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​​Influenza Implementation Guidance


Updated September 2020

​Supply

Influenza Products

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




≥36 mo



≥6 mo



0.25-mL prefilled syringea

(7.5 μg/0.25 mL)

0.5-mL prefilled syringe

(15 μg/0.5 mL)

5.0-mL multidose vialb

(15 μg/0.5 mL)
0




0



24.5





90686




90688



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

Quadrivalent 

Seqirus
≥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

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