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).
