Dosage, Administration, and Storage

On October 24, 2007 CDC's Advisory Committee on Immunization Practices (ACIP) recommended expanding the use of the nasal influenza vaccine LAIV (FluMist®) to include healthy children ages 2-4 years old (24-59 months old) without a history of asthma or recurrent wheezing. The vaccine continues to be recommended for healthy persons ages 5-49 years who are not pregnant. "Healthy" indicates persons who do not have an underlying medical condition that predisposes them to influenza complications.

NOTE: The text below is taken directly from Prevention & Control of Influenza - Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007 Jul 13;56(RR06):1-54. Also available as PDF (720K).

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TIV: Dosage, Administration, and Storage
LAIV: Dosage, Administration, and Storage
Approved Influenza Vaccines for Different Age Groups—2007-08 Season (Table 4)

TIV: Dosage, Administration, and Storage

The composition of TIV varies according to manufacturer, and package inserts should be consulted. TIV formulations in multidose vials typically contain the vaccine preservative thimerosal; preservative-free single dose preparations also are available. TIV should be stored at 35°F–46°F (2°C–8°C) and should not be frozen. TIV that has been frozen should be discarded. Dosage recommendations and schedules vary according to age group (Table 4). Vaccine prepared for a previous influenza season should not be administered to provide protection for any subsequent season.

The intramuscular route is recommended for TIV. Adults and older children should be vaccinated in the deltoid muscle. A needle length of 1 inch or greater (greater than 25 mm) should be considered for persons in these age groups because needles of less than 1 inch might be of insufficient length to penetrate muscle tissue in certain adults and older children. When injecting into the deltoid muscle among children with adequate deltoid muscle mass, a needle length of 7/8–1.25 inches is recommended.

Infants and young children should be vaccinated in the anterolateral aspect of the thigh. A needle length of 7/8–1 inch should be used for children under 12 months of age for intramuscular vaccination into the anterolateral thigh.

LAIV: Dosage, Administration, and Storage

Each dose of LAIV contains the same three antigens used in TIV for the influenza season. However, the antigens are constituted as live, attenuated, cold-adapted, temperature sensitive vaccine viruses. Additional components of LAIV include stabilizing buffers containing monosodium glutamate, hydrolyzed porcine gelatin, arginine, sucrose, and phosphate. LAIV does not contain thimerosal. LAIV is made from attenuated viruses and does not cause systemic symptoms of influenza in vaccine recipients although a minority of recipients experience effects of intranasal vaccine administration or local viral replication (e.g., nasal congestion).

In January 2007, a new formulation of LAIV (sold under the brand name FluMist™) was licensed for the 2007–08 influenza season that will replace the older formulation. Compared with the formulation sold previously, the principal differences are the temperature at which LAIV is shipped and stored after delivery to the clinic and the amount of vaccine administered. LAIV is intended for intranasal administration only and should not be administered by the intramuscular, intradermal, or intravenous route. LAIV is not approved for vaccination of children less than 5 years of age or adults more than 49 years of age. The new formulation of LAIV is supplied in a prefilled, single use sprayer containing 0.2 mL of vaccine. Approximately 0.1 mL (i.e., half of the total sprayer contents) is sprayed into the first nostril while the recipient is in the upright position. An attached dose-divider clip is removed from the sprayer to administer the second half of the dose into the other nostril. The new formulation of LAIV is shipped to end users at 35°F– 46°F (2°C–8°C). LAIV should be stored at 35°F–46°F (2°C– 8°C) upon receipt, and can remain at that temperature until the expiration date is reached.

Table 4. Approved Influenza Vaccines for Different Age Groups—United States, 2007-08 Season
Vaccine	Trade name	Manufacturer	Presentation	Thimerosal mercury content (mcg Hg/0.5 mL dose)	Age group	No. of doses	Route
TIV*	Fluzone®	Sanofi Pasteur	0.25-mL prefilled syringe	0	6-35 mos	1 or 2†	Intramuscular§
			0.5-mL prefilled syringe	0	36 mos and older	1 or 2†	Intramuscular§
			0.5-mL vial	0	36 mos and older	1 or 2†	Intramuscular§
			5.0-mL multidose vial	25	6 mos and older	1 or 2†	Intramuscular§
TIV*	Fluvirin™	Novartis Vaccine	5.0-mL multidose vial	24.5	4 yrs and older	1 or 2†	Intramuscular§
TIV*	Fluarix™	GlaxoSmithKline	0.5-mL prefilled syringe	<1.0	18 yrs and older	1	Intramuscular§
TIV*	FluLuval™	GlaxoSmithKline	5.0-mL multidose vial	25	18 yrs and older	1	Intramuscular§
LAIV¶	FluMist™**	MedImmune	0.2-mL sprayer	0	5-49 yrs	1 or 2††	Intranasal
* Trivalent inactivated vaccine (TIV). A 0.5-mL dose contains 15 mcg each of A/Solomon Islands/3/2006 (H1N1)-like, A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like antigens. † Two doses administered at least 1 month apart are recommended for children aged 6 months–8 years who are receiving TIV for the first time and those who only received 1 dose in their first year of vaccination should receive 2 doses in the following year. § 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. ¶ Live attenuated influenza vaccine (LAIV). ** FluMist dosage and storage requirements have changed for the 2007–08 influenza season. FluMist is now shipped to end users at 35°F–46°F (2°C–8°C). LAIV should be stored at 35°F–46°F (2°C–8°C) upon receipt and should remain at that temperature until the expiration date is reached. The dose is 0.2 mL, divided equally between each nostril. †† Two doses administered at least 4 weeks apart are recommended for children aged 5–8 years who are receiving LAIV for the first time, and those who received only 1 dose in their first year of vaccination should receive 2 doses in the following year.