immunization ce 1.2018 nhc handout version
TRANSCRIPT
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KristyBrittain,PharmD,BCPS,CDEAssociateProfessor,MUSCCollegeofPharmacy
ClinicalPharmacySpecialist,MedicalUniversityofSC
Diclosures� KristyBrittainhasnoconflictofinteresttoreport.
Objectives� Describerecentchangesinadultandpediatricimmunizations
� Discussspecificstoragerequirementsforvaccines� Applyimmunizationrecommendationstospecificpatients
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TipsinImprovingVaccineRates� Communicatingwithotherhealthcareproviders
� Directreferralforservices
� Stayingup-to-datewithrecommendations
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PattyWatkins
Age:65years Gender:Female
PMH Type2diabetesx4yearsHypertensionx10years
Medications Metformin850mgtwicedailyLantus15unitsSQQHSLisinopril40mgoncedaily
VaccineHistory Influenza(IIV3)Oct2016Influenza(IIV3)Nov2015Influenza(IIV3)Dec2014Zoster(Zostavax)1doseDec2014
Otherinformation NKDA
PattyWatkins� HowwillwedeterminewhatvaccinesPattyneeds?� Wherecanwefindthisinformation?
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VaccinationinDiabetesADAStandardsofCareGuidelines(2018)Recommendation:� Provideroutinevaccinationsforchildrenandadultswithdiabetesasforthegeneralpopulationaccordingtoage-relatedrecommendations.
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FluSeason2017-2018
http://www.cdc.gov/flu/weekly/
FluSeason2017-2018
2017-2018InfluenzaFormulaTrivalentvaccineincludes:� A/Michigan/45/2015(H1N1)� A/HongKong/4801/2014(H3N2)� B/Brisbane/60/2008
Quadrivalentincludestheseplus:� B/Phuket/3073/2013
http://www.who.int/influenza/vaccines/virus/recommendations/2017_18_north/en/
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InfluenzaRecommendations� Annualvaccinationforallpersonsaged6monthsandolderwhodonothaveanycontraindications� Shouldoccurbeforeonsetofinfluenzaactivityincommunity
� BeginvaccinatingassoonasthevaccinebecomesavailableandbyOctoberifpossible
� Children6monthsto8yearsshouldreceive2dosesifthisisthefirstyearthevaccineisreceived� Seconddoseshouldbegiven4weeksafterinitialdose
InfluenzaVaccineLiveattenuatedinfluenzavaccine(LAIV)� NOTCURRENTLYRECOMMENDED!Inactivatedinfluenzavaccine(IIV)� Contains“dead”virus� Unabletocauseinfluenza� Contains3(trivalent)or4(quadrivalent)strains
AppropriateVaccineSelection� Agerestriction� IIV3vsIIV4� Eggallergy?� Specificvaccineeligibility
� Fluad� FluzoneHD
� Patientpreference� Needlefear
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Brand(Manufacturer) Type RouteofAdmin Approvedforages
AfluriaAfluriaQuad(Seqirus)
IIV3IIV4
IM 9+years18+years
Fluad(Seqirus)
aIIV3 IM 65+years
FluarixQuad(GSK)
IIV4 IM 6+months(PFS)3+years(MDV)
FluBlokFluBlokQuad(ProteinSciences)
RIV3RIV4
IM
18+years
FlucelvaxQuad(Novartis)
ccIIV4 IM 4+years
FluLavalFluLavalQuad(IDBiomedCorp)
IIV3IIV4
IM 3+years
FluMistQuad(MedImmune)
LAIV4 Intranasal 2-49years
Fluvirin(Seqirus)
IIV3 IM 4+years
FluzoneQuadFluzoneIDFluzoneHD(SanofiPasteur)
IIV4IIV4
IIV3-HD
IMIntradermal
IM
6+months18-64years65+years
PattyWatkins
Age:65years Gender:Female
PMH Type2diabetesx4yearsHypertensionx10years
Medications Metformin850mgtwicedailyLantus15unitsSQQHSLisinopril40mgoncedaily
VaccineHistory Influenza(IIV3)Oct2016Influenza(IIV3)Nov2015Influenza(IIV3)Dec2014Zoster(Zostavax)1doseDec2014
Otherinformation NKDA
PattyWatkins� WhatarewegoingtorecommendtoPattyforherinfluenzavaccination?
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Brand(Manufacturer) Type RouteofAdmin Approvedforages
AfluriaAfluriaQuad(Seqirus)
IIV3IIV4
IM 9+years18+years
Fluad(Seqirus)
aIIV3 IM 65+years
FluarixQuad(GSK)
IIV4 IM 6+months(PFS)3+years(MDV)
FluBlokFluBlokQuad(ProteinSciences)
RIV3RIV4
IM 18+years
FlucelvaxQuad(Novartis)
ccIIV4 IM 4+years
FluLavalFluLavalQuad(IDBiomedCorp)
IIV3IIV4
IM 3+years
FluMistQuad(MedImmune)
LAIV4 Intranasal 2-49years
Fluvirin(Seqirus)
IIV3 IM 4+years
FluzoneQuadFluzoneIDFluzoneHD(SanofiPasteur)
IIV4IIV4
IIV3-HD
IMIntradermal
IM
6+months18-64years65+years
PattyWatkins
Age:65years Gender:Female
PMH Type2diabetesx4yearsHypertensionx10years
Medications Metformin850mgtwicedailyLantus15unitsSQQHSLisinopril40mgoncedaily
VaccineHistory Influenza(IIV3)Oct2016Influenza(IIV3)Nov2015Influenza(IIV3)Dec2014Zoster(Zostavax)1doseDec2014
Otherinformation NKDA
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InfluenzaWhereshouldinfluenzavaccinesbestoredinthepharmacy?A. FridgeB. FreezerC. Shelf(room-temperature)
InfluenzaHowsoonshouldpatientsstartreceivingtheinfluenzavaccine?A. AssoonasitsavailableB. September1stC. October1stD. October15th
InfluenzaWhatisthemostappropriatestartingageforinfluenzavaccinationinchildren?A. 3monthsB. 6monthsC. 12monthsD. 18months
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InfluenzaHowcanwescreenpatientsforinfluenzavaccine?Whattechniquesareusedinyourpracticetoincreasevaccinationrates?
TypesofPneumococcalVaccinePneumococcalConjugateVaccine(PCV13)–targets13pneumococcalserotypesthatcausediseaseinchildren–PCVisdesignedtobeadministeredtochildrenage5andyounger
• ReplacedPCV7
PneumococcalPolysaccharideVaccine(PPSV23)–contains23pneumococcalbacterialserotypesknowtocause85%-90%ofinfections
• UsedinadultsonlyaschildrenwillnotmountaneffectiveimmuneresponsetoPPSV
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PneumococcalRecommendationsPCV13recommendedfor:• Children<5yearsold• Adults65+yearsold• Age6to64yearsoldwithcertainmedicalconditionsresultinginimmunosuppression
Immunocompromised=HIVinfectionChronicrenalfailureOrgantransplantLeukemiaLymphoma
Is Patty a candidate for PCV13?
PneumococcalRecommendationsPCV13recommendedfor:• Children<5yearsold• Adults65+yearsold• Age6to64yearsoldwithcertainmedicalconditionsresultinginimmunosuppression
PPSV23recommendedfor:• Adults65+yearsold• Age2+yearsoldwithhighriskforpneumococcaldiseasesuchassicklecelldiseaseandHIVinfection• Age19to64yearsoldwhosmokecigarettesorhaveasthma,includingdiabetes
Is Patty a candidate for PPSV23?
PneumococcalIntervals
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6434a4.htm
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PneumococcalIntervals
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6434a4.htm
PattyWatkins
Age:65years Gender:Female
PMH Type2diabetesx4yearsHypertensionx10years
Medications Metformin850mgtwicedailyLantus15unitsSQQHSLisinopril40mgoncedaily
VaccineHistory Influenza(IIV3)Oct2016Influenza(IIV3)Nov2015Influenza(IIV3)Dec2014Zoster(Zostavax)1doseDec2014
Otherinformation NKDA
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PneumococcalWhereshouldPCV13andPPSV23vaccinesbestoredinthepharmacy?A. FridgeB. FreezerC. Shelf(room-temperature)
PneumococcalIfapatient(over65years)needsbothPCV13andPPSV23(andhasneverreceivedeitherbefore),whatistheappropriatedosinginterval?A. PCV13first,wait6months,thenPPSV23B. PPSV23first,wait1yearthenPCV13C. PCV13first,wait1yearthenPPSV23D. PPSV23andPCV13givenonthesameday
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PneumococcalWhichofthefollowingconditionswarrantrevaccinationafter5yearsforPCV13orPPSV23?A. AlcoholismB. CigarettesmokingC. SolidorgantransplantationD. Diabetesmellitus
PneumococcalIdentifythebrandname:PCV13PPSV23
PneumococcalHowcanwescreenpatientsforpneumococcalvaccine?Whattechniquesareusedinyourpracticetoincreasevaccinationrates?
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HepatitisBVaccineIndicationsforhepatitisBvaccine� Patientswithdiabetes� Healthcareprofessionals� Patientsw/ESRDoronhemodialysis,chronicliverdisease� DiagnosedorseekingtreatmentforSTIsorMSM� InternationalTravelers
HepatitisBVaccineDosingschedule:� 0,1,4-6monthsProductsavailability:� EngerixB� RecombivaxHB� Twinrix(HepAandHepB)
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PattyWatkins� HowwillweschedulePatty’svaccinesforhepatitisB?
PattyWatkins� WhatarePatty’sTdapneeds?
� Whatfollowupwouldsherequire?
PattyWatkins
Age:65years Gender:Female
PMH Type2diabetesx4yearsHypertensionx10years
Medications Metformin850mgtwicedailyLantus15unitsSQQHSLisinopril40mgoncedaily
VaccineHistory Influenza(IIV3)Oct2016Influenza(IIV3)Nov2015Influenza(IIV3)Dec2014Zoster(Zostavax)1doseDec2014
Otherinformation NKDA
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PattyWatkins� WhatarePatty’szosterneeds?
� Whatfollowupwouldsherequire?
Shingrix(ZosterVaccineRecombinant,Adjuvanted)Whoshouldgetit?
� Shingrix®isrecommendedforthepreventionofherpeszosterandrelatedcomplicationsforimmunocompetentadults50andolder,eveniftheyhavepreviouslyreceivedZostavax®
� PreferredoverZostavax®forthepreventionofherpeszosterandrelatedcomplications
� Thisvaccineisnottobeusedforthetreatmentofzoster,post-herpeticneuralgiaorforpreventionofprimaryvaricella
� A2doseseriesofIMinjections(0.5mLeach),withtheseconddosegiven2to6monthsafterthefirst
Shingrix(ZosterVaccineRecombinant,Adjuvanted)WhatifIwaspreviouslyvaccinatedwithZostavax®?DoIstillneedShingrix?
� Shingrix®isrecommendedforthepreventionofherpeszosterandrelatedcomplicationsforimmunocompetentadults50andolder,eveniftheyhavepreviouslyreceivedZostavax®
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Shingrix(ZosterVaccineRecombinant,Adjuvanted)Whatarethemostcommonsideeffects?
� ThemostcommonsideeffectsseenwiththeShingrix®vaccinearepain,redness,orswellingattheinjectionsite.Systemicsideeffectsmayincludemyalgia,fatigue,headache,shivering,orfever.Thesereactionsaretransientandusuallylastfrom1to3days.
Shingrix(ZosterVaccineRecombinant,Adjuvanted)Howwellarepeoplecoveredafterthefirstdose?
� WhilenumbersofpatientswhoreceivedonlyonedosewereprovidedinthephaseIIIapprovalstudies,anevaluationontheefficacywasnotelucidated
� ItwasdeterminedthatasuboptimalimmuneresponsewasnotedafteronlyoneinjectionoftheShingrix®vaccine
Shingrix(ZosterVaccineRecombinant,Adjuvanted)UpdateonavailabilityinUSMarket
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PattyWatkins-RecapTime Vaccines
Today FluPPSV13HZV(Shingrix)HepB1Tdap
1month HepB24months HepB3
HZV(Shingrix)1year PCV23Yearly FluEvery10years Tdbooster
SherieJohnsonAge:33years Gender:Female
PMH Pregnant(28weeks)Thyroiddisorder
Medications Levothyroxine100mcgoncedailyPrenatalvitaminoncedailywithdinnerEpi-penprnanaphylaxis
VaccineHistory Influenza(RIV3)Dec2016TdapJan2015TdFeb2014HepB3doseseries(2010)
Otherinformation Allergies:Eggs/Milk(hives/rash)Currentlypregnant(28weeks)Previousvaginalchildbirth(2.5yearsago)Returningtoschooltoearnherdoctorateinnursing.
SherieJohnson� HowwillwedeterminewhatvaccinesSherieneeds?� Wherecanwefindthisinformation?
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Brand(Manufacturer) Type RouteofAdmin Approvedforages
AfluriaAfluriaQuad(Seqirus)
IIV3IIV4
IM 9+years18+years
Fluad(Seqirus)
aIIV3 IM 65+years
FluarixQuad(GSK)
IIV4 IM 6+months(PFS)3+years(MDV)
FluBlokFluBlokQuad(ProteinSciences)
RIV3RIV4
IM
18+years
FlucelvaxQuad(Novartis)
ccIIV4 IM 4+years
FluLavalFluLavalQuad(IDBiomedCorp)
IIV3IIV4
IM 3+years
FluMistQuad(MedImmune)
LAIV4 Intranasal 2-49years
Fluvirin(Seqirus)
IIV3 IM 4+years
FluzoneQuadFluzoneIDFluzoneHD(SanofiPasteur)
IIV4IIV4
IIV3-HD
IMIntradermal
IM
6+months18-64years65+years
EggAllergyandInfluenza
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EggAllergyandInfluenza
EggAllergyandInfluenza
Brand(Manufacturer) Type RouteofAdmin Approvedforages
AfluriaAfluriaQuad(Seqirus)
IIV3IIV4
IM 9+years18+years
Fluad(Seqirus)
aIIV3 IM 65+years
FluarixQuad(GSK)
IIV4 IM 6+months(PFS)3+years(MDV)
FluBlokFluBlokQuad(ProteinSciences)
RIV3RIV4
IM
18+years
FlucelvaxQuad(Novartis)
ccIIV4 IM 4+years
FluLavalFluLavalQuad(IDBiomedCorp)
IIV3IIV4
IM 3+years
FluMistQuad(MedImmune)
LAIV4 Intranasal 2-49years
Fluvirin(Seqirus)
IIV3 IM 4+years
FluzoneQuadFluzoneIDFluzoneHD(SanofiPasteur)
IIV4IIV4
IIV3-HD
IMIntradermal
IM
6+months18-64years65+years
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SherieJohnsonAge:33years Gender:Female
PMH Pregnant(28weeks)Thyroiddisorder
Medications Levothyroxine100mcgoncedailyPrenatalvitaminoncedailywithdinnerEpi-penprnanaphylaxis
VaccineHistory Influenza(RIV3)Dec2016TdapJan2015TdFeb2014HepB3doseseries(2010)
Otherinformation Allergies:Eggs/Milk(hives/rash)Currentlypregnant(28weeks)Previousvaginalchildbirth(2.5yearsago)
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TdapRecommendations� Foreveryone11yearsandolder,includingpregnantwomen
� DTaPisforchildren2monthsthrough6yearsofage
CDCrecommendsthatpregnantwomenreceivetheTdapvaccineduringthethirdtrimesterofeachpregnancy.
When should Sherie receive the Tdap?
TdapRecommendations� Tdapshouldbegivenbetween27and36weeksgestation,althoughitmaybegivenatanytimeduringpregnancy.
� Currentavailabledatasuggestsearlierinthe27-36weekwindowwillmaximizeantibodytransfertotheinfant.
� Antibodiesarehighest2weeksafterreceivingthevaccine.
TdapRecommendations� HowcanwescreenpatientsforneedingTdapvaccination?
� WhoelsecanwetargettoreceiveTdapvaccination?
� Howcanthisbeaccomplished?
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SherieJohnson-RecapTime Vaccines
Today FluTdap
Yearly Flu
WaltWhitmanAge:66years Gender:Male
PMH: COPDType2DiabetesProstateCancer(diagnosed7/1/17)
Medications Metformin1000mgBIDStioltotwoinhalationsdailyProairPRNLeuprolide7.5mgIMmonthly
VaccineHistory
FullchildhoodvaccinationsInfluenza(RIV3),October2016Nootherimmunizationsasanadult.
Otherinformation
ReceivingradiationtherapyforprostateCANKDA
VaccineRecommendationsGivenWW’smedicalhistory,whichvaccinesshouldheeventuallyreceive?A. Zostavax,PCV13,HepatitisB,TdapB. Zostavax,PPSV23,HepatitisA/B,TdapC. PCV13,HepatitisB,TdD. PPSV13,HepatitisA/B,Td
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During Chemotherapy/
Radiation
Post radiation
VaccineRecommendationsWhenshouldWWreceivethesevaccinations?A. AllshouldbegivennowB. Giveinactivatedvaccinesnow,givelivevaccines3monthspostradiationC. Giveallvaccinesat3monthspostradiationD. Giveinactivatedvaccinesat3monthspostradiationandlivevaccinesat6months
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VaccineRecommendations� Zoster� PCV13� HepatitisB� Tdap� MMR
*Given3monthsaftertheterminationofradiationtherapy*
PearlsforImmunizingImmunocompromisedPatients
� IDSAandACSbothrecommendinactivatedandlivevaccinesbeadministered3monthsfollowingthecessationofchemotherapy/radiationinmostcases.IfB-cellsuppressivetherapywasused,bothsocietiesrecommendwaiting6months.
� Inactivatedvaccinescanbeadministered,butshouldnotbecountedinthedoseseries,becausepatientsmaybeunabletomounttheimmuneresponsenecessaryforadequateantibodyproduction.
FluShotforWalt?Whatrecommendationscanyoumakeregardinginfluenzavaccination?A. GiveFluadIM3monthspostradiationB. GiveFluMistquadintranasaltodayC. GiveFluBlockwithnextadministrationofradiationD. GiveAfluriaQuadinbetweenradiationcycles
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Brand(Manufacturer) Type RouteofAdmin ApprovedforagesAfluriaAfluriaQuad(Seqirus)
IIV3IIV4
IM 9+years18+years
Fluad(Seqirus)
aIIV3 IM 65+years
FluarixQuad(GSK)
IIV4 IM 6+months(PFS)3+years(MDV)
FluBlokFluBlokQuad(ProteinSciences)
RIV3RIV4
IM
18+years
FlucelvaxQuad(Novartis)
ccIIV4 IM 4+years
FluLavalFluLavalQuad(IDBiomedCorp)
IIV3IIV4
IM 3+years
FluMistQuad(MedImmune)
LAIV4 Intranasal 2-49years
Fluvirin(Seqirus)
IIV3 IM 4+years
FluzoneQuadFluzoneIDFluzoneHD(SanofiPasteur)
IIV4IIV4
IIV3-HD
IMIntradermal
IM
6+months18-64years65+years
� Influenzavaccinemaygiventocancerpatients>6monthsofageunlesstheyare:� 1.undergoingintensivechemotherapy,meaninginduction/
consolidation� 2.ReceivingB-cellantibodies
� Livevaccinesshouldnotbeadministeredduring
radiation/chemotherapybecauseactiveandseriousinfectionshaveoccurredsecondarytolivevaccineuseinthesepatients.
PearlsforImmunizingImmunocompromisedPatients
� AccordingtotheAmericanCancerSociety,influenzavaccinationisbestgiven2weeksbeforechemo/radiationorin-betweencycles.
� Hematopoieticstemcelltransplantrecipientsneedtowaitatleast6monthsbeforereceivinginfluenzavaccine
PearlsforImmunizingImmunocompromisedPatients
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Recommendationsvarywiththetypeofimmunodeficiency.Thefollowingresourcesshouldbeconsultedinprovidingpatientspecificcare:� TheIDSA2013guidelinesVaccinationoftheImmunocompromisedHost.(CID2013;58;1-57)� TheAmericanCancerSociety’s“VaccinationDuringCancerTreatment.”(Cancer.org)� NCCNsupportivecareguidelines
ResourcesforImmunizingImmunocompromisedPatients
MollyFlandersAge:12years Gender:FemalePMH: Chickenpoxatage7
Medications DailyFlintstone'smultivitamin
VaccineHistory
Lastvaccinationsatage6UptodatebyCDCrecommendationsatthattime
Otherinformation
NKDA
VaccinationsforMolly:WhatvaccinationsdoesMollyneedbeforestartingschoolthisyear.Yourecommend:A. Zostavax,PCV13,TdapboosterB. Meningococcal,HPV,TdapboosterC. MMR,HPV,TdapboosterD. Meningococcal,PCV13,Tdapbooster
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FlushotforMollyCanMollygetherflushottoday?Yourecommend:A. Afluriatri-valent,pursuant
toaprescriptionfromPCPB. FluBlockQuad,pursuantto
aprescriptionfromPCPC. FlucelvaxQuad,perstate
protocolD. AfluriaQuad,persate
protocol
Age:12years
Gender:Female
PMH: Chickenpoxatage7
Medications
DailyFlintstone'smultivitamin
VaccineHistory
Lastvaccinationsatage6UptodatebyCDCrecommendationsatthattime
Otherinformation
NKDA
Brand(Manufacturer) Type RouteofAdmin ApprovedforagesAfluriaAfluriaQuad(Seqirus)
IIV3IIV4
IM 9+years18+years
Fluad(Seqirus)
aIIV3 IM 65+years
FluarixQuad(GSK)
IIV4 IM 6+months(PFS)3+years(MDV)
FluBlokFluBlokQuad(ProteinSciences)
RIV3RIV4
IM
18+years
FlucelvaxQuad(Novartis)
ccIIV4 IM 4+years
FluLavalFluLavalQuad(IDBiomedCorp)
IIV3IIV4
IM 3+years
FluMistQuad(MedImmune)
LAIV4 Intranasal 2-49years
Fluvirin(Seqirus)
IIV3 IM 4+years
FluzoneQuadFluzoneIDFluzoneHD(SanofiPasteur)
IIV4IIV4
IIV3-HD
IMIntradermal
IM
6+months18-64years65+years
12/29/17
35
Brand(Manufacturer) Type RouteofAdmin ApprovedforagesAfluriaAfluriaQuad(Seqirus)
IIV3IIV4
IM 9+years18+years
Fluad(Seqirus)
aIIV3 IM 65+years
FluarixQuad(GSK)
IIV4 IM 6+months(PFS)3+years(MDV)
FluBlokFluBlokQuad(ProteinSciences)
RIV3RIV4
IM
18+years
FlucelvaxQuad(Novartis)
ccIIV4 IM 4+years
FluLavalFluLavalQuad(IDBiomedCorp)
IIV3IIV4
IM 3+years
FluMistQuad(MedImmune)
LAIV4 Intranasal 2-49years
Fluvirin(Seqirus)
IIV3 IM 4+years
FluzoneQuadFluzoneIDFluzoneHD(SanofiPasteur)
IIV4IIV4
IIV3-HD
IMIntradermal
IM
6+months18-64years65+years
Brand(Manufacturer) Type RouteofAdmin ApprovedforagesAfluriaAfluriaQuad(Seqirus)
IIV3IIV4
IM 9+years18+years
Fluad(Seqirus)
aIIV3 IM 65+years
FluarixQuad(GSK)
IIV4 IM 6+months(PFS)3+years(MDV)
FluBlokFluBlokQuad(ProteinSciences)
RIV3RIV4
IM
18+years
FlucelvaxQuad(Novartis)
ccIIV4 IM 4+years
FluLavalFluLavalQuad(IDBiomedCorp)
IIV3IIV4
IM 3+years
FluMistQuad(MedImmune)
LAIV4 Intranasal 2-49years
Fluvirin(Seqirus)
IIV3 IM 4+years
FluzoneQuadFluzoneIDFluzoneHD(SanofiPasteur)
IIV4IIV4
IIV3-HD
IMIntradermal
IM
6+months18-64years65+years