influenza virus vaccine, inactivated (Fluogen, Fluzone, Fluvirin, Flushield, Fluarix, Flulaval, Agriflu, Afluria, Flublok Quadrivalent, FluCelVax, Fluad, RIV4)

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Epidemiology

Indications

* live attenuated vaccine not recommended given low effectiveness against (H1N1)pdm09 viruses during 2013-14 & 2014-2015 seasons[101]

Contraindications

* safe & effective to administer Covid-19 vaccine & influenza vaccine at same time[134]

* safe & effective to administer RSV vaccine & influenza vaccine at same time[149]

Caution:

Pregnancy-category: C (safe during pregnancy[15][85][133])

Influenza vaccination during pregnancy does not harm prenatally exposed children[133]

Safety in lactation: ?

Benefit/risk

Dosage

chronically immunosuppressed solid organ transplant recipients

Elderly

Adults & children > 12 years:

Children* 3-12 years:

Children* 6-35 months of age:

Children 6 months-8 years of age who have never received influenza virus vaccine or who have not received 2 or more doses of influenza virus vaccine since July 2010 should receive two doses IM 4 weeks apart (2012-2013 season)[48]

Injection:

2015-16 vaccine: trivalent vaccines will include

  • A/California/7/2009 (H1N1)-like virus
  • an A/Switzerland/9715293/2013 (H3N2)-like virus
  • B/Phuket/3073/2013-like (Yamagata lineage) virus[81]

2015-16 Fluzone Intradermal Quadrivalent vaccine is expected to replace the trivalent Fluzone Intradermal vaccine for adults 18-64 years of age[81]

FDA has approved Fluzone High-Dose Quadrivalent for adults >= 65 years available Fall 2020 - contains 2 influenza A & 2 influenza B strains[122]

High dose flu vaccine contains 4x more antigen than standard dose

  • in 2016-2017 when vaccine composition & circulating virus were well matched, both high-dose & standard-dose vaccines provided similar reductions in post-influenza mortality (25-30%)[147]
  • during other flu seasons, in which vaccine composition & circulating virus were not well matched, post-influenza mortality was ~20& lower with the high-dose vaccine, but this was not a significant difference[147]

* High-Dose & adjuvanted inactivated influenza vaccines more likely to cause local reaction[139]

FDA has recommended a different composition for the 2016-17 influenza virus vaccine[93]

2018-19 World Health Organization (WHO) recommendations:

  • A/Michigan/45/2015 (H1N1)pdm09-like virus;
  • A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus;
  • B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage); &
  • B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage)[106]

* may be given with other routine childhood immunizations single dose of 0.5 mL if previously immunized[20]

vaccination mid-October to mid-November

vaccines that do not need to be given annually are in development[50]

* Flu Shot Coding. HCPCS/CPT Codes[134]

Pharmacokinetics

Adverse effects

* Covid-19 vaccine booster alone did not increase stroke risk[151]

Drug interactions

Methods

Mechanism of action

* Quadrivalent vaccine no longer produced because influenza B/Yamagata lineage virus stopped circulating during the Covid-19 pandemic[155]

Notes

* serology-confirmed influenza after vaccination

  • a modeling study concludes that early vaccination would save lives & reduce costs in the event of an H7N9 pandemic[66]
    • the study may overestimate effectiveness of the vaccine

More general terms

More specific terms

Additional terms

References

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