Flu Vaccines for 2021-22

The chart below provides information about approved influenza vaccines for the 2021-22 season including FDA-approved ages for use, route of administration, dose, cost, and which flu vaccines are egg-free or contain thimerosal. See our FAQ, Communicating About Flu Vaccination, to answer questions about efficacy, coadministration with other vaccines, vaccinating patients who are immunocompromised or during pregnancy, and more.

--None of the available flu vaccines for 2021-22 contain latex.--

Brand Name
Manufacturera

Routea

Approved Ages for Usea

Availabilitya
(Cost/doseb)

Contains Thimerosal?a

Dosea

Commentsa

Quadrivalent inactivated (IIV4): protects against two influenza A-like viruses and two influenza B-like viruses.1,3

Afluria Quadrivalent

Seqirus

IM

≥6 months

0.25 mL and 0.5 mL PFS ($18.36)
5 mL MDV ($16.92)

Yes (MDV only)

6-35 months:

  • 0.25 mL

≥36 months:

  • 0.5 mL

Once entered, the MDV should be discarded within 28 days.

PharmaJet Stratis needle-free injector approved for ages 18-64 years.

Fluad Quadrivalent

Seqirus

IM

≥65 years

0.5 mL PFS ($57.64)

No

0.5 mL

This adjuvanted vaccine may be abbreviated aIIV4.3

Adverse effects (e.g., injection site reactions, fatigue, myalgias, headache) seem similar to the previously available trivalent inactivated, adjuvanted vaccine.

Coadministration of adjuvanted vaccines (e.g., Heplisav-B, Shingrix) has not been studied. There are theoretical concerns about more side effects. If a patient is receiving another adjuvanted vaccine, don’t delay flu vaccination if Fluad Quadrivalent is the only flu vaccine available.3

Fluarix Quadrivalent

GSK

IM

≥6 months

0.5 mL PFS ($18.13)

No

0.5 mL

None

Flucelvax Quadrivalent

Seqirus

IM

≥6 months

0.5 mL PFS ($25.64)
5 mL MDV ($24.26)

Yes (MDV only)

0.5 mL

This cell-cultured vaccine may be abbreviated ccIIV4.3

Egg-free

FluLaval Quadrivalent

GSK

IM

≥6 months

0.5 mL PFS ($18.13)

No

0.5 mL

None

Fluzone Quadrivalent

Sanofi Pasteur

IM

≥6 months

0.5 mL PFS and SDV ($18.09)
5 mL MDV ($16.84)

Yes (MDV only)

6-35 months:

  • 0.25 mL or 0.5 mL

≥36 months:

  • 0.5 mL

None

Fluzone Quadrivalent High-Dose

Sanofi Pasteur

IM

≥65 years

0.7 mL PFS ($56.62)

No

0.7 mL

Contains 60 mcg of each virus strain compared to 15 mcg in standard-dose IM vaccines.3

Higher risk of adverse effects (injection site reactions, myalgia, headache) than the previous high-dose, inactivated, trivalent formulation (IIV3) (which had higher risk of adverse effects vs standard dose vaccine).

Quadrivalent recombinant (RIV4): protects against two influenza A-like viruses and two influenza B-like viruses.1,3

Flublok Quadrivalent

Sanofi Pasteur

IM

≥18 years

0.5 mL PFS ($56.62)

No

0.5 mL

Egg-free

Contains 45 mcg of each virus strain compared to 15 mcg in standard-dose IM vaccines.3

Quadrivalent live-attenuated (LAIV4): protects against two influenza A-like viruses and two influenza B-like viruses.1,3

FluMist Quadrivalent

AstraZeneca

Intranasal

2 to 49 years

0.2 mL prefilled intranasal sprayer ($22.95)

No

0.1 mL per nostril

For healthy, non-pregnant patients.2

Has not been studied in patients with severe asthma or active wheezing.

See our FAQ, Communicating About Flu Vaccination, for who should NOT receive this flu vaccine.

  1. Information is from the following U.S. product labeling unless otherwise specified: Afluria Quadrivalent (March 2021); Fluad Quadrivalent (July 2021); Fluarix Quadrivalent (July 2021); Flucelvax Quadrivalent (October 2021); FluLaval Quadrivalent (July 2021); Fluzone Quadrivalent (July 2021); Fluzone Quadrivalent High-Dose (July 2021); Flublok Quadrivalent (July 2021); FluMist Quadrivalent (August 2021).
  2. Pricing based on wholesale acquisition cost (WAC). Medication pricing by Elsevier, accessed September 2021.

Abbreviations: IM = intramuscular; MDV = multidose vial; PFS = pre-filled syringe; SDV = single-dose vial.

References

  1. CDC. Influenza (Flu). Who should and who should not get a flu vaccine. August 24, 2021. https://www.cdc.gov/flu/prevent/whoshouldvax.htm. (Accessed September 24, 2021).
  2. CDC. Influenza (flu). Live attenuated influenza vaccine [LAIV] (the nasal spray flu vaccine). Updated August 3, 2021. https://www.cdc.gov/flu/prevent/nasalspray.htm. (Accessed September 13, 2021).
  3. CDC. Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices, United States, 2021-22 influenza season. August 27, 2021. https://www.cdc.gov/mmwr/volumes/70/rr/rr7005a1.htm. (Accessed September 13, 2021).

Cite this document as follows: Clinical Resource, Flu Vaccines for 2021-22. Pharmacist’s Letter/Prescriber’s Letter. October 2021[371001]

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