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

U.S. Influenza Vaccine Products for the 2018-19 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 0.5 mL prefilled syringe ≥5 yrs 15 Egg No No No
5.0 mL multi-dose vial ≥5 yrs (needle/syringe)

18 through 64 yrs (jet injector)

15 Egg No No Yes (24.5)
Fluarix Quadrivalent GlaxoSmithKline 0.5 mL prefilled syringe ≥6 months 15 Egg No No No
FluLaval Quadrivalent ID Biomedical Corp. of Quebec 0.5 mL prefilled syringe ≥6 months 15 Egg No No No
5.0 mL multi-dose vial ≥6 months  15 Egg No No Yes (<25)
Flucelvax Quadrivalent Seqirus (ccIIV4) 0.5 mL prefilled syringe ≥4 yrs 15 Cell No No No
5.0 mL multi-dose vial ≥4 yrs  15 Cell No No Yes (25)
Fluzone Quadrivalent Sanofi Pasteur 0.25 mL prefilled syringe 6 through 35 months 7.5/0.25 mL Egg No No No
0.5 mL prefilled syringe ≥3 yrs 15/0.5 mL  Egg No No No
0.5 mL single-dose vial ≥3 yrs  15/0.5 mL  Egg  No No No
5.0 mL multi-dose vial ≥6 months 15/0.5 mL  Egg  No No Yes (25)
Trivalent IIV (IIV3s)
Afluria Seqirus 0.5 mL prefilled syringe ≥5 yrs 15 Egg No No No
5.0 mL multi-dose vial ≥5 yrs (needle/syringe)
18 through 64 yrs (jet injector)
 15 Egg  No No Yes (24.5)
Fluad Seqirus (aIIV3) 0.5 mL prefilled syringe ≥65 yrs 15 Egg Yes No No
Fluzone High-Dose Sanofi Pasteur (HD-IIV3) 0.5 mL prefilled syringe ≥65 yrs 60 Egg No No No
Quadrivalent RIV (RIV4)
Flublok Quadrivalent Sanofi Pasteur 0.5 mL prefilled syringe ≥18 yrs 45 Recombinant No No No

Abbreviations: IIV=inactivated influenza vaccine; RIV=recombinant influenza vaccine; HA=hemagglutinin; mos=months; yrs=years.

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 (IIVs only): the anterolateral thigh is the preferred site.
    • Detailed guidance for administration sites and needle length is available in Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP)
    • Afluria and Afluria Quadrivalent are licensed for intramuscular administration via jet injector (the Pharmajet Stratis), for persons aged 18-64 years only.
    • RIV4 is licensed for persons 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 a History of Egg Allergy, above)
    • 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 Dose
per 0.2mL
(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
FluMist Quadrivalent
AstraZeneca
0.2 prefilled
intranasal sprayer
2 through 49 yrs 106.5–7.5
fluorescent
focus units
Egg No No No

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

LAIV4 Administration

  • LAIV 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 impedes 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 that persons with egg allergy of any severity receive influenza vaccine (see Persons with a History of Egg Allergy, above)
    • 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 IIVs
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