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Seasonal Influenza Vaccine Supply for the U.S. 2013-14 Influenza Season

How much influenza vaccine is projected to be available for the 2013-14 influenza season?

At the current time, seven influenza vaccine manufacturers are projecting that as many as 138-145 million doses of influenza vaccine will be available from currently licensed manufacturers in the U.S. for use during the 2013-14 influenza season.

How much thimerosal-free influenza vaccine is expected to be available for the 2013-14 season?

For the 2013-14 season, manufacturers will produce approximately 89 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine.

Can I still buy influenza vaccine for the 2013-14 season?

Influenza vaccine pre-booking typically occurs between January and March, though most preparations of vaccine should still be available for purchase. Providers should contact distributors and local vendors about remaining supply. Information about manufacturers and distributors who still have influenza vaccine available for sale is available.

What can we anticipate in terms of the timing of vaccine availability for the 2013-14 season?

Distribution of most products is anticipated to begin in August and manufacturer projections indicate that the majority of vaccine will be distributed by the end of October. However, some vaccine distribution will likely continue into November.

Are all influenza vaccines the same?

Different influenza vaccine preparations have different indications as licensed by the FDA. See the table below for an overview of these indications.

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TABLE 1. Influenza Vaccines — United States, 2013–14 Influenza Season*

Vaccine

Trade name

Manufacturer

Presentation

Mercury content (μg Hg/0.5 mL)

Ovalbulmin content (μg/0.5 mL)

Age indications

Route

Inactivated Influenza Vaccine, Trivalent (IIV3), Standard Dose

Afluria®

CSL Limited

0.5 mL single-dose prefilled syringe

0.0

≤ 1

≥9 yrs.†††

IM

5.0 mL multi-dose vial

24.5

≤ 1

Fluarix®

GlaxoSmithKline

0.5 mL single-dose prefilled syringe

0.0

≤0.05

≥3 yrs.

IM

Flucelvax®

Novartis Vaccines

0.5 mL single-dose prefilled syringe

0.0

§§§

≥18 yrs.

IM

FluLaval®

ID Biomedical Corporation of Quebec (distributed by GlaxoSmithKline)

5.0 mL multi-dose vial

<25.0

≤0.3

≥3 yrs

IM

Fluvirin®

Novartis Vaccines

0.5 mL single-dose prefilled syringe

≤1

≤1

≥4 yrs.

IM

5.0 mL multi-dose vial

25.0

≤1

Fluzone®

Sanofi Pasteur

0.25 mL single-dose prefilled syringe

0.0

****

6-35 mos.

IM

0.5 mL single-dose prefilled syringe

0.0

****

≥36 mos.

IM

0.5 mL single-dose vial

0.0

****

≥36 mos.

IM

5.0 mL multi-dose vial

25.0

****

≥6 mos.

IM

Fluzone® Intradermal††

Sanofi Pasteur

0.1 mL prefilled microinjection system

0.0

****

18-64 yrs.

ID§

Inactivated Influenza Vaccine, Trivalent (IIV3), High Dose**

Fluzone® High-Dose

Sanofi Pasteur

0.5 mL single-dose prefilled syringe

0.0

****

≥65 yrs.

IM

Inactivated Influenza Vaccine, Quadrivalent (IIV4), Standard Dose

Fluarix® Quadrivalent

GlaxoSmithKline

0.5 mL single-dose prefilled syringe

0.0

≤0.05

≥3 yrs.

IM

FluLaval® Quadrivalent

ID Biomedical Corporation of Quebec (distributed by GlaxoSmithKline)

5.0 mL multi-dose vial

<25.0

≤0.03

≥3 yrs.

IM

Fluzone® Quadrivalent

Sanofi Pasteur

0.25 mL single-dose prefilled syringe

0.0

****

6-35 mos.

IM

0.5 mL single-dose prefilled syringe

0.0

****

≥36 mos.

IM

0.5 mL single-dose vial

0.0

****

≥36 mos.

IM

Recombinant Influenza Vaccine, Trivalent (RIV3)

FluBlok®

Protein Sciences

0.5 mL single-dose vial

0.0

0.0

18-49 yrs.

IM

Live-attenuated Influenza Vaccine, Quadrivalent (LAIV4)

FluMist® Quadrivalent§§

MedImmune

0.2 mL prefilled intranasal sprayer

0.0 (per 0.2 mL)

<0.24 (per 0.2 mL)

2-49 yrs.***

IN

IIV=Inactivated Influenza Vaccine; IIV3=Inactivated Influenza Vaccine, Trivalent; IIV4=Inactivated Influenza Vaccine, Quadrivalent; RIV=Recombinant Influenza Vaccine LAIV=Live-Attenuated Influenza Vaccine; IM=intramuscular; ID=intradermal; IN=intranasal.

* Immunization providers should check Food and Drug Administration--approved prescribing information for 2013--14 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, and precautions. Package inserts for US-licensed vaccines are available at http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm093833.htm.

† For adults and older children, the recommended site of vaccination is the deltoid muscle. The preferred site for infants and young children is the anterolateral aspect of the thigh. Specific guidance regarding site and needle length for intramuscular administration may be found in the ACIP General Recommendations on Immunization [4].

§ The preferred site is over the deltoid muscle. Fluzone® Intradermal is administered using the delivery system included with the vaccine.

** Inactivated influenza vaccine, high-dose: A 0.5-mL dose contains 60 μg of each vaccine antigen (180 μg total).

†† Inactivated influenza vaccine, intradermal: A 0.1-mL dose contains 9 μg of each vaccine antigen (27 μg total).

§§ It is anticipated that the quadrivalent formulation of FluMist® will replace the trivalent formulation for the 2013-14 season. FluMist® is shipped refrigerated and stored in the refrigerator at 35°F--46°F (2°C--8°C) after arrival in the vaccination clinic. The dose is 0.2 mL divided equally between each nostril. Health-care providers should consult the medical record, when available, to identify children aged 2--4 years with asthma or recurrent wheezing that might indicate asthma. In addition, to identify children who might be at greater risk for asthma and possibly at increased risk for wheezing after receiving LAIV, parents or caregivers of children aged 2--4 years should be asked: "In the past 12 months, has a health-care provider ever told you that your child had wheezing or asthma?" Children whose parents or caregivers answer "yes" to this question and children who have asthma or who had a wheezing episode noted in the medical record within the past 12 months should not receive FluMist®.

*** Flumist® is indicated for healthy, non-pregnant persons aged 2-49 years. Individuals who care for severely immunosuppressed persons who require a protective environment should not receive FluMist given the theoretical risk of transmission of the live attenuated vaccine virus.

††† Age indication per package insert is ≥5 years; however, the ACIP recommends Afluria® not be used in children aged 6 months through 8 years because of increased risk of febrile reactions noted in this age group with CSL’s 2010 Southern Hemisphere IIV3. If no other age-appropriate, licensed inactivated seasonal influenza vaccine is available for a child aged 5--8 years who has a medical condition that increases the child's risk for influenza complications, Afluria® can be used; however, providers should discuss with the parents or caregivers the benefits and risks of influenza vaccination with Afluria® before administering this vaccine. Afluria® may be used in persons aged ≥9 years (5).

§§§ Information not included in package insert. The total egg protein is estimated to be less than 50 femtograms (5x10-14 grams) total egg protein, of which a fraction is ovalbumin, per 0.5 mL dose of Flucelvax®.

**** Available upon request from upon request from Sanofi Pasteur, by telephone, 1-800-822-2463, or e-mail, MIS.Emails@sanofipasteur.com.

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