Flu Vaccines for 2023-24

This chart reviews approved influenza vaccines for the 2023-2024 season. It includes approved ages for use, route of administration, dose, cost (US), and egg and thimerosal content. The FAQ that follows answers questions about efficacy, administration with other vaccines, use in patients who are immunocompromised or pregnant, and more.

--None of the available flu vaccines for 2023-24 contain latex.--

Brand Name

Manufacturera

Routea

Approved Ages for Usea

Availabilitya

(US Cost/doseb)

Contains Thimerosal?a

Dosea

Commentsa

Quadrivalent inactivated (IIV4): protects against two influenza A-like viruses and two influenza B-like viruses.4,24,27

US: Afluria

Quadrivalent

Canada: Afluria Tetra

Seqirus

IM

US: ≥6 months

Canada: ≥5 years

0.5 mL PFS

(~$20)

5 mL MDV

(~$19)

Yes

(MDV only)

6 to 35 months:

  • 0.25 mL

≥36 months:

  • 0.5 mL
  • May contain trace amounts of neomycin and polymyxin B.
  • Afluria Quadrivalent (US): PharmaJet Stratis needle-free injector approved for ages 18 to 64 years.

Fluad Quadrivalent

(US only)

Seqirus

IM

≥65 years

0.5 mL PFS

(~$67)

No

0.5 mL

  • One of the preferred options in the US for people ≥65 years old.22
  • This adjuvanted vaccine may be abbreviated aIIV4.3
  • May contain trace amounts of neomycin and kanamycin.
  • Adverse effects (e.g., injection site reactions, fatigue, myalgias, headache) seem similar to the previously available trivalent inactivated, adjuvanted vaccine.

Fluarix

Quadrivalent (US only)

GSK

IM

≥6 months

0.5 mL PFS

(~$19)

No

0.5 mL

None

US: Flucelvax

Quadrivalent

Canada: Flucelvax Quad

Seqirus

IM

≥6 months

0.5 mL PFS

(~$30)

5 mL MDV

(~$28)

Yes

(MDV only)

0.5 mL

  • This cell-cultured vaccine may be abbreviated ccIIV4 or IIV4-cc.3,24,29
  • Egg-free

US: FluLaval

Quadrivalent

Canada: FluLaval Tetra

GSK

IM

≥6 months

US

  • 0.5 mL PFS (~$19)

Canada

  • 5 mL MDV

US:

  • No

Canada:

  • Yes

0.5 mL

None

Fluzone

Quadrivalent

Sanofi Pasteur

IM

≥6 months

  • 5 mL MDV
  • 0.5 mL PFS
  • 0.5 mL SDV (US only)

(~$18 to $19)

Yes

(MDV only)

6 to 35 months:

  • 0.25 mL (US only) or 0.5 mL

≥36 months:

  • 0.5 mL

None

Fluzone Quadrivalent High-Dose

Sanofi Pasteur

IM

≥65 years

0.7 mL PFS

(~$64)

No

0.7 mL

  • One of the preferred options in the US (the preferred option in Canada) for people ≥65 years old.22,24
  • Contains 60 mcg of each virus strain compared to 15 mcg in standard-dose IM vaccines.3,24
  • 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).

Influvac Tetra (Canada only)

BGP Pharma

IM or deep subcutaneous injection

≥6 months

0.5 mL PFS

No

0.5 mL

  • May contain trace amounts of gentamicin or neomycin and polymyxin B.

Quadrivalent recombinant (RIV4): protects against two influenza A-like viruses and two influenza B-like viruses.4,24,27

US: Flublok Quadrivalent

Canada: Supemtek

Sanofi Pasteur

IM

≥18 years

0.5 mL PFS

(~$64)

No

0.5 mL

  • One of the preferred options in the US for people ≥65 years old.22
  • 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.4,24,27

FluMist

Quadrivalent

MedImmune (US)

AstraZeneca (Canada)

Intranasal

2 to 49 years

(2 to 59 years [Canada])

0.2 mL prefilled intranasal sprayer

(~$24)

No

0.1 mL per nostril

  • For healthy, non-pregnant patients.24,27
  • Has not been studied in patients with severe asthma or active wheezing.
  • The FAQ below, Communicating About Flu Vaccination, addresses who should NOT receive this flu vaccine.
  • May contain trace amounts of gentamicin.

Trivalentinactivated (IIV3) (Only available in Canada): protects against two influenza A-like viruses and one influenza B-like viruses.24

Fluad and Fluad Pediatric (Canada only)

Seqirus

IM

Pediatric: 6 to 23 months

Adult: ≥65 years

Pediatric: 0.25 mL PFS

Adult: 0.5 mL PFS

No

6 to 23 months:

  • 0.25 mL

≥65 years:

  • 0.5 mL
  • This adjuvanted vaccine (with MF59) may be abbreviated IIV3-Adj.
  • May contain trace amounts of kanamycin and neomycin.
  1. FDA-approved product information is from the following US product labeling unless otherwise specified: Afluria Quadrivalent (June 2023); Fluad Quadrivalent (June 2023); Fluarix Quadrivalent (June 2023); Flucelvax Quadrivalent (June 2023); FluLaval Quadrivalent (June 2023); Fluzone Quadrivalent (June 2023); Fluzone Quadrivalent High-Dose (June 2023); Flublok Quadrivalent (June 2023); FluMist Quadrivalent (August 2023). Information for Health Canada-approved products is from the Government of Canada (https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/national-advisory-committee-immunization-statement-seasonal-influenza-vaccine-2023-2024.html) unless otherwise specified.24
  2. Pricing based on wholesale acquisition cost (WAC). Medication pricing by Elsevier, accessed July 2023.

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

 

Communicating About Flu Vaccination

Use this FAQ to answer common questions about flu vaccines.

Question

Answer/Pertinent Information

Who should receive a flu vaccine?

Flu vaccination is recommended for everyone ≥6 months without contraindications, using any age-appropriate vaccine.24,27

  • Canadian guidelines recommend focusing vaccination efforts on:24
    • people at high risk of severe disease, flu-related complications or hospitalization.
    • people capable of transmitting flu to those at high risk.
    • people who provide essential community services.
    • people in direct contact with poultry infected with avian flu during culling operations.

In light of COVID-19, it’s more important than ever for patients to get a flu vaccine. The flu vaccine won’t protect against COVID-19 but getting the flu vaccine can help conserve healthcare resources, by reducing the risk of flu illnesses, hospitalizations, and death.21,27

For patients who cannot remember if they received this season’s flu vaccine, avoid missed opportunities to vaccinate by giving the flu vaccine even if this means giving a second dose to some patients.11

Which flu vaccine is preferred?

Avoid delaying vaccination in order to use a specific “preferred” flu vaccine.16,24

In the US:22

  • A higher-dose or adjuvanted flu vaccine is preferred (if available) over standard-dose vaccines for people ≥65 years old.
  • There is not a preferred vaccine when selecting among licensed, age-appropriate vaccines for patients between 6 months and 64 years old.

In Canada:24

  • quadrivalent flu vaccines are preferred over trivalent flu vaccines in children.
  • a high-dose flu vaccine is preferred over a standard-dose flu vaccine in patients 65 years and older.

When are two doses of a flu vaccine needed?

To provide optimal protection, children 6 months through eight years should receive two doses of flu vaccine (separated by at least four weeks) if they have not received at least two doses of flu vaccine (separated by at least four weeks) prior to July 1 of the current year (US) or if they have not previously received the seasonal flu vaccine (Canada).24,28

  • US guidance specifies that for children who should receive two doses, if the child turns nine years old between doses one and two of the vaccine, two doses are still recommended.28

When should flu vaccines be given?

In the US, encourage patients to try to complete vaccination by the end of October. Generally, avoid starting vaccinations before September, due to the possibility of reduced effectiveness later in the flu season.27

  • Consider earlier vaccination in children, especially if they require two doses, and pregnant patients in their third trimester.27

In Canada, start vaccinations as soon as possible based on availability.24

Don’t miss an opportunity to vaccinate due to fears the vaccine’s effectiveness will not last throughout the entire flu season.

  • Though delayed vaccination may lead to increased immunity later in the season, it could also lead to missed opportunities to vaccinate, and is not recommended.24,27 Some evidence suggests that vaccination early in the season may lead to “waning” or “wearing off” before the end of the flu season.15However, this has not been consistently seen from year to year, nor among different patient populations.
    • Booster doses are NOT recommended later in the season for patients who receive their vaccine early in the season.11,24
  • The timing of flu outbreaks is unpredictable.11

Continue to vaccinate as long as flu viruses are circulating.11,24

Can flu vaccines be given with other vaccines?

Live-attenuated and inactivated flu vaccines can be given with other vaccines, using separate administration sites.5,24

  • If two live vaccines (including FluMist) are NOT given on the same day, they should be administered at least four weeks apart.5 (Canada: FluMist can be given together with or at any time before or after any other live-attenuated or inactivated vaccine.24)
  • Any flu vaccines (including FluMist) can be coadministered with COVID-19 vaccines, as long as different injection sites are used, preferably different limbs (due to the potential for increased local reactions [e.g., injection site pain, redness]).24,33

Data are limited for coadministration of two adjuvanted vaccines (e.g., Fluad Quadrivalent, Heplisav-B, Shingrix).24,34 There are theoretical concerns about more side effects. If a patient is receiving another adjuvanted vaccine, don’t delay flu vaccination if an adjuvanted flu vaccine (i.e., Fluad Quadrivalent) is the only flu vaccine available.16,35

Can the flu vaccine be given to someone who is acutely ill?

Continue to give the flu vaccine to patients with mild (and moderate in Canada) acute illnesses to avoid missed opportunities to vaccinate.12,24 Most acute illness with or without fever (e.g., diarrhea, upper respiratory infection) is not a contraindication to receiving the vaccine.12,24

Severe (and moderate in the US) acute illness is a precaution for administering any vaccine.12 Vaccination side effects (e.g., fever, malaise) may make it difficult to assess management of acute illness.12Assess the risks and benefits of delaying vaccination in patients with moderate to severe illness.12 In Canada, it is recommended to usually delay vaccination until serious acute illness symptoms have improved.24

Generally, delay flu vaccination in anyone with symptomatic COVID-19 infection, until they are no longer moderately or severely ill and have completed their COVID-19 isolation period.30,31

Can immuno-compromised patients receive the flu vaccine?

Immunocompromised patients may receive any licensed, recommended, age-appropriate injectable flu vaccine.14,24

  • However, some experts recommend a high-dose or adjuvanted flu vaccine for immunocompromised patients. These vaccines may lead to an improved antibody response compared to standard-dose vaccines. However, there is no evidence yet that this antibody response correlates with better protection against flu.37-39
  • See our FAQ, Vaccinating Immunocompromised Patients, for more detailed information about use of FluMist in immunocompromised patients.

Can pregnant or lactating patients receive the flu vaccine?

Vaccinate pregnant women (any trimester) with any licensed, recommended, age-appropriate injectable flu vaccine, regardless of thimerosal content.6,11

  • Risk of flu and potential complications in pregnant woman and/or the fetus exceeds possible risks associated with flu vaccination.7,8,11,24

Flu vaccination is safe while breastfeeding.9 Vaccinate post-partum women who did not receive a flu vaccine while pregnant, especially if breastfeeding an infant <6 months old, as these infants are too young to receive a flu vaccine.6,10

  • FluMist is an option for breastfeeding patients younger than 50 years old (younger than 59 years [Canada]), if there are no other contraindications.17,24

Can patients with an egg allergy receive a flu vaccine?

Patients with a history of severe egg allergy (symptoms more severe than hives [e.g., angioedema, respiratory distress, requiring epinephrine]) do not have higher reaction rates to egg-containing vaccines compared to non-egg allergic patients.16

Patients with an egg allergy may receive any age-appropriate flu vaccine, including FluMist, without prior flu vaccine skin test and with the full dose, irrespective of a past severe reaction to egg, and in any setting where vaccines are routinely administered.16,24

Refer to the chart above comparing available flu vaccines for egg-free vaccine options.

Should unvaccinated people who had the flu this season still get the flu vaccine?

Yes. Vaccinate unvaccinated people who have already had the flu during this season. The vaccine might protect against other circulating flu viruses.

How effective are flu vaccines?

Flu vaccination is typically about 40% to 60% effective (e.g., reduces flu illness, reduces laboratory confirmed flu).18,19,27 Generally, flu vaccines are more effective against influenza B and influenza A (H1N1) strains compared to influenza A (H3N2) strains.18

  • Influenza vaccination reduces the risk of severe flu and death, even when the vaccine is not perfectly matched with that particular years’ circulating flu strains.13,32
  • Avoid trying to compare these rates to those achieved with COVID-19 vaccines. These vaccines and the definitions for effectiveness are different; comparing them is like comparing apples to oranges.20
    • Flu vaccines and COVID-19 vaccines target different viruses (i.e., influenza, coronavirus).20
    • The flu vaccine targets multiple flu viruses. COVID-19 vaccines target one or two coronaviruses.20
  • Higher dose or adjuvanted flu vaccines seem more effective than standard-dose flu vaccines for seniors, especially at reducing flu-related hospitalizations.36

    The previously available trivalent of the Fluzone High Dose provided modestly greater protection against lab-confirmed flu vs standard-dose trivalent vaccine in patients ≥65 years of age (n=31,989; NNT=200), [Evidence Level A-1].3,25 There is no comparative data for the quadrivalent vaccines.

    Recombinant quadrivalent flu vaccines (i.e., Flublok Quadrivalent [US], Supemtek [Canada]) may be slightly more effective in preventing laboratory confirmed flu than quadrivalent inactivated flu vaccines in patients ≥50 years of age (N=8,604; NNT=100), [Evidence Level A-1].2,26

    Fluad (Canada only) 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].23

Who should NOT receive the LIVE-attenuated flu vaccine (FluMist)?

Avoid use of the live-attenuated flu vaccine (FluMist) in the following patients:

  • children younger than 2 years (or, in the US: older than 50 years).17,24
  • anyone who is pregnant.17,24
  • adults or children with contraindications to live vaccines (e.g., certain chronic diseases, immunosuppression, severely immunosuppressed close contacts).17,27
  • adults or children who recently took an antiviral (see row below “Can the LIVE-attenuated flu vaccine (FluMist) be given to someone who received an antiviral?”).17,24
  • adults or children with asplenia, a non-functional spleen, cochlear implants, or active cerebrospinal fluid leaks (US).17
  • children between the ages of 2 and 4 years with asthma or a history of wheezing in the last 12 months (US).17
  • severe asthma or medically-attended wheezing within the previous seven days (Canada).24
  • children and adolescents on chronic aspirin or salicylate therapy.1,17,24 If aspirin therapy is needed, separate aspirin and the live-attenuated flu vaccine by at least four weeks.24
  • healthcare workers (Canada) or patients who care for someone severely immunocompromised (i.e., who requires a protected environment).17,24 US guidance recommends avoiding contact with severely immunocompromised patients for 7 days after receiving the live-attenuated flu vaccine.17

Can the LIVE-attenuated flu vaccine (FluMist) be given to someone who received an antiviral?

Most advise avoiding FluMist within 48 hours of an antiviral.24 However, based on antiviral half-lives, it is possible antivirals could interfere with FluMist effectiveness if FluMist is given within the following timeframes AFTER an antiviral:17

  • 48 hours (oseltamivir and zanamivir)
  • five days (peramivir [approved but not marketed in Canada])
  • 17 days (baloxavir [approved but not marketed in Canada])

Antivirals may interfere with FluMist effectiveness. Recommend revaccination with an age-appropriate inactivated flu vaccine or recombinant flu vaccine (US only) if a patient receives a flu antiviral medication within two weeks of vaccination with FluMist (or revaccinating with FluMist 48 hours after completing antiviral therapy [Canada only]).11,24

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 randomized controlled trial (RCT)
  2. Systematic review (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).

[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. https://www.aafp.org/pubs/afp/issues/2004/0201/p548.html.]

References

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  2. Dunkle LM, Izikson R, Patriarca P, et al. Efficacy of Recombinant Influenza Vaccine in Adults 50 Years of Age or Older. N Engl J Med. 2017 Jun 22;376(25):2427-2436.
  3. DiazGranados CA, Dunning AJ, Kimmel M, et al.Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med. 2014 Aug 14;371(7):635-45.
  4. Merced-Morales A, Daly P, Abd Elal AI, et al. Influenza Activity and Composition of the 2022-23 Influenza Vaccine - United States, 2021-22 Season. MMWR Morb Mortal Wkly Rep. 2022 Jul 22;71(29):913-919.
  5. Immunize.org. Ask the experts: administering vaccines. June 19, 2023. https://www.immunize.org/askexperts/administering-vaccines.asp. (Accessed July 20, 2023).
  6. CDC. Flu vaccine safety and pregnancy. December 2, 2022. https://www.cdc.gov/flu/highrisk/qa_vacpregnant.htm. (Accessed July 21, 2023).
  7. Zerbo O, Modaressi S, Chan B, et al.No association between influenza vaccination during pregnancy and adverse birth outcomes. Vaccine. 2017 May 31;35(24):3186-3190.
  8. CDC. Addressing concerns pregnant people might have about influenza vaccine safety. December 2, 2022. https://www.cdc.gov/flu/professionals/vaccination/vaccination-possible-safety-signal.html. (Accessed July 21, 2023).
  9. Government of Canada. Immunization in pregnancy and breastfeeding: Canadian immunization guide. March 1, 2023. https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-3-vaccination-specific-populations/page-4-immunization-pregnancy-breastfeeding.html#p3c3a6. (Accessed July 21, 2023).
  10. The American College of Obstetricians and Gynecologists. The flu vaccine and pregnancy. Reviewed December 2021. https://www.acog.org/patient-resources/faqs/pregnancy/the-flu-vaccine-and-pregnancy. (Accessed July 21, 2023).
  11. Immunization Action Coalition. Ask the experts: influenza. Updated June 19, 2023. https://www.immunize.org/askexperts/experts_inf.asp. (Accessed July 20, 2023).
  12. Immunization Action Coalition. Ask the experts: contraindications and precautions. Updated June 19, 2023. http://www.immunize.org/askexperts/precautions-contraindications.asp. (Accessed July 21, 2023).
  13. Goldberg R. Do influenza vaccines that are mismatched to flu viruses protect children? February 11, 2022. https://www.pulmonologyadvisor.com/home/topics/influenza/do-flu-vaccines-mismatched-to-flu-viruses-protect-children/. (Accessed July 26, 2023).
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  15. Ray GT, Lewis N, Klein NP, et al.Intraseason Waning of Influenza Vaccine Effectiveness. Clin Infect Dis. 2019 May 2;68(10):1623-1630.
  16. Grohskopf LA, Blanton LH, Ferdinands JM, et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023-24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1-25.
  17. CDC. Influenza (flu). Live attenuated influenza vaccine [LAIV] (the nasal spray flu vaccine). Reviewed August 25, 2022. https://www.cdc.gov/flu/prevent/nasalspray.htm. (Accessed July 21, 2023).
  18. CDC. Influenza (flu) vaccine effectiveness: how well do flu vaccines work? Reviewed February 8, 2023. https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm. (Accessed July 24, 2023).
  19. Government of Canada. FluWatch annual report: 2019-2020 influenza season. November 1, 2022. https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2022-48/issue-10-october-2022/national-influenza-annual-report-canada-2021-2022-brief-late-influenza-epidemic.html. (Accessed July 24, 2023).
  20. Reuters. Fact check: COVID-19 and influenza vaccines too different to be directly compared. December 8, 2020. https://www.reuters.com/article/uk-factcheck-covid-influenza-vaccines/fact-check-covid-19-and-influenza-vaccines-too-different-to-be-directly-compared-idUSKBN28I2UE. (Accessed July 24, 2023).
  21. Government of Canada. Guidance on the use of influenza vaccine in the presence of COVID-19. November 26, 2021. https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/guidance-use-influenza-vaccine-covid-19.html. (Accessed July 29, 2022).
  22. CDC. Influenza (Flu). Who should and who should not get a flu vaccine. Reviewed August 25, 2022. https://www.cdc.gov/flu/prevent/whoshouldvax.htm. (Accessed July 24, 2023).
  23. 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 Jan 23;35(4):513-520.
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  29. CDC. Influenza (flu). Seasonal influenza vaccine safety: a summary for clinicians. Reviewed September 14, 2022. https://www.cdc.gov/flu/professionals/vaccination/vaccine_safety.htm. (Accessed July 24, 2023).
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  32. Olson SM, Newhams MM, Halasa NB, et al. Vaccine Effectiveness Against Life-Threatening Influenza Illness in US Children. Clin Infect Dis. 2022 Jan 13:ciab931. doi: 10.1093/cid/ciab931.
  33. CDC. Vaccines & immunizations. Interim clinical considerations for use of COVID-19 vaccines currently approved or authorized in the United States. Updated May 12, 2023. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html. (Accessed July 26, 2023).
  34. CDC. Vaccines and preventable disease. Administering Shingrix. January 24, 2022. https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/administering-vaccine.html. (July 26, 2023).
  35. Washington State Department of Health. Office of Immunization and Child Profile Vaccine Advisory Committee. High-dose and adjuvanted flu vaccine for persons 65 years and older. March 2020. https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs//348-518-SupplementalGuidance.pdf?uid=624bc0743191e. (Accessed July 26, 2023).
  36. CDC. National center for immunization and respiratory diseases. Influenza vaccines for persons aged ≥65 years: evidence to recommendations framework. June 22, 2022. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-06-22-23/03-influenza-grohskopf-508.pdf. (Accessed July 26, 2023).
  37. American College of Rheumatology. 2022 American College of Rheumatology (ACR) guideline for vaccinations in patients with rheumatic or musculoskeletal diseases: guideline summery. https://www.rheumatology.org/Portals/0/Files/Vaccinations-Guidance-Summary.pdf. (Accessed July 26, 2023).
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Cite this document as follows: Clinical Resource, Flu Vaccines for 2023-24. Pharmacist’s Letter/Pharmacy Technician’s Letter/Prescriber Insights.September 2023. [390901]

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