible adult/guardian who will monitor the vaccine recipient for a minimum of 15 minutes post-vaccination (this applies to both children and adults) and knows where to seek assistance and medical services if required
  • They agree to stay in the post-vaccination waiting area for the shortened observation period, along with the responsible adult/guardian, notify staff if they feel or look unwell, and be aware that any symptom of an adverse event after the shortened observation period will require a longer period of observation in the clinic

Refer to NACI’s updated recommendations on the duration of post-vaccination observation period for flu vaccines.

Ordering flu vaccines

The first set of vaccine orders to physicians are expected to be delivered anytime from early to late October. Number of doses received in the first order may need to be adjusted by the Ministry or Public Health Unit based on available supply.

After receiving your first order, you can order again starting the week of October 16 for delivery or pick-up, depending on your Public Health Unit. 

Connect with your Public Health Unit for more ordering information.


Billing codes for administering the flu vaccine vary depending on whether you are a primary care provider who is:

  • Part of a Family Health Organization (FHO) or Family Health Network (FHN)
  • Fee for service

The flu vaccine G590 is in basket for FHN physicians. 

Sole purpose for visit

  • Service: G590  flu vaccine
  • Premium: Q590A
  • Tracking code: Q130A

With assessment

  • Service: G590  flu vaccine + assessment fee code
  • Tracking code: Q130A

Flu vaccine (add-on to visit)

  • Fee: $5.65 
  • Fee code: G590 

Note: Flu vaccine assessment is not separately billable, it is included in this billing code. If an assessment is performed in the same visit as the flu vaccine but is unrelated to the flu vaccine, then the appropriate assessment fee is eligible for payment.  

Flu vaccine (sole purpose for visit)

  • Fee: $5.65 + $5.60 
  • Fee code: G590 + G700 

Note: If the flu vaccine is the sole reason for the visit, G700 may be eligible for payment in addition to G590.  Eligibility requirements for G700 are on page J3 of the current OHIP schedule.

If you are administering the flu vaccine at the same time as a COVID-19 vaccine, you can bill G590 ($5.65) for the flu vaccine in addition to the applicable COVID-19 vaccine fee codes. If these two vaccines are the sole reason for the patient’s visit, G700 can be applied. 

G700 is not eligible for payment if both of these apply: 

  • A consultation or assessment is payable to the same physician for the same patient on the same day
  • That physician has a financial interest in the facility where the service is rendered


  • G700 is not eligible for payment for a service provided in a hospital
  • G700 is not eligible for payment when the service marked with ( + ) is not eligible for payment
  • G700 is payable at 15 per cent of the listed fee when the service is rendered to a patient who has signed the ministry's Patient Enrolment and Consent to Release Personal Health Information form and who is enrolled to a physician or group of physicians who are signatories to a ministry alternate funding plan agreement paying physicians primarily by capitation rather than fee for service. This applies regardless of which physician of the group renders the service to the enrolled patient