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Influenza vaccines — United States, 2017–18 influenza season*

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TABLE 1. Influenza vaccines — United States, 2017–18 influenza season*

Trade name Manufacturer Presentation Age indication Mercury (from thimerosal, µg/0.5 mL) Latex Route
Inactivated influenza vaccines, quadrivalent (IIV4s), standard-dose†
Afluria Quadrivalent Seqirus 0.5 mL prefilled syringe ≥18 years NR No IM§
5.0 mL multidose vial ≥18 years (by needle/syringe)
18 through 64 years (by jet injector)		 24.5 No IM
Fluarix Quadrivalent GlaxoSmithKline 0.5 mL prefilled syringe ≥3 years NR No IM
FluLaval Quadrivalent ID Biomedical Corp. of Quebec (distributed by GlaxoSmithKline) 0.5 mL prefilled syringe ≥6 months NR No IM
5.0 mL multidose vial ≥6 months <25 No IM
Fluzone Quadrivalent Sanofi Pasteur 0.25 mL prefilled syringe 6 through 35 months NR No IM
0.5 mL prefilled syringe ≥3 years NR No IM
0.5 mL single-dose vial ≥3 years NR No IM
5.0 mL multidose vial ≥6 months 25 No IM
Inactivated influenza vaccine, quadrivalent (ccIIV4), standard-dose,† cell culture-based
Flucelvax Quadrivalent Seqirus 0.5 mL prefilled syringe ≥4 years NR No IM
5.0 mL multidose vial ≥4 years 25 No IM
Inactivated influenza vaccine, quadrivalent (IIV4), standard-dose, intradermal
Fluzone Intradermal Quadrivalent Sanofi Pasteur 0.1 mL single-dose prefilled microinjection system 18 through 64 years NR No ID**
Inactivated Influenza Vaccines, trivalent (IIV3s), standard-dose†
Afluria Seqirus 0.5 mL prefilled syringe ≥5 years NR No IM
5.0 mL multidose vial ≥5 years (by needle/syringe)
18 through 64 years (by jet injector)		 24.5 No IM
Fluvirin Seqirus 0.5 mL prefilled syringe ≥4 years ≤1 Yes†† IM
5.0 mL multidose vial ≥4 years 25 No IM
Adjuvanted inactivated influenza vaccine, trivalent (aIIV3),† standard-dose
Fluad Seqirus 0.5 mL prefilled syringe ≥65 years NR Yes†† IM
Inactivated Influenza Vaccine, trivalent (IIV3), high-dose§§
Fluzone High-Dose Sanofi Pasteur 0.5 mL prefilled syringe ≥65 years NR No IM
Recombinant Influenza Vaccine, quadrivalent (RIV4)¶¶
Flublok Quadrivalent Protein Sciences 0.5 mL prefilled syringe ≥18 years NR No IM
Recombinant Influenza Vaccine, trivalent (RIV3)¶¶
Flublok Protein Sciences 0.5 mL single-dose vial ≥18 years NR No IM
Live Attenuated Influenza Vaccine, quadrivalent (LAIV4)*** (not recommended for use during the 2017–18 season)
FluMist Quadrivalent MedImmune 0.2 mL single-dose prefilled intranasal sprayer 2 through 49 years NR No NAS

Abbreviations: ACIP = Advisory Committee on Immunization Practices; ID = intradermal; IM = intramuscular; NAS = intranasal; NR = not relevant (does not contain thimerosal).
* Immunization providers should check Food and Drug Administration–approved prescribing information for 2017–18 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm093833.htm. Availability of specific products and presentations might change and differ from what is described in this table and in the text of this report.
† Standard dose intramuscular IIVs contain 15 µg of each vaccine HA antigen (45 µg total for trivalents and 60 µg total for quadrivalents) per 0.5 mL dose.
§ For adults and older children, the recommended site for intramuscular influenza vaccination is the deltoid muscle. The preferred site for infants and young children is the anterolateral aspect of the thigh. Specific guidance regarding site and needle length for intramuscular administration is available in the ACIP General Best Practice Guidelines for Immunization, available at https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html.
Quadrivalent inactivated influenza vaccine, intradermal: a 0.1-mL dose contains 9 µg of each vaccine HA antigen (36 μg total).
** The preferred injection site is over the deltoid muscle. Fluzone Intradermal Quadrivalent is administered per manufacturer’s instructions using the delivery system included with the vaccine.
†† Syringe tip cap might contain natural rubber latex.
§§ High-dose IIV3 contains 60 μg of each vaccine antigen (180 μg total) per 0.5 mL dose.
¶¶ RIV contains 45 μg of each vaccine HA antigen (135 μg total for trivalent 180 μg total for quadrivalent) per 0.5 mL dose.
***ACIP recommends that FluMist Quadrivalent (LAIV4) not be used during the 2017–18 season.

TABLE 2. Contraindications and precautions to the use of influenza vaccines — United States, 2017–18 influenza season*

Vaccine type Contraindications Precautions
IIV History of severe allergic reaction to any component of the vaccine† or after previous dose of any influenza vaccine Moderate-to-severe acute illness with or without fever
History of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine
RIV History of severe allergic reaction to any component of the vaccine Moderate-to-severe acute illness with or without fever
History of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine
LAIV
For the 2017–18 season, ACIP recommends that LAIV not be used. Content is provided for information. 		History of severe allergic reaction to any component of the vaccine† or after a previous dose of any influenza vaccine
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 the previous 48 hours		 Moderate-to-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 after wild-type influenza infection (e.g., chronic pulmonary, cardiovascular [except isolated hypertension], renal, hepatic, neurologic, hematologic, or metabolic disorders [including diabetes mellitus])

Abbreviations: ACIP = Advisory Committee on Immunization Practices; IIV = Inactivated Influenza Vaccine; LAIV = Live-Attenuated Influenza Vaccine; RIV = Recombinant Influenza Vaccine.
* Immunization providers should check Food and Drug Administration–approved prescribing information for 2017–18 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, and precautions. Package inserts for US-licensed vaccines are available at https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm093833.htm.
† History of severe allergic reaction (e.g., anaphylaxis) to egg is a labeled contraindication to the use of IIV and LAIV. However, ACIP recommends that any licensed, recommended, and appropriate IIV or RIV may be administered to persons with egg allergy of any severity (see Persons with a History of Egg Allergy).

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