Influenza vaccines — United States, 2019–20 influenza season*

U.S. Influenza Vaccine Products for the 2019-20 Season

Inactivated Influenza Vaccines (IIVs) and Recombinant Influenza Vaccine (RIV4)

Trade Name [Manufacturer] Presentation Age Indication HA, µG/dose (each virus) Egg-grown virus, Cell culture-grown virus, or Recombinant HA Adjuvanted Yes/No Latex Yes/No Thimerosal Yes/No
If yes, Mercury,
μg/0.5mL
Quadrivalent IIVs (IIV4s)
Afluria Quadrivalent* Seqirus 0.25 mL prefilled syringe* 6 through 35 mos* 7.5/0.25 mL Egg No No No
0.5 mL prefilled syringe* ≥3 yrs* 15/0.5 mL Egg No No No
5.0 mL multi-dose vial* ≥6 mos*(needle/syringe)

18 through 64 yrs (jet injector)

See note for dosing* Egg No No Yes (24.5)
Fluarix Quadrivalent GlaxoSmithKline 0.5 mL prefilled syringe ≥6 mos 15/0.5mL Egg No No No
FluLaval Quadrivalent ID GlaxoSmithKline 0.5 mL prefilled syringe ≥6 mos 15/0.5mL Egg No No No
5.0 mL multi-dose vial ≥6 mos  15/0.5mL Egg No No Yes (<25)
Flucelvax Quadrivalent Seqirus (ccIIV4) 0.5 mL prefilled syringe ≥4 yrs 15/0.5mL Cell No No No
5.0 mL multi-dose vial ≥4 yrs  15/0.5mL Cell No No Yes (25)
Fluzone Quadrivalent Sanofi Pasteur 0.25 mL prefilled syringe 6 through 35 mos 7.5/0.25 mL Egg No No No
0.5 mL prefilled syringe ≥6 mos 15/0.5 mL  Egg No No No
0.5 mL single-dose vial ≥6 mos See note
for dosing
 Egg  No No No
5.0 mL multi-dose vial ≥6 mos See note
for dosing
 Egg  No No Yes (25)
Trivalent IIV (IIV3s)
Fluad Seqirus (aIIV3) 0.5 mL prefilled syringe ≥65 yrs 15/0.5mL Egg Yes No No
Fluzone High-Dose Sanofi Pasteur (HD-IIV3) 0.5 mL prefilled syringe ≥65 yrs 60/0.5mL Egg No No No
Quadrivalent RIV (RIV4)
Flublok Quadrivalent Sanofi Pasteur 0.5 mL prefilled syringe ≥18 yrs 45/0.5mL Recombinant No No No

Abbreviations: IIV=inactivated influenza vaccine; RIV=recombinant influenza vaccine; HA=hemagglutinin; months=months; yrs=years. * for Afluria Quadrivalent, children aged 6 through 35 months should receive 0.25mL per dose. Persons ≥36 months (≥3 years) should receive 0.5mL per dose. for Fluzone Quadrivalent, children aged 6 through 35 months may receive either 0.25mL or 0.5mL per dose. Persons ≥36 months (≥3 years) should receive 0.5mL per dose

Administration of IIVs and RIV4

  • IIVs and RIV4 are administered intramuscularly (IM):
    • Adults and older children: the deltoid is the preferred site;
    • Infants and younger children: the anterolateral thigh is the preferred site.
    • Detailed guidance for administration sites and needle length is available in Best Practices Guidelines of the Advisory Committee on Immunization Practices (ACIP)
    • Afluria Quadrivalent is licensed for intramuscular administration via jet injector (the Pharmajet Stratis), for persons aged 18 through 64 years only.
    • RIV4 is licensed for persons aged ≥18 years and should not be used for children aged <18 years.

IIV and RIV4 Contraindications and Precautions

Contraindications:

  • History of severe allergic reaction to the vaccine or any of its components
    • ACIP recommends that persons with egg allergy of any severity receive influenza vaccine (see Persons with Egg Allergy).
    • Information about vaccine components is located in package inserts from each manufacturer.

Precautions:

  • Moderate or severe acute illness with or without fever.
  • Guillain–Barré syndrome within 6 weeks following a previous dose of influenza vaccine.

Live Attenuated Influenza Vaccine (LAIV4)

Trade Name Manufacturer Presentation Age Indication Virus Count per dose
(each virus)
Egg-grown virus, Cell
culture-grown virus,
or Recombinant HA
Adjuvanted
(Yes/No)
Latex
(Yes/No)
Thimerosal
Yes/No
If yes, Mercury,
μg/0.2mL
FluMist Quadrivalent
AstraZeneca
0.2 mL prefilled
intranasal sprayer
2 through 49 yrs 106.5–7.5
fluorescent
focus units/0.2mL
Egg No No No

Abbreviations: LAIV=live attenuated influenza vaccine; mos=months; yrs=years.

Administration of LAIV4

  • LAIV4 is administered intranasally using the supplied prefilled, single-use sprayer containing 0.2 mL of vaccine.
    • Half of the total sprayer contents is sprayed into the first nostril while the recipient is in the upright position.
    • The attached divider clip is removed and the second half of the dose administered into the other nostril.
  • If the vaccine recipient sneezes immediately after administration, the dose should not be repeated.
  • If nasal congestion is present that might interfere with delivery of the vaccine to the nasopharyngeal mucosa, deferral should be considered, or another age appropriate vaccine should be administered.

LAIV4 Contraindications and Precautions

Contraindications:

  • History of severe allergic reaction to any vaccine component or after previous dose of any influenza vaccine;
    • ACIP recommends influenza vaccination for persons with egg allergy of any severity (see Persons with Egg Allergy).
    • Information about vaccine components is located in package inserts from the manufacturer.
  • 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 previous 48 hours.

Precautions:

  • 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 attributable to severe influenza (e.g., chronic pulmonary, cardiovascular [excluding isolated hypertension], renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus)).

Vaccine Abbreviations
  • IIV = Inactivated Influenza Vaccine.
    • IIV3 = Trivalent Inactivated Influenza Vaccine;
    • IIV4 = Quadrivalent Inactivated Influenza Vaccine.
  • RIV4 = Quadrivalent Recombinant Influenza Vaccine.
  • LAIV4 = Quadrivalent Live Attenuated Influenza Vaccine.
  • aIIV3 refers specifically to adjuvanted IIV3.
  • ccIIV4 refers specifically to cell-culture based IIV4.
  • HD-IIV3 refers specifically to high-dose IIV3.
  • SD-IIV3 and SD-IIV4 refer specifically to standard-dose trivalent IIV and standard-dose quadrivalent IIV, respectively.
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