Indications
- One dose should be administered annually. A second dose is not recommended.
- All persons >6 months of age, including those age >65 years and/or with high-risk conditions such as chronic pulmonary (including asthma) or cardiovascular (except hypertension); chronic hepatic, renal disease or hemoglobinopathies; immunosuppression; metabolic disorder (eg, diabetes); neurologic or neuromuscular disorder (eg, cognitive dysfunction, seizures, spinal cord injury).
- All residents of nursing homes or chronic care facilities.
- All household contacts of high-risk adults or those 65+ years.
Contraindications and Precautions
- Any prior anaphylactic reaction to vaccine or components (eg, eggs).
- Do not give live vaccine (LAIV) to persons 50+ years.
- Guillain-Barré syndrome within 6 weeks of a previous dose.
Vaccine Dosing and Administration
Dosing
ACIP recommends that adults aged 65+ preferentially receive any one of the following higher dose or adjuvanted influenza vaccines:
- trivalent high-dose inactivated influenza vaccine (HD-IIV3)-Fluzone, High Dose
- trivalent adjuvanted inactivated influenza vaccine (all IIV3)-Fluad Trivalent
- trivalent recombinant influenza vaccine (RIV3)-Flublok Trivalent
If none of these three vaccines is available at an opportunity for vaccine administration, than any other age-appropriate influenza vaccine should be used, below.
- Inactivated influenza vaccine, quadrivalent (IIV3), standard dose
- Fluarix Trivalent
- FluLaval Trivalent
- Fluzone Trivalent
- Afluria Trivalent
- Flucelvax Trivalent
Administration
- Store at 35–46oF (2–8oC). Do not freeze.
- Vaccinate in deltoid muscle using needle length ≥1 inch (≥25 mm).
- Administer just prior to annual flu season.
Side Effects
- Soreness, redness at injection site lasting 1–2 days
- Joint pain
- Fatigue
- Fever/ chills
- Muscle aches
- Hoarseness, sore or red eyes
- Headache
Talking Points with Patients
- Influenza is a serious respiratory disease and is not the same as the common cold.
- Flu causes 40,000 deaths and 200,000 hospitalizations in the US/year.
- Flu spreads easily to other people, especially those most vulnerable (this includes those who are 65 years and older, immunocompromised, diagnosed with multiple chronic conditions, etc.).
- Vaccination is effective in preventing death and hospitalization…
- in community-dwelling older persons; and
- among patients residing in long-term care institutions.
- Can be given concurrently with the COVID-19 vaccine.