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Seasonal Influenza Vaccine Supply for the U.S. 2018-2019 Influenza Season

More of the latest information is available on the total distribution of influenza vaccine doses for the 2018-2019 season.

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How much influenza vaccine is projected to be available for the 2018-2019 influenza season?

Flu vaccine is produced by private manufacturers, so supply depends on manufacturers. Vaccine manufacturers have projected that they will supply as many as 163 million to 168 million doses of i flu vaccine for the 2018-2019 season.

How much thimerosal-free influenza vaccine is expected to be available for the 2018-2019 season?

For the 2018-2019 season, manufacturers will produce influenza vaccines containing thimerosal and some vaccines that do not contain thimerosal. For the 2018-2019 season, only multidose vial presentations of influenza vaccines contain thimerosal.

More than 80 percent of projected vaccine supply produced for the 2018-2019 flu season will be thimerosal-free (i.e., preservative-free).

How much quadrivalent (four-component) vaccine is expected to be available for the 2018-2019 season?

For the 2018-2019 season, manufacturers will produce both trivalent (three-component) and quadrivalent (four-component) influenza vaccines.

More than 80 percent of the projected vaccine supply produced for the 2018-2019 flu season will be quadrivalent (4-component) vaccines. The remaining vaccine will be trivalent (3-component), including the high dose and adjuvanted flu vaccines, as well as one brand of standard-dose inactivated vaccine.

How much of the U.S. flu vaccine supply for 2018-2019 will be produced using egg-based manufacturing?

Approximately 85 percent of the projected vaccine supply produced for the 2018-2019 flu season will be produced using egg-based manufacturing technology. The remaining vaccine will be produced using cell-based and recombinant technology.

Can I still buy influenza vaccine for the 2018-2019 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. In addition, beginning in early October each year, information about manufacturers and distributors who still have influenza vaccine available for sale can be found at http://www.preventinfluenza.org/ivats/.

Updates on the distribution of influenza vaccine doses for the 2018-2019 season will be provided as the season progresses.

What can we anticipate in terms of the timing of vaccine availability for the 2018-2019 season?

The timing of vaccine availability depends on when production is completed. Some influenza vaccine shipments have already begun and will continue throughout August, September, October, and November until all of the vaccine is distributed.

Are all influenza vaccines the same?

All influenza vaccines contain antigen derived from the same influenza viruses, with the one difference being that trivalent vaccines have 3 different antigens and quadrivalent vaccines have four different antigens (the same three that are in the trivalent vaccines, plus one more).

However, aside from the antigen composition, the different influenza vaccine preparations have different indications as licensed by the FDA. In particular, each is licensed for a specific age range. All recipients should receive a vaccine that is appropriate for their age. In addition, LAIV is not recommended for use in some populations. See the table below for an overview of these indications.

Special Consideration Regarding Egg Allergy

People with egg allergies can receive any licensed, recommended age-appropriate influenza vaccine (IIV, RIV4, or LAIV4) that is otherwise appropriate. People who have a history of severe egg allergy (those who have had any symptom other than hives after exposure to egg) should be vaccinated in a medical setting, supervised by a health care provider who is able to recognize and manage severe allergic reactions.

Where can I find information about vaccine supply?

Information about vaccine supply is available on the CDC influenza web site.

TABLE 1. Influenza vaccines — United States, 2018–19 influenza season*

Trade name Manufacturer Presentation Age indication Mercury (from thimerosal, µg/0.5 mL) Latex Route
Inactivated influenza vaccines, quadrivalent (IIV4s), standard-dose

Afluria Quadrivalent

Seqirus

0.5 mL prefilled syringe ≥5 years No thimerosal No IM§
5.0 mL multidose vial ≥5 years (by needle/syringe)
18 through 64 years (by jet injector)
24.5 No IM

Fluarix Quadrivalent

GlaxoSmithKline

0.5 mL prefilled syringe ≥6 months No thimerosal No IM

FluLaval Quadrivalent

ID Biomedical Corp. of Quebec (distributed by GlaxoSmithKline)

0.5 mL prefilled syringe ≥6 months No thimerosal No IM
5.0 mL multidose vial ≥6 months <25 No IM

Fluzone Quadrivalent

Sanofi Pasteur

0.25 mL prefilled syringe 6 through 35 months No thimerosal No IM
0.5 mL prefilled syringe ≥3 years No thimerosal No IM
0.5 mL single-dose vial ≥3 years No thimerosal No IM
5.0 mL multidose vial ≥6 months 25 No IM
Inactivated influenza vaccine, quadrivalent (ccIIV4), standard-dose, cell culture-based

Flucelvax Quadrivalent

Seqirus

0.5 mL prefilled syringe ≥4 years No thimerosal No IM
5.0 mL multidose vial ≥4 years 25 No IM
Inactivated Influenza Vaccines, trivalent (IIV3s), standard-dose

Afluria

Seqirus

0.5 mL prefilled syringe ≥5 years No thimerosal No IM
5.0 mL multidose vial ≥5 years (by needle/syringe)
18 through 64 years (by jet injector)
24.5 No IM
Adjuvanted inactivated influenza vaccine, trivalent (aIIV3), standard-dose

Fluad

Seqirus

0.5 mL prefilled syringe ≥65 years No thimerosal Yes†† IM
Inactivated Influenza Vaccine, trivalent (IIV3), high-dose§§

Fluzone High-Dose

Sanofi Pasteur

0.5 mL prefilled syringe ≥65 years No thimerosal No IM
Recombinant Influenza Vaccine, quadrivalent (RIV4)¶¶

Flublok Quadrivalent

Sanofi Pasteur

0.5 mL prefilled syringe ≥18 years No thimerosal No IM
Live Attenuated Influenza Vaccine, quadrivalent (LAIV4)***

FluMist Quadrivalent

AstraZeneca

0.2 mL single-dose prefilled intranasal sprayer 2 through 49 years No thimerosal No NAS

Abbreviations: ACIP = Advisory Committee on Immunization Practices; IM = intramuscular; NAS = intranasal.
* Immunization providers should check Food and Drug Administration–approved prescribing information for 2018–19 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm093833.htm. Availability of specific products and presentations might change and differ from what is described in this table and in the text of this report.

Standard dose intramuscular IIVs contain 15 µg of each vaccine HA antigen (45 µg total for trivalents and 60 µg total for quadrivalents) per 0.5 mL dose.
§ For adults and older children, the recommended site for intramuscular influenza 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 is available in the ACIP General Best Practice Guidelines for Immunization, available at https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html.
¶ aIIV3 contains the adjuvant MF59
** High-dose IIV3 contains 60 μg of each vaccine antigen (180 μg total) per 0.5 mL dose.
†† RIV4 contains 45 μg of each vaccine HA (180 μg total) per 0.5 mL dose.

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TABLE 2. Contraindications and precautions to the use of influenza vaccines — United States, 2018–19 influenza season*

Vaccine type Contraindications Precautions

IIV

History of severe allergic reaction to any component of the vaccine or after previous dose of any influenza vaccine Moderate or severe acute illness with or without fever
History of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine

RIV

History of severe allergic reaction to any component of the vaccine Moderate or severe acute illness with or without fever
History of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine

LAIV

History of severe allergic reaction to any component of the vaccine† or after a previous dose of any influenza vaccine
Concomitant aspirin or salicylate-containing therapy in children and adolescents
Children aged 2 through 4 years who have received a diagnosis of asthma or whose parents or caregivers report that a health care provider has told them during the preceding 12 months that their child had wheezing or asthma or whose medical record indicates a wheezing episode has occurred during the preceding 12 months
Children and adults who are immunocompromised due to any cause (including immunosuppression caused by medications or by HIV infection)
Close contacts and caregivers of severely immunosuppressed persons who require a protected environment
Pregnancy
Receipt of influenza antiviral medication within the previous 48 hours
Moderate or severe acute illness with or without fever
History of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine
Asthma in persons aged ≥5 years
Other underlying medical conditions that might predispose to complications after wild-type influenza infection (e.g., chronic pulmonary, cardiovascular [except isolated hypertension], renal, hepatic, neurologic, hematologic, or metabolic disorders [including diabetes mellitus])

Abbreviations: ACIP = Advisory Committee on Immunization Practices; IIV = Inactivated Influenza Vaccine; LAIV = Live-Attenuated Influenza Vaccine; RIV = Recombinant Influenza Vaccine.
* Immunization providers should check Food and Drug Administration–approved prescribing information for 2018–19 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 https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm093833.htm.
† History of severe allergic reaction (e.g., anaphylaxis) to egg is a labeled contraindication to the use of IIV and LAIV. However, ACIP recommends that any licensed, recommended, and appropriate influenza vaccine may be administered to persons with egg allergy of any severity (see Persons with a History of Egg Allergy in the 2018-19 ACIP Statement for more information).

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