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

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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
FluLaval Quadrivalent ID GlaxoSmithKline	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
Flucelvax Quadrivalent Seqirus (ccIIV4)	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 IIV4 and RIV4

IIV4s and RIV4 are administered intramuscularly (IM). For adults and older children, the deltoid is the preferred site. For infants and younger children, the anterolateral thigh is the preferred site. Detailed guidance for administration sites and needle length is available in the General Best Practice Guidelines on Immunization.
RIV4 is licensed for persons aged ≥18 years and should not be used for children and adolescents aged <18 years.
HD-IIV4 and aIIV4 are licensed for persons aged ≥65 years and should not be used for persons aged <65 years.

Table 2: Live Attenuated Influenza Vaccine (LAIV4)

Table 2: Live Attenuated Influenza Vaccine (LAIV4)
Trade Name *Manufacturer*	Available presentations	Approved age indication	Volume per dose
Quadrivalent LAIV (LAIV4) – Egg-based (contains 10^6.5-7.5 fluorescent focus units/0.2 mL)
FluMist Quadrivalent AstraZeneca	0.2 mL prefilled single-use intranasal sprayer	2 through 49 yrs	0.1 mL each nostril (0.2 mLtotal)

Table 3: Influenza Vaccine Contraindications and Precautions

Table 3: Influenza Vaccine Contraindications and Precautions
Egg-based IIV4s	Contraindications: History of severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine (other than egg), or to a previous dose of any influenza vaccine (any egg-based IIV, ccIIV, RIV, or LAIV of any valency). Precautions: Moderate or severe acute illness with or without fever. History of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine.
ccIIV4	Contraindications: History of severe allergic reaction (e.g., anaphylaxis) to ccIIV of any valency, or to any component of ccIIV4. Precautions: Moderate or severe acute illness with or without fever. History of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine. History of severe allergic reaction to a previous dose of any other influenza vaccine (any egg-based IIV, RIV, or LAIV of any valency).
RIV4	Contraindications: History of severe allergic reaction (e.g., anaphylaxis) to RIV of any valency, or to any component of RIV4 Precautions: Moderate or severe acute illness with or without fever History of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine History of severe allergic reaction to a previous dose of any other influenza vaccine (any egg-based IIV, ccIIV, or LAIV of any valency).
LAIV4	Contraindications: History of severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine (other than egg) or to a previous dose of any influenza vaccine (i.e, any egg-based IIV, ccIIV, RIV, or LAIV of any valency). 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 but not limited to medications, congenital or acquired immunodeficiency states, HIV infection, anatomic asplenia, or functional asplenia (e.g., due to sickle-cell anemia) Close contacts and caregivers of severely immunosuppressed persons who require a protected environment Pregnancy Persons with active communication between the CSF and the oropharynx, nasopharynx, nose, or ear or any other cranial CSF leak Persons with cochlear implants (due to potential for CSF leak, which might exist for some period of time after implantation. Providers might consider consultation with a specialist concerning risk of persistent CSF leak if an age-appropriate inactivated or recombinant vaccine cannot be used). Receipt of influenza antiviral medication within the previous 48 hours for oseltamivir and zanamivir, 5 days for peramivir, and 17 days for baloxavir (see Vaccination and influenza antiviral medications for additional guidance). 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 from influenza (e.g., chronic pulmonary, cardiovascular [except isolated hypertension], renal, hepatic, neurologic, hematologic, or metabolic disorders [including diabetes mellitus])

Vaccine Abbreviations

Main influenza vaccine types:
- IIV= Inactivated Influenza Vaccine
- RIV= Recombinant Influenza Vaccine
- LAIV= Live Attenuated Influenza Vaccine
Numerals after letters indicate valency (the number of influenza viruses represented):
- 4 for quadrivalent vaccines
- 3 for trivalent vaccines
Prefixes are sometimes used to refer to specific IIVs:
- a for adjuvanted IIV (e.g., aIIV4)
- cc for cell culture-based IIV (e.g., ccIIV4)
- HD for high-dose IIV (e.g., HD-IIV4)
- SD for standard-dose IIV (e.g., SD-IIV4)

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