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

U.S. Influenza Vaccine Products for the 2018-19 Season

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

* For Afluria, Afluria Quadrivalent, and Fluzone Quadrivalent, the dose volume for children aged 6 through 35 months is 0.25mL. For persons aged 36 months (three years) and older, the dose volume is 0.5 mL.

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.

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)).