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​​Influenza Implementation Guidance


Updated September 2019

​Supply

Influenza Products

For the 2019-20 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. In the AAP influenza statement, the types of vaccine available for children are described and Table 2, extracted below, provides  information on recommended vaccines for different age groups.  .

Table 2. Recommended Seasonal Influenza Vaccines for Different Age Groups: United States, 2019–2020 Influenza Season

​Vaccine
​Trade Name
​Manufacturer
Presentation
Hemagglutinin Antigen content (IIVs and RIV4) or virus count (LAIV4) per dose for each vaccine virus
​Thimerosal Mercury Content
​Age  Group
​CPT Code

(μg of Hg/0.5-mL dose)
​Inactivated Trivalent

​IIV3

Fluzone High-Dose
​Sanofi Pasteur
​0.5-mL prefilled syringe
(60 μg/0.5 mL)
​0
​≥65 y

​90652

​aIIV3
​Fluad MF-59 adjuvanted
​Seqirus
​0.5-mL prefilled syringe
(15 μg/0.5 mL)
​0
​≥65 y
​90653
Quadrivalent Egg Based

​IIV4
​Fluzone 
Quadrivalent
​Sanofi Pasteur
​0.25-mL prefilled syringe 
(7.5 μg/0.25 mL)
​0
​6–35 mo
​90685

​0.5-mL prefilled syringe
0.5-mL single-dose vial
(15 μg/0.5 mL)
​0
​≥6 mo
​90686

​5.0-mL multidose vial*
(7.5 μg/0.25 mL)
(15 μg/0.5 mL)
​25
​≥6 mo
​90687, 90688
​IIV4
​Fluarix 
Quadrivalent
​GlaxoSmithKline
​0.5-mL prefilled syringe
(15 μg/0.5 mL)
​0
​≥6 mo
​90686
​IIV4
​FluLaval 
Quadrivalent
​ID Biomedical Corporation of Quebec
(distributed by GlaxoSmithKline)
​0.5-mL prefilled syringe
(15 μg/0.5 mL)
​0
​≥6 mo
​90686

​5.0-mL multidose vial
(15 μg/0.5 mL)
​<25
​≥6 mo
​90688
​IIV4
​Afluria 
Quadrivalent
​Seqirus
​.25-mL prefilled syringe
(7.5 μg/0.25 mL)
​0
​6–35 mo


​0.5-mL prefilled syringe
(15 μg/0.5 mL)
​0
​≥36 mo
​90686
​Cell-Based

​ ccIIV4
​Flucelvax Quadrivalent
​Seqirus
​0.5-mL prefilled syringe
​0
​≥4 y
​90674
​Recombinant
​RIV4
​Flublok Quadrivalent
​Protein Sciences Corporation (distributed by Sanofi Pasteur)
​.5-mL prefilled syringe
(45 μg/0.5 mL)
​0
​≥18 y
​90682
Live Attenuated

​LAIV4
​FluMist Quadrivalent
​MedImmune
​0.2-mL prefilled intranasal sprayer
(Virus dose: 10 6.5–7.5 FFU/0.2 mL)
​0
​2–49 y
​90672

*For vaccines that include a multidose vial presentation and a 0.25-mL dose, a maximum of 10 doses can be drawn from a multidose vial.

Data sources: American Academy of Pediatrics, Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2019-2020. Pediatrics. 2019; and 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, 2019–2020 influenza season. MMWR Recomm Rep. 2019; in press.

Influenza Vaccine Supply

Supply Delay

This year the World Health Organization and the Food and Drug Administration decided to delay selection of the A/H3N2 strain to be included in the 2019-2020 seasonal influenza vaccine by one month, due to late-emerging A/H3N2 viruses. Authorities used this time to collect additional data that would help assure the best possible selection of the A/H3N2 strain for inclusion in the 2019-2020 seasonal flu vaccine. Because of this delay, influenza vaccine manufacturers may begin to distribute flu vaccine later than in typical years. Below is a table describing when manufactures anticipate beginning to distribute flu vaccine for the 2019-2020 season. This information was presented at the June 2019 meeting of the Advisory Committee on Immunization Practices.

ManufacturerDistribution Estimated to Begin
AstraZenecaEarly September
GSKMid August
Sanofi PasteurLate August/Early September
Seqirus
Mid August


Supply Shortage for Live-attenuated Influenza Vaccine

The supply of nasal spray flu vaccine will be limited during the 2019-'20 season due to manufacturing constraints, according to AstraZeneca. The reduced supply of FluMist Quadrivalent, a live attenuated influenza vaccine (LAIV), will impact both the public and private sectors, according to a company spokesperson. AstraZeneca plans to spread distribution throughout the season and said the reduced supply will not impact vaccine quality. Centers for Disease Control and Prevention (CDC) officials said the LAIV shortage is not expected to cause an overall shortage of flu vaccine.

Health care providers may need to check with multiple suppliers or purchase a different brand of vaccine. Those replacing LAIV also will need to consider factors like the ages of their patients and the setting for vaccine administration.

There is no change in the recommendations for influenza vaccine administration. In March, the AAP announced it will not have a preference between LAIV and inactivated influenza vaccine next season. The move is a change from the current season in which the AAP considered inactivated influenza vaccine the primary choice, while saying LAIV could be used for children who would not otherwise receive a vaccine.

AAP announced the limited supply of nasal spray flu vaccine to members via AAP News, Nasal spray flu vaccine supply will be limited next season. (Login required)

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