Flu Vaccines for 2019-2020

New NACI flu vaccine recommendations for 2019-20 are available. The composition of the vaccine for 2019-20 is different from 2018-19. There are no changes to the influenza B virus components (the “extra” B virus component in the quadrivalent vaccine is also the same).1-3 Vaccination is recommended for all persons age six months and older, including pregnant women.1 A quadrivalent formulation should be used in all children six months through 17 years, if available.1 For patients 65 years of age and older, offer the high-dose IIV3 over standard-dose IIV3, but any age-appropriate vaccine can be used.1 As in past years, children ages six months through eight years who have never received the flu shot before will require two doses of vaccine, at least four weeks apart.1 LAIV (FluMist) will NOT be available in Canada this season due to manufacturing issues.1 All influenza vaccines, including LAIV (not available for the 2019-20 season), may be given at the same time as, or at any time before or after, administration of other vaccines.1 In theory, there may be more adverse effects when an adjuvanted flu vaccine (e.g., Fluad) is given with another adjuvanted vaccine (e.g., Shingrix).8 The following table summarizes characteristics of the influenza vaccines authorized for use in Canada for the 2019-2020 flu season. The full guidelines can be accessed at https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/healthy-living/canadian-immunization-guide-statement-seasonal-influenza-vaccine-2019-2020/NACI_Stmt_on_Seasonal_Influenza_Vaccine_2019-2020_v12.3_EN.pdf. Note that each province/territory determines which vaccines will be covered by publicly funded programs.

Abbreviations: CTAB = cetyltrimethyl-ammonium bromide; FFU = fluorescent focus units; GSK = GlaxoSmithKline; HA = haemagglutinin; IIV3 = trivalent influenza inactivated vaccine (previously abbreviated TIV); IM = intramuscular; LAIV = live attenuated influenza vaccineb; n/a = not applicable; NACI = National Advisory Committee on Immunization.

Chart is adapted from the NACI statement (reference 1).

Product Characteristics

Trivalent Inactivated Vaccines

Quadrivalent Inactivated Vaccines

Product Name

Fluviral

Agriflu

Fluad and Fluad Pediatric

Fluzone High-Dosed

Influvac Tetra4

Afluria Tetra

Flulaval Tetra

Fluzone Quadrivalent

Manufacturer

GSK

Seqirus

Seqirus

Sanofi Pasteur

BGP Pharma

Seqirus

GSK

Sanofi Pasteur

Vaccine Type

split virus

subunit

subunit

split virus

subunit

split virus

split virus

split virus

Route of Administration

IM

IM

IM

IM

IMa

IM

IM

IM

Authorized Ages for Use

6 months and older

6 months and older

6 to 23 months (peds); 65 years and older (adult)

65 years and older

18 years and older

5 years and older

6 months and older

6 months and older

Antigen Content (of each strain per 0.5 mL dose, unless otherwise specified)

15 mcg HA

15 mcg HA

Pediatric: 7.5 mcg HA per 0.25 mL dose

Adult 15 mcg HA

60 mcg HA

15 mcg HA

15 mcg HA

15 mcg HA

15 mcg HA

Adjuvant

No

No

MF59 (oil in water emulsion)

No

No

No

No

No

Formats Available

5 mL multidose vial

5 mL multidose vial, single-dose pre-filled syringe (no needle)

Single-dose pre-filled syringe
(no needle)

Single-dose pre-filled syringe (no needle)6

Single-dose pre-filled syringe (with or without a needle)

5 mL multi-dose vial, single-dose pre-filled syringe (no needle)

5 mL multidose vial, single-dose pre-filled syringe

5 mL multidose vial, single-dose pre-filled syringe (no needle), single-dose vial

Shelf-Life After Vial Puncture

28 days

28 days

n/a

n/a

n/a

28 days7

28 days

Until expiry on vial

Thimerosal

Yes

Yes (multi-dose vial)

No

No

No

Yes (multi-dose vial)

Yes (multi-dose vial)

Yes (multidose vial)

Antibiotics (traces)

None

Kanamycin and neomycin

Kanamycin and neomycin

None

Gentamicin (or neomycin and polymyxin B)

Neomycin and polymyxin B

None

None

Other Clinically Relevant Nonmedicinal Ingredientse

Egg protein,c alpha-tocopheryl hydrogen succinate, ethanol formalde-hyde, polysorbate 80, sodium deoxycholate, sucrose

Egg protein,c CTAB, formaldehyde, hydro-cortisone, polysorbate 80

Egg protein,c barium, CTAB, formaldehyde, hydro-cortisone, polysorbate 80

Egg protein,c formalde-hyde, Triton X-100

Egg and chicken protein,c CTAB, formaldehyde, hydro-cortisone, polysorbate 80, sucrose

Egg protein,c sodium tauro-deoxychloate, sucrose

Egg protein,c alpha-tocopheryl hydrogen succinate, ethanol, formalde-hyde, sodium deoxycholate, polysorbate 80, sucrose

Egg protein,c formalde-hyde, Triton X-100

 

  1. Product monograph lists deep subcutaneous injection as an alternate route of administration.4
  2. LAIV (not available for the 2019-2020 season) is contraindicated in immunocompromised patients, those with severe asthma (taking oral or high-dose inhaled glucocorticosteroids or actively wheezing) or with medically attended wheezing within the previous seven days, during pregnancy, and in children two to 17 years of age taking aspirin. Delay aspirin therapy for four weeks after LAIV.1
  3. Egg allergic patients can receive any flu vaccine that is appropriate for the patient without a prior vaccine skin test and in any settings where vaccines are routinely administered.1
  4. Fluzone High-Dose: For adults 65 and older, the high-dose trivalent vaccine should be more effective and likely prevents one more confirmed flu case for every 200 standard vaccine doses given. May cause more local reactions and flu-like symptoms.5
  5. Consult product monograph for complete listing of nonmedicinal ingredients and excipients.

 

Project Leader in preparation of this clinical resource (351015): Annette Murray, BScPharm

References

  1. Public Health Agency of Canada. An Advisory Committee Statement (ACS). National Advisory Committee on Immunization (NACI). Canadian immunization guide chapter on influenza and statement on seasonal influenza vaccine for 2019-2020. August 16, 2019. https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/canadian-immunization-guide-statement-seasonal-influenza-vaccine-2019-2020.html. (Accessed September 6, 2019).
  2. World Health Organization. Recommended composition of influenza virus vaccines for use in the 2019-2020 northern hemisphere influenza season. March 2019. https://www.who.int/influenza/vaccines/virus/recommendations/2019_20_north/en/. (Accessed September 6, 2019).
  3. World Health Organization. Recommended composition of influenza virus vaccines for use in the 2018-2019 northern hemisphere influenza season. February 2018. http://www.who.int/influenza/vaccines/virus/recommendations/201802_recommendation.pdf?ua=1. (Accessed September 6, 2019).
  4. Product monograph for Influvac Tetra. BCP Pharma. Etobicoke, ON M8Z 2S6. March 2019.
  5. Public Health Agency of Canada. An Advisory Committee Statement (ACS). National Advisory Committee on Immunization (NACI). A review of the literature of high dose seasonal influenza vaccine for adults 65 years and older. Modified April 11, 2016. http://www.phac-aspc.gc.ca/naci-ccni/influenza-vaccine-65-plus-vaccin-contre-la-grippe-65-plus-eng.php. (Accessed September 10, 2019).
  6. Product monograph for Fluzone High-Dose. Sanofi Pasteur. Toronto, ON M2R 3T4. April 2019.
  7. Product monograph for Afluria Tetra. Seqirus Canada. Ottawa, ON K1P 6L5. February 2019.
  8. CDC. Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices – United States, 2019-2020 influenza season. Updated August 23, 2019. https://www.cdc.gov/mmwr/volumes/68/rr/rr6803a1.htm. (Accessed September 11, 2019).

Cite this document as follows: Clinical Resource, Flu Vaccines for 2019-2020. Pharmacist’s Letter/Pharmacy Technician’s Letter. October 2019.

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