For the 2020-21 influenza season, all inactivated influenza and live attenuated influenza vaccines for children in the United States will be quadrivalent vaccines, with specific age indications for available formulations. The vaccine formulations available for children 6 through 35 months of age have been updated.
6-35 months
Afluria Quadrivalent will be the only vaccine for children 6 through 35 months of age with a dosing volume of 0.25 mL.
>36 months
Fluzone Quadrivalent, which is licensed in a 0.25-mL and a 0.5-mL dosing volume, will likely be available only in a 0.5-mL dosing volume for this age group this season. The dosing volume for the 2 other vaccines available for this age group, Fluarix and FluLaval, is 0.5 mL.
The AAP has no preference for one product over another. In the
AAP influenza statement, the types of vaccine available for children are described and Table 3, extracted below, provides information on recommended vaccines for different age groups.
Table 3. Recommended Seasonal Influenza Vaccines for Different Age Groups: United States, 2020–2021 Influenza Season
Vaccine
| Trade Name
(Manufacturer)
| Age Group
| Presentation
Hemagglutinin Antigen Content (IIVs and RIV4) or Virus Count (LAIV4) per dose for Each Antigen
| Thimerosal Mercury Content
(μg Hg/0.5-mL dose)
| CPT Code
|
Quadrivalent Standard Dose – Egg-Based Vaccines
|
|
| | | | |
IIV4
| Afluria
Quadrivalent (Seqirus)
| 6 through 35 mo
| 0.25-mL prefilled syringea
(15 μg/0.5 mL)
| 0
|
|
IIV4
| Fluarix
Quadrivalent (GlaxoSmithKline)
| ≥6 mo
| 0.5-mL prefilled syringe
(15 μg/0.5 mL)
| 0
| 90686
|
IIV4
| FluLaval
Quadrivalent
(GlaxoSmithKline)
| ≥6 mo
| 0.5-mL prefilled syringe
(15 μg/0.5 mL)
| 0
| 90686
90688
|
IIV4
| Fluzone
Quadrivalent (Sanofi Pasteur)
| ≥6 mo
≥6 mo
≥6 mo
| 0.5-mL prefilled syringe
(15 μg/0.5 mL)
0.5-mL single-dose vial
(15 μg/0.5 mL)
5.0-mL multidose vialb (15 μg/0.5 mL)
| 0
0
25
| 90686
90687
90688
|
Quadrivalent Standard Dose – Cell-Based Vaccines
|
ccIIV4
| Flucelvax Quadrivalent (Seqirus)
| ≥4 y
≥4 y
| 0.5-mL prefilled syringe
(15 μg/0.5 mL)
5.0 mL multidose vial (15 μg/0.5 mL)
| 0
25
| 90674
90756
|
Standard Dose – Egg-Based With Adjuvant Vaccines
|
aIIV3
MF-59
adjuvanted
| Fluad
Trivalent
Seqirus
| ≥65 y
| 0.5-mL prefilled syringe (15 μg/0.5 mL)
| 0
| 90653
|
aIIV4
MF-59
adjuvanted
| Fluad
| ≥65 y
| 0.5-mL prefilled syringe (15 μg/0.5 mL)
| 0
| 90653
|
Quadrivalent High Dose – Egg-Based Vaccine
|
IIV4
| Fluzone
High-Dose
(Sanofi Pasteur)
| ≥65 y
| 0.7-mL prefilled syringe (60 μg/0.7 mL)
| 0
| 90682
|
Recombinant Vaccine
|
RIV4
| Flublok
Quadrivalent
(Sanofi Pasteur)
| ≥18 y
| 0.5-mL prefilled syringe (45 μg/0.5 mL)
| 0
| 90682
|
Live Attenuated Vaccine
|
LAIV4
| FluMist Quadrivalent (MedImmune)
| 2–49 y
| 0.2-mL prefilled intranasal sprayer (Virus dose: 10 6.5–7.5 FFU/0.2 mL)
| 0
| 90672
|
a For Afluria Quadrivalent, children 6 through 35 months of age should receive 0.25 mL per dose; people ≥36 months (≥3 years) of age should receive 0.5 mL per dose.
b For vaccines that include a multidose vial presentation a maximum of 10 doses can be drawn from a multidose vial.
c Note: The 7.5-μg/0.25-mL dosing volume is no longer available this season.
Data sources: Centers for Disease Control and Prevention. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2020–2021 influenza season. MMWR Recomm Rep. 2020; in press.
Implementation guidance on supply, pricing, payment, CPT coding, and liability issues can be found at www.aapredbook.org/implementation
Tools and Resources
Influenza Vaccine Availability Tracking System (IVATS) – Each year, the Immunization Action Coalition's Influenza Summit hosts IVATS, which serves to connect providers seeking influenza vaccine to distributors and manufacturers (those who sell direct to customers) who have influenza vaccine.
Vaccine Products and Ordering – The Influenza Summit has provided information on how vaccine can be ordered and from whom.
Manufacturers