Flu Vaccines for 2024-25 (United States)

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For the 2024-25 influenza season, US influenza vaccines are all trivalent (two influenza A-like viruses and one influenza B-type virus).¹ The B/Yamagata vaccine component has been removed from the prior year’s quadrivalent flu vaccines as these viruses not been detected worldwide since March 2020.² This chart reviews approved influenza vaccines for the 2024-25 season. It includes approved ages for use, route of administration, dose, cost, and egg and thimerosal content. For information about efficacy, administration with other vaccines, use in patients who are immunocompromised or pregnant, and more, see our resource, Communicating About Flu Vaccination.

--None of the available flu vaccines for 2024-25 contain latex.--

Brand Name Manufacturer^a	Route^a	Approved Ages for Use^a	Availability^a (Cost/dose^b)	Contains Thimerosal?^a	Dose^a	Comments^a
Trivalent inactivated influenza vaccine (IIV3)
*Afluria* Seqirus	IM	≥6 months Administering Afluria* with the PharmaJet Stratis needle-free injector is only approved for ages 18 to 64 years.	0.5 mL PFS (~$21) 5 mL MDV (~$20)	Yes (MDV only)	6 to 35 months: 0.25 mL ≥36 months: 0.5 mL	May contain trace amounts of neomycin and polymyxin B.
*Fluad* Seqirus	IM	≥65 years	0.5 mL PFS (~$73)	No	≥65 years: 0.5 mL	One of the preferred options for people ≥65 years old.³ This adjuvanted vaccine may be abbreviated aIIV3.⁴ May contain trace amounts of neomycin and kanamycin. Per ACIP, adjuvanted influenza vaccines are an option for solid organ transplant recipients ages 18 to 64 years who are taking immunosuppressants.⁸
*Fluarix* GSK	IM	≥6 months	0.5 mL PFS (~$19)	No	0.5 mL	May contain trace amounts of gentamicin.
*Flucelvax* Seqirus	IM	≥6 months	0.5 mL PFS (~$32) 5 mL MDV (~$32)	Yes (MDV only)	0.5 mL	This cell-cultured vaccine may be abbreviated ccIIV3.⁵ Egg-free
*FluLaval* GSK	IM	≥6 months	0.5 mL PFS (~$19)	No	0.5 mL	None
*Fluzone* Sanofi Pasteur	IM	≥6 months	5 mL MDV (~$20) 0.5 mL PFS (~$19)	Yes (MDV only)	6 to 35 months: 0.25 mL or 0.5 mL ≥36 months: 0.5 mL	None
*Fluzone High-Dose* Sanofi Pasteur	IM	≥65 years	0.5 mL PFS (~$73)	No	0.5 mL	One of the preferred options for people ≥65 years old.³ Per ACIP, high-dose influenza vaccines are an option for solid organ transplant recipients ages 18 to 64 years who are taking immunosuppressants.⁸ Contains 60 mcg of each virus strain compared to 15 mcg in standard-dose IM vaccines.⁶ Fluzone High-Dose has a higher risk of adverse effects (injection site reactions, myalgia, headache) compared to Fluzone vaccine.
Trivalent recombinant influenza vaccine (RIV3)
*Flublok* Sanofi Pasteur	IM	≥18 years	0.5 mL PFS (~$73)	No	0.5 mL	One of the preferred options for people ≥65 years old.³ Egg-free Contains 45 mcg of each virus strain compared to 15 mcg in standard-dose IM vaccines.⁶
Trivalent live-attenuated influenza vaccine (LAIV3)
*FluMist Intranasal Spray* MedImmune (an AstraZeneca company)	Intranasal	2 to 49 years	0.2 mL prefilled intranasal sprayer (~$24)* *cost of 2023-24 product. Pricing for 2024-25 product was not available at time of publication of this chart.)	No	0.1 mL per nostril	Not recommended for patients who are pregnant, immunocompromised, or with certain medical conditions.⁷ See our resource, Communicating About Flu Vaccination, for more on who should NOT receive live intranasal flu vaccine. Has not been studied in patients with severe asthma or active wheezing. May contain trace amounts of gentamicin.

Information is from product labeling, unless otherwise noted: Afluria (July 2024); Fluad (July 2024); Fluarix (July 2024); Flucelvax (July 2024); FluLaval (March 2024); Fluzone (July 2024); Fluzone High-Dose (July 2024); Flublok Trivalent (July 2024); FluMist (August 2024).
Pricing based on one dose at wholesale acquisition cost (WAC). Medication pricing by Elsevier, accessed August 2024.

Abbreviations: ACIP = Advisory Committee on Immunization Practices; GSK = GlaxoSmithKline; IM = intramuscular; MDV = multidose vial; PFS = pre-filled syringe; SDV = single-dose 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.*	High-quality randomized controlled trial (RCT) Systematic review (SR)/Meta-analysis of RCTs with consistent findings All-or-none study
B	Inconsistent or limited-quality patient-oriented evidence.*	Lower-quality RCT SR/Meta-analysis with low-quality clinical trials or of studies with inconsistent findings Cohort study 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

CDC. CDC recommends updated 2024-2025 COVID-19 and flu vaccines for fall/winter virus season. June 27, 2024. https://www.cdc.gov/media/releases/2024/s-t0627-vaccine-recommendations.html#:~:text=Updated%202024%2D2025%20COVID%2D19%20Vaccine%20Recommendation,with%20a%20COVID%2D19%20vaccine. (Accessed August 15, 2024).
CDC. Trivalent influenza vaccines. March 14, 2024. https://www.cdc.gov/flu/prevent/trivalent.htm. (Accessed August 16, 2024).
CDC. Influenza (Flu). Who should and who should not get a flu vaccine. Reviewed August 25, 2023. https://www.cdc.gov/flu/prevent/whoshouldvax.htm. (Accessed August 15, 2024).
Goldberg R. Influenza vaccines in older adults: aIIV3 more effective than HD-IIV3e and IIV4e. June 5, 2024. https://www.pulmonologyadvisor.com/news/influenza-vaccines-in-adults-65-aiiv3-vs-hd-iiv3e-vs-iiv4e/. (Accessed August 15, 2024).
CDC. Vaccine abbreviations. August 1, 2024. https://www.cdc.gov/vaccines/hcp/vaccines-us/abbreviations.html?CDC_AAref_Val=https://www.cdc.gov/vaccines/terms/vacc-abbrev.html. (Accessed August 15, 2024).
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.
CDC. Influenza (flu). Key facts about seasonal flu vaccine. Reviewed March 22, 2024. https://www.cdc.gov/flu/prevent/keyfacts.htm. (Accessed August 15, 2024).
CDC. CDC updates vaccine recommendations. July 12, 2024. https://www.cdc.gov/ncird/whats-new/cdc-updates-vaccine-recommendations-july-2024.html. (Accessed August 19, 2024)

Cite this document as follows: Clinical Resource, Flu Vaccines for 2024-25 (United States). Pharmacist’s Letter/Pharmacy Technician’s Letter/Prescriber Insights. September 2024. [400901]

Flu Vaccines for 2024-25 (United States)

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