Dosage, Administration, and Storage

Influenza Prevention and Control Recommendations

Published for the 2010-11 Influenza Season; Adapted for the 2012-13 Influenza Season

TIV: Dosage, Administration, and Storage

The composition of trivalent inactivated influenza vaccine (TIV) varies according to manufacturer. Age indications for the various available TIV preparations also differ by manufacturer. Package inserts should be consulted for specific age indications and contents. TIV formulations in multidose vials contain the vaccine preservative thimerosal; preservative-free, single-dose preparations also are available. TIV should be stored at 35°F--46°F (2°C--8°C) and should not be frozen. TIV that has been frozen should be discarded. Dosage recommendations and schedules vary according to age group (Table). Vaccine prepared for a previous influenza season should not be administered to provide protection for any subsequent season.

With the exception of Fluzone Intradermal (Sanofi Pasteur), TIV preparations are administered intramuscularly. The preferred site for adults and older children is  the deltoid muscle. Infants and young children should be vaccinated in the anterolateral aspect of the thigh. A needle length should be selected that will ensure intramuscular deposition. Specific guidance regarding recommended injection sites and needle types may be found in the General Recommendations on Immunization.  Fluzone Intradermal is administered intradermally, using the microinjection syringe supplied with the vaccine.

More information about available vaccine products and indications for the 2012-2013 influenza season can be found in the 2012-2013 recommendations.

LAIV: Dosage, Administration, and Storage

Each dose of live-attenuated influenza vaccine (LAIV) contains the same three vaccine antigens used in TIV. However, the antigens are constituted as live, attenuated, cold-adapted, temperature-sensitive vaccine viruses. Providers should refer to the package insert, which contains additional information about the formulation of this vaccine and other vaccine components. LAIV does not contain thimerosal. LAIV is made from attenuated viruses that are able to replicate efficiently only at temperatures present in the nasal mucosa. LAIV recipients might experience nasal congestion or mild fever, which is probably a result of effects of intranasal vaccine administration or local viral replication. However, LAIV does not typically cause the more prominent systemic symptoms of influenza such as high fever, myalgia, and severe fatigue.

LAIV is intended for intranasal administration only and should not be administered by the intramuscular, intradermal, or intravenous route. LAIV is not licensed for vaccination of children aged younger than 2 years or adults aged older than 49 years. LAIV is supplied in a prefilled, single-use sprayer containing 0.2 mL of vaccine. Approximately 0.1 mL (i.e., half of the total sprayer contents) is sprayed into the first nostril while the recipient is in the upright position. An attached dose-divider clip is removed from the sprayer to administer the second half of the dose into the other nostril. LAIV is shipped at 35°F--46°F (2°C--8°C). LAIV should be stored at 35°F--46°F (2°C--8°C) on receipt and can remain at that temperature until the expiration date is reached. Vaccine prepared for a previous influenza season should not be administered to provide protection for any subsequent season.

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