Flu Vaccines for 2021-22

The chart below provides information about approved influenza vaccines for the 2021-22 season including Health Canada-approved ages for use, route of administration, dose, 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.

-Chart is adapted from the 2021-22 NACI statement (reference 1)-

Brand Name
Manufacturer

Route

Approved Ages for Use

Availability

Contains Thimerosal?

Dosea

Comments

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

Afluria Tetra

Seqirus

IM

≥5 years

0.5 mL PFS (no needle)

5 mL MDV

Yes (MDV only)

0.5 mL

Once entered, the MDV should be discarded within 28 days. Store opened and unopened vials in the fridge (2 to 8°C).2

Contains trace amounts of neomycin and polymyxin B.

Flucelvax Quad
(vaccine type may be abbreviated IIV4-cc)

Seqirus

IM

≥2 years

0.5 mL PFS (no needle)

5 mL MDV

Yes (MDV only)

0.5 mL

Once entered, the MDV should be discarded within 28 days. Store opened and unopened vials in the fridge (2 to 8°C).3

This cell-cultured vaccine is egg-free.3

FluLaval Tetra

GSK

IM

≥6 months

5 mL MDV

Yes

0.5 mL

Once entered, the MDV should be discarded within 28 days. Store opened and unopened vials in the fridge (2 to 8°C).4

Fluzone Quadrivalent

Sanofi Pasteur

IM

≥6 months

0.5 mL PFS (no needle)

5 mL MDV

Yes (MDV only)

0.5 mL

Once entered, the MDV should be discarded by the expiry on the vial. Store opened and unopened vials in the fridge (2 to 8°C).5

Fluzone High-Dose Quadrivalent
(vaccine type may be abbreviated IIV4-HD)

Sanofi Pasteur

IM

≥65 years

0.7 mL PFS (no needle)

No

0.7 mL

Contains 60 mcg HA of each flu strain/
0.7 mL

Patients 65 years and older were 18% to 24% less likely to have confirmed influenza after receiving IIV3-HD compared to after a IIV3-SD.6

Higher risk of adverse effects (injection site reactions, myalgia, headache) than the previous IIV3-HD (which had higher risk compared to IIV3-SD).

Influvac Tetra

BGP Pharma

IM or deep subcutaneous injection

≥3 years

0.5 mL PFS (with or without a needle)

No

0.5 mL

Contains trace amounts of gentamicin or neomycin and polymyxin B.

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

FluMist Quadrivalent

AstraZeneca

Intranasal

2 to 59 years

0.2 mL prefilled intranasal sprayer

No

0.1 mL per nostril

Contains 106.5-7.5 FFU of LAR/0.2 mL

For healthy, non-pregnant patients.

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

Avoid close association with severely immunocompromised patients for at least two weeks after receiving LAIV4.

Contains trace amounts of gentamicin.

Trivalent inactivated (IIV3): protects against two influenza A-like viruses and one influenza B-like viruses.

Fluad and Fluad Pediatric

(vaccine type may be abbreviated IIV3-Adj)

Seqirus

IM

Pediatric: 6 to 23 months

Adult: ≥65 years

Pediatric: 0.25 mL PFS (no needle)

Adult: 0.5 mL PFS (no needle)

No

Pediatric: 0.25 mL

Adult: 0.5 mL

Adjuvanted with MF59.

May provide modestly greater protection against laboratory-confirmed flu vs non-adjuvanted trivalent vaccine in patients
≥65 years of age (n=227, unable to calculate NNT), [Evidence Level B-2].7

Coadministration of adjuvanted vaccines (e.g., Shingrix) has not been studied. There are theoretical concerns about more adverse effects. If a patient is receiving another adjuvanted vaccine, don’t delay flu vaccination if Fluad is the only flu vaccine available.8

Contains trace amounts of kanamycin and neomycin.

  1. All injectable flu vaccines contain 15 mcg HA of each flu strain/0.5 mL, unless otherwise noted.

Abbreviations: FFU = fluorescent focus units; HA = haemagglutinin; IIV3-HD = trivalent inactivated high-dose; IIV3-SD = trivalent inactivated standard-dose; IM = intramuscular; LAIV = live attenuated influenza vaccine; LAR = live attenuated reassortants; PFS = pre-filled syringe; MDV = multidose vial.

Levels of Evidence

In accordance with our goal of providing Evidence-Based information, we are citing the LEVEL OF EVIDENCE for the clinical recommendations we publish.

Level

Definition

Study Quality

A

Good-quality patient-oriented evidence.*

  1. High-quality RCT
  2. SR/Meta-analysis of RCTs with consistent findings
  3. All-or-none study

B

Inconsistent or limited-quality patient-oriented evidence.*

  1. Lower-quality RCT
  2. SR/Meta-analysis with low-quality clinical trials or of studies with inconsistent findings
  3. Cohort study
  4. Case control study

C

Consensus; usual practice; expert opinion; disease-oriented evidence (e.g., physiologic or surrogate endpoints); case series for studies of diagnosis, treatment, prevention, or screening.

*Outcomes that matter to patients (e.g., morbidity, mortality, symptom improvement, quality of life).

RCT = randomized controlled trial; SR = systematic review [Adapted from Ebell MH, Siwek J, Weiss BD, et al. Strength of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician 2004;69:548-56. http://www.aafp.org/afp/2004/0201/p548.pdf.]

References

  1. Government of Canada. National Advisory Committee on Immunization (NACI). Canadian immunization guide chapter on influenza and statement on seasonal influenza vaccine for 2021-2022. May 31, 2021. https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/canadian-immunization-guide-statement-seasonal-influenza-vaccine-2021-2022.html. (Accessed September 20, 2021).
  2. Product monograph for Afluria Tetra. Seqirus Canada. Kirkland, QC H9H 4M7. April 2021.
  3. Product monograph for Flucelvax Quad. Seqirus Canada. Kirkland, QC H9H 4M7. September 2021.
  4. Product monograph for FluLaval Tetra. GlaxoSmithKline. Mississauga, ON L5N 6L4. April 2021.
  5. Product monograph for Fluzone Quadrivalent. Sanofi Pasteur. Toronto, ON M2R 3T4. April 2021.
  6. 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 22, 2021).
  7. Domnich A, Arata L, Amicizia D, et al. Effectiveness of MF59-adjuvanted seasonal influenza vaccine in the elderly: a systematic review and meta-analysis. Vaccine 2017;35:513-20.
  8. 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 22, 2021).

Cite this document as follows: Clinical Resource, Flu Vaccines 2021-22. Pharmacist’s Letter/Pharmacy Technician’s Letter. October 2021. [371017]