​Inf​luenza Implementation Guidance

Updated September 2020


Each year, pre-booking of influenza (flu) vaccine (ordering doses for the next year's flu season) begins around February, before the current season is over. There are several things to consider when pre-booking to help determine the number of doses needed for the next season. It is helpful to use your electronic health record (EHR) or immunization information system (IIS), as most EHRs and IISs can categorize the number of patients by date of birth, which is important when calculating who will need 2 doses of vaccine. Some considerations for ordering include:

  • Number of children in each age group. Some influenza vaccines are licensed for children as young as 6 months, the earliest age that annual vaccination is recommended. Other age groupings will be determined by the brand of vaccine used.

    • If you use Afluria Quadrivalent® (Seqirus) pre-filled syringes, how many children will be under 36 months or 3+ years by the start of the season?

    • If you use Flucelvax Quadrivalent® (Seqirus), how many children with be 4+ years by the start of the season?
    • If you use Flumist® Quadrivalent (AstraZeneca), how many children with be 2+ years by the start of the season?
  • Approximate number of children who will need 2 doses. This is important to factor into your pre-booking because children who need 2 doses will not be fully protected until they receive the second dose.

    • Children age 6 months through 8 years receiving influenza vaccine for the first time should receive two doses at least 28 days apart.

  • Approximate number of new patients each year. For example, if you have a 3% increase in patients each year, you will want to increase your prebooking order accordingly. For pediatricians, new patients should also include the number of expected newborns who will be 6 months of age by flu season. It's important to remember to plan for babies not yet born and also recognize that these infants will need a second dose.

  • Storage. Sufficient storage space is needed for the vaccines. Some practices may want to consider a separate fridge to use just during flu season. If a vaccine refrigerator is packed too tightly, temperature fluctuations can occur and potentially make the flu vaccine and your other vaccine stock unusable. Remember that prefilled syringes take up more space per dose than multi-dose vials. Consider which you will stock (or how much of each) when you plan your storage needs.

Make sure you have enough needles/syringes on hand. If you use prefilled syringes, you won't need to purchase additional syringes.

Keep in mind the following:
  • Pre-booking period of vaccine manufacturers generally takes place between November 1st – March 31st with the option to continue to place orders after this time, if product is available  

  • Some manufacturers allow providers to sign up for recurring reservations 

  • Manufacturers may offer discounts, other special promotions and/or delivery guarantees to providers who prebook by the deadline 

  • Manufacturers and/or their distributors may offer the flexibility to return up to a certain percentage of a pre-booked order

  • Check with the vaccine manufacturer(s) on the terms related to adjusting an order prior to or following the pre-booking deadline 

Considerations for Vaccines for Children VFC providers:

The pre-booking process for the VFC Program varies state to state. If you participate in the VFC Program, your state immunization program may have specific timelines for when pre-booking should be complete and processes for how pre-book orders are placed. Your VFC program may not be able to guarantee quantity and/or formulation availability of pre-booked influenza vaccine.  VFC providers who do not pre-book may encounter delays in receipt of influenza vaccine. Please refer to your local VFC program.

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