Influenza Vaccine

Influenza vaccine
From Wikipedia, the free encyclopedia

Jump to navigationJump to search
Influenza vaccine
US Navy crew member receiving an influenza vaccination
Vaccine description
Target Influenza virus
Vaccine type inactivated, attenuated, recombinant
Clinical data
Trade names Afluria, Fluarix, Fluzone, others
AHFS/ Inactivated: Monograph Intranasal: Monograph Recom
Drugs.com
binant: Monograph
Pregnancy AU: B1/B2[1][2]
category
Routes of Intramuscular, intranasal, intradermal
administratio
n
ATC code J07BB01 (WHO) J07BB02 (WHO), J07BB03 (WHO),
J07BB04 (WHO)
Legal status
Legal status AU: S4 (Prescription only) [1][2]
CA: Rx-only / Schedule D [3][4][5][6]
UK: POM (Prescription only)
US: ℞-only
EU: Rx-only
In general: ℞ (Prescription only)
Identifiers
CAS 1704512-59-3
Number
ChemSpider none
KEGG D04536
Influenza vaccines, also known as flu shots, are vaccines that protect against

infection by influenza viruses.[7] New versions of the vaccines are developed twice a
year, as the influenza virus rapidly changes.[7] While their effectiveness varies from
year to year, most provide modest to high protection against influenza. [7][8] The United
States Centers for Disease Control and Prevention (CDC) estimates that vaccination
against influenza reduces sickness, medical visits, hospitalizations, and deaths. [9]
[10]
Immunized workers who do catch the flu return to work half a day sooner on
average.[11] Vaccine effectiveness in those over 65 years old remains uncertain due to
a lack of high-quality research.[12][13] Vaccinating children may protect those around
them.[7]
Vaccination against influenza began in the 1930s, with large-scale availability in the
United States beginning in 1945.[14][15] It is on the World Health Organization's List of
Essential Medicines.[16]
The World Health Organization (WHO) and the CDC recommend yearly vaccination
for nearly all people over the age of six months, especially those at high risk. [7][17][18]
[19]
The European Centre for Disease Prevention and Control (ECDC) also
recommends yearly vaccination of high risk groups. [20] These groups
include pregnant women, the elderly, children between six months and five years of
age, and those with certain health problems.[7][19]
The vaccines are generally safe, including for people who have severe egg allergies.
[21]
Fever occurs in five to ten percent of children vaccinated, and temporary muscle
pains or feelings of tiredness may occur. In certain years, the vaccine was linked to
an increase in Guillain–Barré syndrome among older people at a rate of about one
case per million doses.[7] Influenza vaccines are not recommended in those who have
had a severe allergy to previous versions of the vaccine itself.[7][21] The vaccine comes
in inactive and weakened viral forms. The live, weakened vaccine is generally not
recommended in pregnant women, children less than two years old, adults older
than 50, or people with a weakened immune system.[7] Depending on the type they
can be injected into a muscle, sprayed into the nose, or injected into the middle layer
of the skin (intradermal).[7] The intradermal vaccine was not available during the
2018–2019 and 2019–2020 influenza seasons. [22][23][24]
Contents
 1History
o 1.1Origins and development
o 1.2Acceptance
o 1.3Quadrivalent vaccines for seasonal flu
 2Medical uses
o 2.1Effectiveness
o 2.2Children
o 2.3Adults
o 2.4Elderly
o 2.5Pregnancy
 3Safety
o 3.1Side effects
o 3.2Guillain–Barré syndrome
o 3.3Egg allergy
o 3.4Other
 4Types
 5Recommendations
o 5.1World Health Organization
o 5.2Canada
o 5.3European Union
o 5.4United States
o 5.5United Kingdom
o 5.6Australia
 6Uptake
o 6.1At risk groups
o 6.2Health care workers
 7Manufacturing
o 7.1Egg-based
o 7.2Other methods of manufacture
o 7.3Vaccine manufacturing countries
 8Cost-effectiveness
 9Research
o 9.1Rapid response to pandemic flu
o 9.2Universal flu vaccines
o 9.3Oral influenza vaccine
o 9.4COVID-19
o 9.5Criticism
 10Veterinary use
o 10.1Horses
o 10.2Poultry
o 10.3Pigs
o 10.4Dogs
 11Annual reformulation
o 11.12020–2021 northern hemisphere
o 11.22021 southern hemisphere
o 11.42022 southern hemisphere
 12Notes
 13See also
 14References
 15Further reading
 16External links
History[edit]
See also: Timeline of vaccines
Vaccines are used in both humans and nonhumans. Human vaccine is meant unless
specifically identified as a veterinary, poultry or livestock vaccine.
Origins and development[edit]
In the worldwide Spanish flu pandemic of 1918, "Pharmacists tried everything they
knew, everything they had ever heard of, from the ancient art of bleeding patients,
to administering oxygen, to developing new vaccines and serums (chiefly against
what we now call Hemophilus influenzae – a name derived from the fact that it was
originally considered the etiological agent – and several types of pneumococci). Only
one therapeutic measure, transfusing blood from recovered patients to new victims,
showed any hint of success."[25]
In 1931, viral growth in embryonated hens' eggs was reported by Ernest William
Goodpasture and colleagues at Vanderbilt University. The work was extended to
growth of influenza virus by several workers, including Thomas Francis, Jonas Salk,
Wilson Smith and Macfarlane Burnet, leading to the first experimental influenza
vaccines.[26] In the 1940s, the US military developed the first approved inactivated
vaccines for influenza, which were used in the Second World War. [27] Hen's eggs
continued to be used to produce virus used in influenza vaccines, but manufacturers
made improvements in the purity of the virus by developing improved processes to
remove egg proteins and to reduce systemic reactivity of the vaccine. [28] In 2012, the
US Food and Drug Administration (FDA) approved influenza vaccines made by
growing virus in cell cultures[29][30][31] and influenza vaccines made from recombinant
proteins[32] have been approved, with plant-based influenza vaccines being
tested[when?] in clinical trials.[33]
Acceptance[edit]
The egg-based technology for producing influenza vaccine was created in the 1950s.
[34]
In the US swine flu scare of 1976, President Gerald Ford was confronted with a
potential swine flu pandemic. The vaccination program was rushed, yet plagued by
delays and public relations problems. Meanwhile, maximum military containment
efforts succeeded unexpectedly in confining the new strain to the single army base
where it had originated. On that base, a number of soldiers fell severely ill, but only
one died. The program was canceled after about 24% of the population had received
vaccinations. An excess in deaths of 25 over normal annual levels as well as 400
excess hospitalizations, both from Guillain–Barré syndrome, were estimated to have
occurred from the vaccination program itself, demonstrating that the vaccine itself is
not free of risks. The result can be cited to support lingering doubts about
vaccination as well as to counter ungrounded claims about the safety of vaccination.
[35]
In the end, however, even the maligned 1976 vaccine may have saved lives. A
2010 study found a significantly enhanced immune response against the 2009
pandemic H1N1 in study participants who had received vaccination against the
swine flu in 1976.[36]
Quadrivalent vaccines for seasonal flu[edit]
Preparation of the flu vaccine for sailors serving aboard the USS Gerald R. Ford in 2019
A quadrivalent flu vaccine administered by nasal mist was approved by the FDA in
March 2012.[37][38] Fluarix Quadrivalent was approved by the FDA in December 2012. [39]
In 2014, the Canadian National Advisory Committee on Immunization (NACI)
published a review of quadrivalent influenza vaccines. [40]
Starting with the 2018–2019 influenza season most of the regular-dose egg-based
flu shots and all the recombinant and cell-grown flu vaccines in the United States are
quadrivalent.[41] In the 2019–2020 influenza season all regular-dose flu shots and all
recombinant influenza vaccine in the United States are quadrivalent. [42]
In November 2019, the FDA approved Fluzone High-Dose Quadrivalent for use in
the United States starting with the 2020–2021 influenza season. [43][44]
In February 2020, the FDA approved Fluad Quadrivalent for use in the United
States.[45][46] In July 2020, the FDA approved both Fluad and Fluad Quadrivalent for
use in the United States for the 2020–2021 influenza season. [45][47]
Medical uses[edit]
The U.S Centers for Disease Control and Prevention (CDC) recommends the flu
vaccine as the best way to protect people against the flu and prevent its spread.
[48]
The flu vaccine can also reduce the severity of the flu if a person contracts a strain
that the vaccine did not contain.[48] It takes about two weeks following vaccination for
protective antibodies to form.[48][49]
A 2012 meta-analysis found that flu vaccination was effective 67 percent of the time;
the populations that benefited the most were HIV-positive adults aged 18 to 55
(76 percent), healthy adults aged 18 to 46 (approximately 70 percent), and healthy
children aged six months to 24 months (66 percent).[50] The influenza vaccine also
appears to protect against myocardial infarction with a benefit of 15–45%.[51]
Effectiveness[edit]
US vaccine effectiveness (%) against symptomatic disease.[52][53][54][55][56] Notes: unestimable for the 2020–21
flu season,[57] data missing for seasons 1999–2000 to 2002–03.
A vaccine is assessed by its efficacy – the extent to which it reduces risk of disease

under controlled conditions – and its effectiveness – the observed reduction in risk
after the vaccine is put into use.[58] In the case of influenza, effectiveness is expected
to be lower than the efficacy because it is measured using the rates of influenza-like
illness, which is not always caused by influenza.[11] Studies on the effectiveness of flu
vaccines in the real world are difficult; vaccines may be imperfectly matched, virus
prevalence varies widely between years, and influenza is often confused with other
influenza-like illnesses.[59] However, in most years (16 of the 19 years before 2007),
the flu vaccine strains have been a good match for the circulating strains, [60] and even
a mismatched vaccine can often provide cross-protection. [48] The virus rapidly
changes due to antigenic drift, a slight mutation in the virus that causes a new strain
to arise.[61]
The effectiveness of seasonal flu vaccines varies significantly, with an estimated
average efficacy of 50–60% against symptomatic disease,[62] depending on vaccine
strain, age, prior immunity, and immune function, so vaccinated people can still
contract influenza.[63] The effectiveness of flu vaccines is considered to be suboptimal,
particularly among the elderly,[64] but vaccination is still beneficial in reducing the
mortality rate and hospitalization rate due to influenza as well as duration of
hospitalization.[63][65] Vaccination of school-age children has shown to provide indirect
protection for other age groups. LAIVs are recommended for children based on
superior efficacy, especially for children under 6, and greater immunity against non-
vaccine strains when compared to inactivated vaccines.[66][67]
From 2012 to 2015 in New Zealand, vaccine effectiveness against admission to
an intensive care unit was 82%.[68] Effectiveness against hospitalized influenza illness
in the 2019–2020 United States flu season was 41% overall and 54% in people aged
65 years or older.[69] One review found 31% effectiveness against death among
adults.[70][71]
Repeated annual influenza vaccination generally offer consistent year-on-year
protection against influenza.[71] There is, however, suggestive evidence that repeated
vaccinations may cause a reduction in vaccine effectiveness for certain influenza
subtypes; this has no relevance to current recommendations for yearly vaccinations
but might influence future vaccination policy.[72][73] As of 2019, the CDC recommends a
yearly vaccine as most studies demonstrate overall effectiveness of annual influenza
vaccination.[71]
There is not enough evidence to establish significant differences in the effectiveness
of different influenza vaccine types,[74] but there are high-dose or adjuvanted products
that induce a stronger immune response in the elderly. [75]
Children[edit]
In April 2002, the Advisory Committee on Immunization Practices (ACIP)
encouraged that children 6 to 23 months of age be vaccinated annually against
influenza.[76] In 2010, ACIP recommended annual influenza vaccination for those 6
months of age and older.[76] Currently the CDC recommends that everyone
except infants under the age of six months should receive the seasonal influenza
vaccine.[17] Vaccination campaigns usually focus special attention on people who are
at high risk of serious complications if they catch the flu, such as pregnant women,
children under 59 months, the elderly, and people with chronic
illnesses or weakened immune systems, as well as those to whom they are exposed,
such as health care workers.[17][77]
As the death rate is also high among infants who catch influenza, the CDC and the
WHO recommend that household contacts and caregivers of infants be vaccinated to
reduce the risk of passing an influenza infection to the infant. [77][78]
In children, the vaccine appears to decrease the risk of influenza and
possibly influenza-like illness.[79] In children under the age of two data are limited.
During the 2017–18 flu season, the CDC director indicated that 85 percent of the
[79]
children who died "likely will not have been vaccinated". [80]
In the United States, as of January 2019, the CDC recommend that children aged six
through 35 months may receive either 0.25 milliliters or 0.5 milliliters per dose
of Fluzone Quadrivalent.[42][81] There is no preference for one or the other dose volume
of Fluzone Quadrivalent for that age group. [42] All persons 36 months of age and older
should receive 0.5 milliliters per dose of Fluzone Quadrivalent. [42] As of October 2018,
Afluria Quadrivalent is licensed for children six months of age and older in the United
States.[42][82] Children six months through 35 months of age should receive
0.25 milliliters for each dose of Afluria Quadrivalent. [42] All persons 36 months of age
and older should receive 0.5 milliliters per dose of Afluria Quadrivalent.[42] As of
February 2018, Afluria Tetra is licensed for adults and children five years of age and
older in Canada.[83]
In 2014, the Canadian National Advisory Committee on Immunization (NACI)
published a review of influenza vaccination in healthy 5–18-year-olds, [84] and in 2015,
published a review of the use of pediatric Fluad in children 6–72 months of age. [85] In
one study, conducted in a tertiary referral center, the rate of influenza vaccination in
children was only 31%. Higher rates were found among immuno-suppressed
pediatric patients (46%), and in patients with inflammatory bowel disease (50%). [86]
Adults[edit]
A US Navy hospital corpsman administers a flu shot aboard the USS Theodore Roosevelt (CVN-71) in

2020.
In unvaccinated adults, 16% get symptoms similar to the flu, while about 10% of
vaccinated adults do.[11] Vaccination decreased confirmed cases of influenza from
about 2.4% to 1.1%.[11] No effect on hospitalization was found.[11]
In working adults, a review by the Cochrane Collaboration found that vaccination
resulted in a modest decrease in both influenza symptoms and working days lost,
without affecting transmission or influenza-related complications. [11] In healthy working
adults, influenza vaccines can provide moderate protection against virologically
confirmed influenza, though such protection is greatly reduced or absent in some
seasons.[12]
In health care workers, a 2006 review found a net benefit. [87] Of the eighteen studies
in this review, only two also assessed the relationship of patient mortality relative to
staff influenza vaccine uptake; both found that higher rates of health care worker
vaccination correlated with reduced patient deaths. [87] A 2014 review found benefits to
patients when health care workers were immunized, as supported by moderate
evidence[88] based in part on the observed reduction in all-cause deaths in patients
whose health care workers were given immunization compared with comparison
patients where the workers were not offered vaccine. [89]
Elderly[edit]
Evidence for an effect in adults over 65 is unclear.[90] Systematic reviews examining
both randomized controlled and case–control studies found a lack of high-quality
evidence.[12][13] Reviews of case–control studies found effects against laboratory-
confirmed influenza, pneumonia, and death among the community-dwelling elderly. [91]
[92]
The group most vulnerable to non-pandemic flu, the elderly, benefits least from the
vaccine. There are multiple reasons behind this steep decline in vaccine efficacy, the
most common of which are the declining immunological function and frailty
associated with advanced age.[93] In a non-pandemic year, a person in the United
States aged 50–64 is nearly ten times more likely to die an influenza-associated
death than a younger person, and a person over 65 is more than ten times more
likely to die an influenza-associated death than the 50–64 age group. [94]
There is a high-dose flu vaccine specifically formulated to provide a stronger immune
response.[95] Available evidence indicates that vaccinating the elderly with the high-
dose vaccine leads to a stronger immune response against influenza than the
regular-dose vaccine.[96][97][98]
A flu vaccine containing an adjuvant was approved by the US Food and Drug
Administration (FDA) in November 2015, for use by adults aged 65 years of age and
older. The vaccine is marketed as Fluad in the US and was first available in the
2016–2017 flu season. The vaccine contains the MF59C.1 adjuvant[99] which is an oil-
in-water emulsion of squalene oil. It is the first adjuvanted seasonal flu vaccine
marketed in the United States.[100][101][102] It is not clear if there is a significant benefit for
the elderly to use a flu vaccine containing the MF59C.1 adjuvant. [103][104][105] Per Advisory
Committee on Immunization Practices guidelines, Fluad can be used as an
alternative to other influenza vaccines approved for people 65 years and older. [101]
Vaccinating health care workers who work with elderly people is recommended in
many countries, with the goal of reducing influenza outbreaks in this vulnerable
population.[106][107][108] While there is no conclusive evidence from randomized clinical
trials that vaccinating health care workers helps protect elderly people from
influenza, there is tentative evidence of benefit. [109]
Fluad Quad was approved for use in Australia in September 2019, [110] Fluad
Quadrivalent was approved for use in the United States in February 2020, [45] and
Fluad Tetra was approved for use in the European Union in May 2020. [111]
Pregnancy[edit]
As well as protecting mother and child from the effects of an influenza infection, the
immunization of pregnant women tends to increase their chances of experiencing a
successful full-term pregnancy.[112]
The trivalent inactivated influenza vaccine is protective in pregnant women infected
with HIV.[113]
Safety[edit]
See also: Vaccine controversies
Side effects[edit]
Common side effects of vaccination include local injection-site reactions and cold-
like symptoms. Fever, malaise, and myalgia are less common. Flu vaccines are
contraindicated for people who have experienced a severe allergic reaction in
response to a flu vaccine or to any component of the vaccine. LAIVs are not given to
children or adolescents with severe immunodeficiency or to those who are using
salicylate treatments because of the risk of developing Reye syndrome.[66] LAIVs are
also not recommended for children under the age of 2, [67] pregnant women, and
adults with immunosuppression. Inactivated flu vaccines cannot cause influenza and
are regarded as safe during pregnancy.[66]
While side effects of the flu vaccine may occur, they are usually minor, including
soreness, redness, and swelling around the point of injection, headache, fever,
nausea or fatigue.[114] Side effects of a nasal spray vaccine may include runny nose,
wheezing, sore throat, cough, or vomiting.[115]
In some people, a flu vaccine may cause serious side effects, including an allergic
reaction, but this is rare. Furthermore, the common side effects and risks are mild
and temporary when compared to the risks and severe health effects of the
annual influenza epidemic.[48]
Guillain–Barré syndrome[edit]
Although Guillain–Barré syndrome had been feared as a complication of vaccination,
the CDC states that most studies on modern influenza vaccines have seen no link
with Guillain–Barré.[116][117] Infection with influenza virus itself increases both the risk of
death (up to one in ten thousand) and the risk of developing Guillain–Barré
syndrome to a far higher level than the highest level of suspected vaccine
involvement (approximately ten times higher by 2009 estimates). [118][119]
Although one review gives an incidence of about one case of Guillain–Barré per
million vaccinations,[120] a large study in China, covering close to a hundred million
doses of vaccine against the 2009 H1N1 "swine" flu found only eleven cases of
Guillain–Barré syndrome, (0.1 per million doses) total incidence in persons
vaccinated, actually lower than the normal rate of the disease in China, and no other
notable side effects.[119][121]
Egg allergy[edit]
Fresh eggs being prepared for influenza vaccine production at Instituto Butantan
Although most influenza vaccines are produced using egg-based techniques,

influenza vaccines are nonetheless still recommended as safe for people with egg
allergies, even if severe,[21] as no increased risk of allergic reaction to the egg-based
vaccines has been shown for people with egg allergies. [122] Studies examining the
safety of influenza vaccines in people with severe egg allergies found
that anaphylaxis was very rare, occurring in 1.3 cases per million doses given. [21]
Monitoring for symptoms from vaccination is recommended in those with more
severe symptoms.[123] A study of nearly 800 children with egg allergy, including over
250 with previous anaphylactic reactions, had zero systemic allergic reactions when
given the live attenuated flu vaccine.[124][125]
Vaccines produced using other technologies, notably recombinant vaccines and
those based on cell culture rather than egg protein, started to become available from
2012 in the US,[126] and later in Europe[127] and Australia.[122]
Other[edit]
Several studies have identified an increased incidence of narcolepsy among
recipients of the pandemic H1N1 influenza AS03-adjuvanted vaccine;[128] efforts to
identify a mechanism for this suggest that narcolepsy is autoimmune, and that the
AS03-adjuvanted H1N1 vaccine may mimic hypocretin, serving as a trigger.[129]
Some injection-based flu vaccines intended for adults in the United States
contain thiomersal (also known as thimerosal), a mercury-based preservative.[130]
[131]
Despite some controversy in the media,[132] the World Health Organization's Global
Advisory Committee on Vaccine Safety has concluded that there is no evidence of
toxicity from thiomersal in vaccines and no reason on grounds of safety to change to
more-expensive single-dose administration.[133]
Types[edit]
Main article: List of seasonal influenza vaccines
Flu vaccines are available either as:[citation needed]
 a trivalent or quadrivalent intramuscular injection (IIV3,

IIV4, or RIV4, that is, TIV or QIV), which contains the
inactivated form of the virus
 a nasal spray of live attenuated influenza vaccine (LAIV,
Q/LAIV), which contains the live but attenuated
(weakened) form of the virus.
TIV or QIV induce protection after injection (typically intramuscular, though
subcutaneous and intradermal routes can also be protective) [134] based on an immune
response to the antigens present on the inactivated virus, while cold-adapted LAIV
works by establishing infection in the nasal passages. [135]
Recommendations[edit]
Various public health organizations, including the World Health Organization (WHO),
recommend that yearly influenza vaccination be routinely offered, particularly to
people at risk of complications of influenza and those individuals who live with or
care for high-risk individuals, including:
 people aged 50 years of age or older[19]

 people with chronic lung diseases, including asthma[19]
 people with chronic heart diseases[19]
 people with chronic liver diseases[19]
 people with chronic kidney diseases[19]
 people who have had their spleen removed or whose
spleen is not working properly[medical citation needed]
 people who are immunocompromised[19]
 residents of nursing homes and other long-term care
facilities[19]
 health care workers (both to prevent sickness and to
prevent spread to their patients)[136][137]
 women who are or will be pregnant during the influenza
season[19]
 children and adolescents (aged 6 months through 18
years) who are receiving aspirin- or salicylate-containing
medications and who might be at risk for experiencing
Reye syndrome after influenza virus infection[19]
 American Indians/Alaska Natives[19]
 people who are extremely obese (body mass index ≥40
for adults)[19]
The flu vaccine is contraindicated for those under six months of age and those with
severe, life-threatening allergies to flu vaccine or any ingredient in the vaccine. [17][138][21]
World Health Organization[edit]
As of 2016, the World Health Organization (WHO) recommends seasonal influenza
vaccination for:[139][140][141][142][143]
First priority:
 Pregnant women
Second priority (in no particular order):
 Children aged 6–59 months

 Elderly
 Individuals with specific chronic medical conditions
 Health-care workers
Canada[edit]
The National Advisory Committee on Immunization (NACI), the group that advises
the Public Health Agency of Canada, recommends that everyone over six months of
age be encouraged to receive annual influenza vaccination, and that children
between the age of six months and 24 months, and their household contacts, should
be considered a high priority for the flu vaccine. [144] Particularly:
 People at high risk of influenza-related complications or

hospitalization, including people who are morbidly
obese, healthy pregnant women, children aged 6–59
months, the elderly, aboriginals, and people with one of
an itemized list of chronic health conditions
 People capable of transmitting influenza to those at high
risk, including household contacts and health care
workers
 People who provide essential community services
 Certain poultry workers
Live attenuated influenza vaccine (LAIV) was not available in Canada for the 2019–
2020 season.[144]
European Union[edit]
The European Centre for Disease Prevention and Control (ECDC) recommends
vaccinating the elderly as a priority, with a secondary priority people with chronic
medical conditions and health care workers.[145]
The influenza vaccination strategy is generally that of protecting vulnerable people,
rather than limiting influenza circulation or eliminating human influenza sickness.
This is in contrast with the high herd immunity strategies for other infectious diseases
such as polio and measles.[146] This is also due in part to the financial and logistics
burden associated with the need of an annual injection. [147]
United States[edit]
A young woman displays her bandage after receiving the vaccine at a drug store.
In the United States routine influenza vaccination is recommended for all persons
aged six months and over.[19][148] It takes up to two weeks after vaccination for sufficient
antibodies to develop in the body.[148] The CDC recommends vaccination before the
end of October,[19] although it considers getting a vaccine in December or even later
to be still beneficial.[19][48][148]
According to the CDC, the live attenuated virus (LAIV4) (which comes in the form of
the nasal spray in the US) should be avoided by some groups. [19][149]
Within its blanket recommendation for general vaccination in the United States, the
CDC, which began recommending the influenza vaccine to health care workers in
1981, emphasizes to clinicians the special urgency of vaccination for members of
certain vulnerable groups, and their caregivers:
Vaccination is especially important for people at
higher risk of serious influenza complications or
people who live with or care for people at higher risk
for serious complications.[150] In 2009, a new high-
dose formulation of the standard influenza vaccine
was approved.[151] The Fluzone High Dose is
specifically for people 65 and older; the difference is
that it has four times the antigen dose of the
standard Fluzone.[152][153][154][155]
The US government requires hospitals to report worker
vaccination rates. Some US states and hundreds of US
hospitals require health care workers to either get
vaccinations or wear masks during flu season. These
requirements occasionally engender union lawsuits on
narrow collective bargaining grounds, but proponents
note that courts have generally endorsed forced
vaccination laws affecting the general population during
disease outbreaks.[156]
Vaccination against influenza is especially considered
important for members of high-risk groups who would be
likely to have complications from influenza, for example
pregnant women[19][157] and children and teenagers from
six months to 18 years of age who are receiving aspirin-
or salicylate-containing medications and who might be
at risk for experiencing Reye syndrome after influenza
virus infection;[19]
 In raising the upper age limit to 18 years, the aim is

to reduce both the time children and parents lose
from visits to pediatricians and missing school and
the need for antibiotics for complications[158]
 An added benefit expected from the vaccination of
children is a reduction in the number of influenza
cases among parents and other household
members, and of possible spread to the general
community.[158]
The CDC indicated that live attenuated influenza
vaccine (LAIV), also called the nasal spray vaccine, was
not recommended for the 2016–2017 flu season in the
United States.[159]
Furthermore, the CDC recommends that health care
personnel who care for severely immunocompromised
persons receive injections (TIV or QIV) rather than
LAIV.[160]
United Kingdom[edit]
Dr Jenny Harries maintained winter 2021–2022 in the
UK will be "uncertain" since flu and COVID-19 will be
circulating together for the first time. She urged eligible
people to get COVID-19 and flu vaccines. She
maintains flu vaccination is important every year. People
need to know that flu can be fatal as many people do
not know this.[161]
Australia[edit]
The Australian Government recommends seasonal flu
vaccination for everyone over the age of six months.
Australia uses inactivated vaccines.[162] Until 2021, the
egg-based vaccine has been the only one available
(and continues to be the only free one), but from March
2021 a new cell-based vaccine is available for those
who wish to pay for it, and it is expected that this one
will become the standard by 2026.[122] The standard flu
vaccine is free for the following people:[163]
 children aged six months to five years;

 people aged 65 years and over;
 Aboriginal and Torres Strait Islander people aged six
months and over;
 pregnant women; and
 anyone over six months of age with medical
conditions such as severe asthma, lung disease or
heart disease, low immunity or diabetes that can
lead to complications from influenza.
Uptake[edit]
Vaccination rate in the OECD, 2018 or latest[164]
Country Region % aged 65+
Republic of Korea Asia 83
Australia Oceania 75
United Kingdom Europe 73
United States Americas 68
New Zealand Oceania 65
Chile Americas 65
Netherlands Europe 64
Canada Americas 61
Portugal Europe 61
Israel Asia 58
Ireland Europe 58
Spain Europe 54
Italy Europe 53
Denmark Europe 52
Japan Asia 50
France Europe 50
Sweden Europe 49
Finland Europe 48
Iceland Europe 45
Luxembourg Europe 38
Germany Europe 35
Norway Europe 34
Hungary Europe 27
Czech Republic Europe 20

Lithuania Europe 13
Slovak Republic Europe 13
Slovenia Europe 12
Latvia Europe 8
Turkey Asia 7
Estonia Europe 5
At risk groups[edit]
Uptake of flu vaccination, both seasonally and during
pandemics, is often low.[165] Systematic reviews of
pandemic flu vaccination uptake have identified several
personal factors that may influence uptake, including
gender (higher uptake in men), ethnicity (higher in
people from ethnic minorities) and having a chronic
illness.[166][167] Beliefs in the safety and effectiveness of the
vaccine are also important.[165]
A number of measures have been found to be useful to
increase rates of vaccination in those over sixty
including: patient reminders using leaflets and letters,
postcard reminders, client outreach programs, vaccine
home visits, group vaccinations, free vaccinations,
physician payment, physician reminders and
encouraging physician competition.[168]
Health care workers[edit]
Frontline health care workers are often recommended to
get seasonal and any pandemic flu vaccination. For
example, in the UK all health care workers involved in
patient care are recommended to receive the seasonal
flu vaccine, and were also recommended to be
vaccinated against the H1N1/09 (later renamed
A(H1N1)pdm09[note 1][169]) swine flu virus during the 2009
pandemic. However, uptake is often low.[137] During the
2009 pandemic, low uptake by healthcare workers was
seen in countries including the UK,[137] Italy,[170] Greece,
[171]
and Hong Kong.[172]
In a 2010 survey of United States health care workers,
63.5% reported that they received the flu vaccine during
the 2010–11 season, an increase from 61.9% reported
the previous season. US Health professionals with
direct patient contact had higher vaccination uptake,
such as physicians and dentists (84.2%) and nurse
practitioners (82.6%).[173][174][175]
The main reason to vaccinate health care workers is to
prevent staff from spreading flu to their patients and to
reduce staff absence at a time of high service demand,
but the reasons health care workers state for their
decisions to accept or decline vaccination may more
often be to do with perceived personal benefits. [137]
In Victoria (Australia) public hospitals, rates of health
care worker vaccination in 2005 ranged from 34% for
non-clinical staff to 42% for laboratory staff. One of the
reasons for rejecting vaccines was concern over
adverse reactions; in one study, 31% of resident
physicians at a teaching hospital incorrectly believed
Australian vaccines could cause influenza.[176]
Manufacturing[edit]
Schematic of influenza vaccine creation
Research continues into the idea of a "universal"

influenza vaccine that would not require tailoring to a
particular strain, but would be effective against a broad
variety of influenza viruses.[177] No vaccine candidates
had been announced by November 2007,[178] but as of
2021, there are several universal vaccines candidates,
in pre-clinical development and in clinical trials. [179][180][181][182]
In a 2007 report, the global capacity of approximately
826 million seasonal influenza vaccine doses
(inactivated and live) was double the production of 413
million doses. In an aggressive scenario of
producing pandemic influenza vaccines by 2013, only
2.8 billion courses could be produced in a six-month
time frame. If all high- and upper-middle-income
countries sought vaccines for their entire populations in
a pandemic, nearly two billion courses would be
required. If China pursued this goal as well, more than
three billion courses would be required to serve these
populations.[183] Vaccine research and development is
ongoing to identify novel vaccine approaches that could
produce much greater quantities of vaccine at a price
that is affordable to the global population.[citation needed]
Egg-based[edit]
Most flu vaccines are grown by vaccine manufacturers
in fertilized chicken eggs.[184][178] In the Northern
hemisphere, the manufacturing process begins following
the announcement (typically in February) of the WHO
recommended strains for the winter flu season.[184]
[185]
Three strains (representing an H1N1, an H3N2, and a
B strain) of flu are selected and chicken eggs are
inoculated separately. These monovalent harvests are
then combined to make the trivalent vaccine.[186]
Avian flu vaccine development by reverse genetics technique
As of November 2007, both the conventional injection

and the nasal spray are manufactured using chicken
eggs. The European Union also approved Optaflu, a
vaccine produced by Novartis using vats of animal cells.
This technique is expected to be more scalable and
avoid problems with eggs, such as allergic reactions
and incompatibility with strains that affect avians like
chickens.[178]
Influenza vaccines are produced in pathogen-free eggs
that are eleven or twelve days old.[187] The top of the egg
is disinfected by wiping it with alcohol and then the egg
is candled to identify a non-veinous area in the allantoic
cavity where a small hole is poked to serve as a
pressure release.[188] A second hole is made at the top of
the egg, where the influenza virus is injected in the
allantoic cavity, past the chorioallantoic membrane. The
two holes are then sealed with melted paraffin and the
inoculated eggs are incubated for 48 hours at 37
degrees Celsius.[187] During incubation time, the virus
replicates and newly replicated viruses are released into
the allantoic fluid[189]
After the 48-hour incubation period, the top of the egg is
cracked and the ten milliliters of allantoic fluid is
removed, from which about fifteen micrograms of the flu
vaccine can be obtained. At this point, the viruses have
been weakened or killed and the viral antigen is purified
and placed inside vials, syringes, or nasal sprayers.
[189]
Done on a large-scale, this method is used to
produce the flu vaccine for the human population. [citation needed]
Other methods of manufacture[edit]
Methods of vaccine generation that bypass the need for
eggs include the construction of influenza virus-like
particles (VLP). VLP resemble viruses, but there is no
need for inactivation, as they do not include viral coding
elements, but merely present antigens in a similar
manner to a virion. Some methods of producing VLP
include cultures of Spodoptera frugiperda Sf9 insect
cells and plant-based vaccine production (e.g.,
production in Nicotiana benthamiana). There is
evidence that some VLPs elicit antibodies that
recognize a broader panel of antigenically distinct viral
isolates compared to other vaccines in
the hemagglutination-inhibition assay (HIA).[190]
A gene-based DNA vaccine, used to prime the immune
system after boosting with an inactivated H5N1 vaccine,
underwent clinical trials in 2011.[191][192][193]
On November 20, 2012, Novartis received FDA
approval for the first cell-culture vaccine.[126][30][194][195] In
2013, the recombinant influenza vaccine, Flublok, was
approved for use in the United States.[32][196][197][198]
On September 17, 2020, the Committee for Medicinal
Products for Human Use (CHMP) of the European
Medicines Agency (EMA) adopted a positive opinion,
recommending the granting of a marketing authorization
for Supemtek, a quadrivalent influenza vaccine
(recombinant, prepared in cell culture).[199] The applicant
for this medicinal product is Sanofi Pasteur.[199] Supemtek
was approved for medical use in the European Union in
November 2020.[127]
Australia authorised its first and cell-based vaccine in
March 2021, based on an "eternal cell line" of a
dog kidney. Because of the way it is produced, it
produces better-matched vaccine (to the flu strains). [122]
Vaccine manufacturing countries[edit]
According to the WHO, as of 2019, countries where
influenza vaccine is produced include: [200]
 Australia
 Brazil
 Canada
 China
 France
 Germany
 Hungary
 India
 Iran
 Japan
 Mexico
 Netherlands
 Nicaragua
 Russian Federation
 South Korea
 United Kingdom
 United States
 Vietnam
In addition, Kazakhstan, Serbia and Thailand had
facilities in final stages of establishing production. [200]
Cost-effectiveness[edit]
The cost-effectiveness of seasonal influenza vaccination
has been widely evaluated for different groups and in
different settings.[201] In the elderly (over 65), the majority
of published studies have found that vaccination is cost
saving, with the cost savings associated with influenza
vaccination (e.g. prevented health care visits)
outweighing the cost of vaccination.[202] In older adults
(aged 50–64 years), several published studies have
found that influenza vaccination is likely to be cost-
effective, however the results of these studies were
often found to be dependent on key assumptions used
in the economic evaluations.[203] The uncertainty in
influenza cost-effectiveness models can partially be
explained by the complexities involved in estimating the
disease burden,[204] as well as the seasonal variability in
the circulating strains and the match of the vaccine. [205]
[206]
In healthy working adults (aged 18–49 years), a 2012
review found that vaccination was generally not cost-
saving, with the suitability for funding being dependent
on the willingness to pay to obtain the associated health
benefits.[207] In children, the majority of studies have
found that influenza vaccination was cost-effective,
however many of the studies included (indirect)
productivity gains, which may not be given the same
weight in all settings.[208] Several studies have attempted
to predict the cost-effectiveness of interventions
(including prepandemic vaccination) to help protect
against a future pandemic, however estimating the cost-
effectiveness has been complicated by uncertainty as to
the severity of a potential future pandemic and the
efficacy of measures against it.[209]
Research[edit]
Influenza research includes molecular
virology, molecular evolution, pathogenesis,
host immune responses, genomics, and epidemiology.
These help in developing influenza countermeasures
such as vaccines, therapies and diagnostic tools.
Improved influenza countermeasures require basic
research on how viruses enter cells, replicate, mutate,
evolve into new strains and induce an immune
response. The Influenza Genome Sequencing Project is
creating a library of influenza sequences[210] that will help
researchers' understanding of what makes one strain
more lethal than another, what genetic determinants
most affect immunogenicity, and how the virus evolves
over time. Solutions to limitations in current[when?] vaccine
methods are being[when?] researched.
A different approach uses Internet content to estimate
the impact of an influenza vaccination campaign. More
specifically, researchers have used data
from Twitter and Microsoft's Bing search engine, and
proposed a statistical framework which, after a series of
operations, maps this information to estimates of the
influenza-like illness reduction percentage in areas
where vaccinations have been performed. The method
has been used to quantify the impact of two flu
vaccination programmes in England (2013/14 and
2014/15), where school-age children were administered
a live attenuated influenza vaccine (LAIV). Notably, the
impact estimates were in accordance with estimations
from Public Health England based on traditional
syndromic surveillance endpoints.[211][212]
Rapid response to pandemic flu[edit]
The rapid development, production, and distribution of
pandemic influenza vaccines could potentially save
millions of lives during an influenza pandemic. Due to
the short time frame between identification of a
pandemic strain and need for vaccination, researchers
are looking at novel technologies for vaccine production
that could provide better "real-time" access and be
produced more affordably, thereby increasing access for
people living in low- and moderate-income countries,
where an influenza pandemic may likely originate, such
as live attenuated (egg-based or cell-based) technology
and recombinant technologies (proteins and virus-like
particles).[213] As of July 2009, more than seventy known
clinical trials have been completed or are ongoing for
pandemic influenza vaccines.[214] In September 2009, the
FDA approved four vaccines against the 2009 H1N1
influenza virus (the 2009 pandemic strain), and
expected the initial vaccine lots to be available within
the following month.[215]
In January 2020, the US Food and Drug
Administration (FDA) approved Audenz as a vaccine for
the H5N1 flu virus.[216] Audenz is a vaccine indicated for
active immunization for the prevention of disease
caused by the influenza A virus H5N1 subtype
contained in the vaccine. Audenz is approved for use in
persons six months of age and older at increased risk of
exposure to the influenza A virus H5N1 subtype
contained in the vaccine.[217]
Universal flu vaccines[edit]
Main article: Universal flu vaccine
A "universal vaccine" that would not have to be
designed and made for each flu season in each
hemisphere would stabilize the supply, avoid error in
predicting the season's variants, and protect against
escape of the circulating strains by mutation.[177] Such a
vaccine has been the subject of research for decades. [218]
One approach is to use broadly neutralizing
antibodies that, unlike the annual seasonal vaccines
used over the first decades of the 21st century
that provoke the body to generate an immune response,
instead provide a component of the immune response
itself. The first neutralizing antibodies were identified in
1993, via experimentation.[219] It was found that the flu
neutralizing antibodies bound to the stalk of the
Hemagglutinin protein. Antibodies that could bind to the
head of those proteins were identified. The highly
conserved M2 proton channel was proposed as a
potential target for broadly neutralizing antibodies. [218][220]
The challenges for researchers are to identify single
antibodies that could neutralize many subtypes of the
virus, so that they could be useful in any season, and
that target conserved domains that are resistant
to antigenic drift.[218]
Another approach is to take the conserved domains
identified from these projects, and to deliver groups of
these antigens to provoke an immune response; various
approaches with different antigens, presented different
ways (as fusion proteins, mounted on virus-like
particles, on non-pathogenic viruses, as DNA, and
others), are under development.[220][221][222]
Efforts have also been undertaken to develop universal
vaccines that specifically activate a T-cell response,
based on clinical data showing that people with a
strong, early T-cell response have better outcomes
when infected with influenza and because T-cells
respond to conserved epitopes. The challenge for
developers is that these epitopes are on internal protein
domains that are only mildly immunogenic.[220]
Along with the rest of the vaccine field, people working
on universal vaccines have experimented with vaccine
adjuvants to improve the ability of their vaccines to
create a sufficiently powerful and enduring immune
response.[220][223]
Oral influenza vaccine[edit]
As of 2019, an oral flu vaccine was in clinical research.
[224]
The oral vaccine candidate is based on
an adenovirus type 5 vector modified to remove genes
needed for replication, with an added gene that
expresses a small double-stranded RNA hairpin
molecule as an adjuvant.[225] In 2020, a Phase II human
trial of the pill form of the vaccine showed that it was
well tolerated and provided similar immunity to a
licensed injectable vaccine.[226]
COVID-19[edit]
An influenza vaccine and a COVID-19 vaccine may be
given safely at the same time.[49][227] Preliminary research
indicates that influenza vaccination does not
prevent COVID-19, but may reduce the incidence and
severity of COVID-19 infection.[228]
Criticism[edit]
Tom Jefferson, who has led Cochrane
Collaboration reviews of flu vaccines, has called clinical
evidence concerning flu vaccines "rubbish" and has
therefore declared them to be ineffective; he has called
for placebo-controlled randomized clinical trials, which
most in the field hold as unethical. His views on the
efficacy of flu vaccines are rejected by medical
institutions including the CDC and the National Institutes
of Health, and by key figures in the field like Anthony
Fauci.[229]
Michael Osterholm, who led the Center for Infectious
Disease Research and Policy 2012 review on flu
vaccines, recommended getting the vaccine but
criticized its promotion, saying, "We have overpromoted
and overhyped this vaccine ... it does not protect as
promoted. It's all a sales job: it's all public relations." [230]
Veterinary use[edit]
See also: Influenza A virus and Influenza § Infection in
other animals
Veterinary influenza vaccination aims to achieve the
following four objectives:[231]
1. Protection from clinical disease

2. Protection from infection with virulent virus
3. Protection from virus excretion
4. Serological differentiation of infected from
vaccinated animals (so-called DIVA principle).
Horses[edit]
Horses with horse flu can run a fever, have a dry
hacking cough, have a runny nose, and become
depressed and reluctant to eat or drink for several days
but usually recover in two to three weeks. "Vaccination
schedules generally require a primary course of two
doses, 3–6 weeks apart, followed by boosters at 6–12
month intervals. It is generally recognized that in many
cases such schedules may not maintain protective
levels of antibody and more frequent administration is
advised in high-risk situations."[232]
It is a common requirement at shows in the United
Kingdom that horses be vaccinated against equine flu
and a vaccination card must be produced;
the International Federation for Equestrian Sports (FEI)
requires vaccination every six months.[233][234]
Poultry[edit]
Poultry vaccines for bird flu are made inexpensively and
are not filtered and purified like human vaccines to
remove bits of bacteria or other viruses. They usually
contain whole virus, not just hemagglutinin as in most
human flu vaccines. Another difference between human
and poultry vaccines is that poultry vaccines
are adjuvated with mineral oil, which induces a strong
immune reaction but can cause inflammation and
abscesses. "Chicken vaccinators who have accidentally
jabbed themselves have developed painful swollen
fingers or even lost thumbs, doctors said. Effectiveness
may also be limited. Chicken vaccines are often only
vaguely similar to circulating flu strains – some contain
an H5N2 strain isolated in Mexico years ago. 'With a
chicken, if you use a vaccine that's only 85 percent
related, you'll get protection,' Dr. Cardona said. 'In
humans, you can get a single point mutation, and a
vaccine that's 99.99 percent related won't protect you.'
And they are weaker [than human vaccines]. 'Chickens
are smaller and you only need to protect them for six
weeks, because that's how long they live till you eat
them,' said Dr. John J. Treanor, a vaccine expert at the
University of Rochester. Human seasonal flu vaccines
contain about 45 micrograms of antigen, while an
experimental A(H5N1) vaccine contains 180. Chicken
vaccines may contain less than one microgram. 'You
have to be careful about extrapolating data from poultry
to humans,' warned Dr. David E. Swayne, director of the
agriculture department's Southeast Poultry Research
Laboratory. 'Birds are more closely related
to dinosaurs.'"[235]
Researchers, led by Nicholas Savill of the University of
Edinburgh in Scotland, used mathematical models to
simulate the spread of H5N1 and concluded that "at
least 95 percent of birds need to be protected to prevent
the virus spreading silently. In practice, it is difficult to
protect more than 90 percent of a flock; protection levels
achieved by a vaccine are usually much lower than
this."[236] The Food and Agriculture Organization of the
United Nations has issued recommendations on the
prevention and control of avian influenza in poultry,
including the use of vaccination.[237]
A filtered and purified Influenza A vaccine for humans is
being developed[when?] and many countries have
recommended it be stockpiled so if an Avian influenza
pandemic starts jumping to humans, the vaccine can
quickly be administered to avoid loss of life. Avian
influenza is sometimes called avian flu, and commonly
bird flu.[238]
Pigs[edit]
Swine influenza vaccines are extensively used in pig
farming in Europe and North America. Most swine flu
vaccines include an H1N1 and an H3N2 strain.
Swine influenza has been recognized as a major
problem since the outbreak in 1976. Evolution of the
virus has resulted in inconsistent responses to
traditional vaccines. Standard commercial swine flu
vaccines are effective in controlling the problem when
the virus strains match enough to have significant cross-
protection. Customised (autogenous) vaccines made
from the specific viruses isolated, are made and used in
the more difficult cases.[239] The vaccine
manufacturer Novartis claims that the H3N2 strain (first
identified in 1998) has brought major losses to pig
farmers. Abortion storms are a common sign and sows
stop eating for a few days and run a high fever. The
mortality rate can be as high as fifteen percent.[240]
Dogs[edit]
In 2004, influenza A virus subtype H3N8 was
discovered to cause canine influenza. Because of the
lack of previous exposure to this virus, dogs have no
natural immunity to this virus. However, a vaccine was
found in 2004.[241]
Annual reformulation[edit]
Further information: Historical annual reformulations of
the influenza vaccine
See also: 2009 flu pandemic vaccine
Each year, three strains are chosen for selection in that
year's flu vaccination by the WHO Global Influenza
Surveillance and Response System.[242] The chosen
strains are the H1N1, H3N2, and Type-B strains thought
most likely to cause significant human suffering in the
coming season. Starting with the 2012–2013 Northern
Hemisphere influenza season (coincident with the
approval of quadrivalent influenza vaccines), the WHO
has also recommended a 2nd B-strain for use in
quadrivalent vaccines. The World Health
Organization (WHO) coordinates the contents of the
vaccine each year to contain the most likely strains of
the virus to attack the next year.
"The WHO Global Influenza Surveillance Network
was established in 1952 [renamed "Global Influenza
Surveillance and Response System" in 2011]. [243] The
network comprises four WHO Collaborating Centres
(WHO CCs) and 112 institutions in 83 countries,
which are recognized by WHO as WHO National
Influenza Centres (NICs). These NICs collect
specimens in their country, perform primary virus
isolation and preliminary antigenic characterization.
They ship newly isolated strains to WHO CCs for
high level antigenic and genetic analysis, the result
of which forms the basis for WHO recommendations
on the composition of influenza vaccine for the
Northern and Southern Hemisphere each year." [244]
The Global Influenza Surveillance and Response
System's selection of viruses for the vaccine
manufacturing process is based on its best estimate
of which strains will predominate the next year,
amounting in the end to well-informed but fallible
guesswork.[245]
Formal WHO recommendations were first issued in
1973. Beginning in 1999 there have been two
recommendations per year: one for the northern
hemisphere and the other for the southern
hemisphere.[246]
Historical annual reformulations of the influenza
vaccine are listed in a separate article. Recent WHO
seasonal influenza vaccine composition
recommendations:
2020–2021 northern hemisphere[edit]
The composition of virus vaccines for use in the
2020–2021 Northern Hemisphere influenza season
recommended by the World Health Organization on
February 28, 2020, is:[247]
for egg-based:
 an A/Guangdong-Maonan/SWL1536/2019
(H1N1)pdm09-like virus
 an A/Hong Kong/2671/2019 (H3N2)-like virus
 a B/Washington/02/2019 (B/Victoria lineage)-like
virus
 a B/Phuket/3073/2013 (B/Yamagata lineage)-like
virus
for cell- or recombinant-based:[citation needed]
 an A/Hawaii/70/2019 (H1N1)pdm09-like virus

 an A/Hong Kong/45/2019 (H3N2)-like virus
virus
virus
The WHO recommends that trivalent vaccines use
as their influenza B virus a B/Washington/02/2019
(B/Victoria lineage)-like virus.[247]
United States
The Vaccines and Related Biological Products
Advisory Committee (VRBPAC) of the Food and
Drug Administration (FDA) recommended that the
quadrivalent formulation of egg-based influenza
vaccines for the US 2020–2021 influenza season
contain the following:[248]
(H1N1)pdm09-like virus;
 an A/HongKong/2671/2019 (H3N2)-like virus;
 a B/Washington/02/2019-like virus (B/Victoria
lineage);
 a B/Phuket/3073/2013-like virus (B/Yamagata
lineage).
The committee recommended that the quadrivalent
formulation of cell- or recombinant-based influenza
 an A/Hawaii/70/2019 (H1N1)pdm09-like virus;

 an A/HongKong/45/2019 (H3N2)-like virus;
 a B/Washington/02/2019-like virus (B/Victoria
lineage);
lineage)
For trivalent influenza vaccines for use in the US for
the 2020–2021 influenza season, depending on the
manufacturing method of the vaccine, the committee
recommended that the A(H1N1)pdm09, A(H3N2)
and B/Victoria lineage viruses recommended above
for the quadrivalent vaccines be used. [248]
European Union
European Union for the 2020–2021 Northern
Hemisphere influenza season recommended by the
European Medicines Agency on April 1, 2020, was:
[249]
Egg-based or live attenuated trivalent vaccines

should contain:[249]
(H1N1)pdm09-like virus;
 an A/Hong Kong/2671/2019 (H3N2)-like virus;
virus.
Cell-based trivalent vaccines should contain: [249]
 an A/Hawaii/70/2019 (H1N1)pdm09-like virus;

virus.
A B/Phuket/3073/2013-like virus is recommended in
addition to the strains mentioned above for the
quadrivalent vaccines.[249]
2021 southern hemisphere[edit]
The composition of vaccines for use in the 2021
Southern Hemisphere influenza season influenza
season recommended by the World Health
Organization in September 2020:[250]
For egg-based (trivalent):
 an A/Victoria/2570/2019 (H1N1)pdm09-like virus;

and
virus.
For cell- or recombinant-based (trivalent):
 an A/Wisconsin/588/2019 (H1N1)pdm09-like
virus;
 an A/Hong Kong/45/2019 (H3N2)-like virus; and
virus.
The quadrivalent version should contain, in addition
to the above:

virus.
In Australia, the standard vaccine under the National
Immunisation Program for 2021 is the quadrivalent
one.[251]
is
European Union
European Medicines Agency on March 30, 2021, is:
[252][253]
Egg-based or live attenuated trivalent vaccines


 an A/Cambodia/e0826360/2020 (H3N2)-like
virus;
virus.
Cell-based trivalent vaccines should contain: [252]
virus;
virus;
virus.
A B/Phuket/3073/2013-like virus is recommended in
addition to the strains mentioned above for the
quadrivalent vaccines.[252]
United States
The FDA Vaccines and Related Biological Products
Advisory Committee (VRBPAC) recommended that
the quadrivalent formulation of egg-based influenza
vaccines for the US 2021-2022 influenza season
 an A/Victoria/2570/2019 (H1N1) pdm09-like

virus;
virus;
 a B/Washington/02/2019- like virus (B/Victoria
lineage);
lineage).
formulation of cell- or recombinant based influenza
vaccines for the US 2021-2022 influenza season
 an A/Wisconsin/588/2019 (H1N1) pdm09-like

virus;
virus;
 a B/Washington/02/2019- like virus (B/Victoria
lineage);
lineage).
the 2021-2022 influenza season, depending on the
recommended that the A(H1N1) pdm09, A(H3N2)
and B/Washington/02/2019-like virus (B/Victoria
lineage) viruses recommended above for the
quadrivalent vaccines be used.[254]
2022 southern hemisphere[edit]
The composition of vaccines for use in the 2022
Southern Hemisphere influenza season influenza
season recommended by the World Health
Organization in September 2021:[255]
Egg-based vaccines:
 A/Victoria/2570/2019 (H1N1)pdm09-like virus;

 A/Darwin/9/2021 (H3N2)-like virus;
 B/Austria/1359417/2021 (B/Victoria lineage)-like
virus; and
 B/Phuket/3073/2013 (B/Yamagata lineage)-like
virus.
Cell- or recombinant-based vaccines:
 A/Wisconsin/588/2019 (H1N1)pdm09-like virus;

 A/Darwin/6/2021 (H3N2)-like virus;
virus; and
 B/Phuket/3073/2013 (B/Yamagata lineage)-like
virus.
It is recommended that trivalent influenza vaccines
for use in the 2022 southern hemisphere influenza
season contain the following:
Egg-based vaccines:
 A/Victoria/2570/2019 (H1N1)pdm09-like virus;

 A/Darwin/9/2021 (H3N2)-like virus; and
virus.
Cell- or Recombinant-based vaccines:
 A/Wisconsin/588/2019 (H1N1)pdm09-like virus;

 A/Darwin/6/2021 (H3N2)-like virus; and
virus
is[256]
European Union
European Medicines Agency on March 29, 2022, is:
[257][258]
Quadrivalent egg-based or live attenuated vaccines


 an A/Darwin/9/2021 (H3N2)-like virus;
 a B/Austria/1359417/2021 (B/Victoria lineage)-
like virus; and
virus.
Quadrivalent cell-culture or recombinant-based
vaccines should contain:[257]
virus;
 a B/Austria/1359417/2021 (B/Victoria lineage)-
like virus; and
virus.
United States
The FDA Vaccines and Related Biological Products
Advisory Committee (VRBPAC) recommended that
the quadrivalent formulation of egg-based influenza
vaccines for the U.S. 2022-2023 influenza season

 a B/Austria/1359417/2021-like virus (B/Victoria
lineage); and
lineage).
formulation of cell- or recombinant-based influenza
virus;
 a B/Austria/1359417/2021-like virus (B/Victoria
lineage); and
lineage).
the 2022–2023 influenza season, depending on the
recommended that the A(H1N1)pdm09, A(H3N2)
and B/Austria/1359417/2021-like virus (B/Victoria
lineage) viruses recommended above for the
quadrivalent vaccines be used.[259]
Notes[edit]
1. ^ (H1N1)pdm09 is newer nomenclature for the 2009
pandemic H1N1 virus, not a different strain.
See also[edit]
 H5N1 vaccine
 Seasonal influenza vaccine brands
 Universal influenza vaccine
References[edit]
1. ^ Jump up to:a b "AusPAR: Influenza Haemagglutinin
Recombinant". Therapeutic Goods Administration (TGA).
August 23, 2021. Archived from the original on
September 11, 2021. Retrieved September 10, 2021.
2. ^ Jump up to:a b "AusPAR: Inactivated quadrivalent
influenza vaccine (split virion) influenza virus
haemagglutinin". Therapeutic Goods Administration
(TGA). December 2, 2020. Archived from the original on
September 11, 2021. Retrieved September 10, 2021.
3. ^ "Summary Basis of Decision (SBD) for
Supemtek". Health Canada. October 23,
2014. Archived from the original on May 30, 2022.
Retrieved May 29, 2022.
4. ^ "Regulatory Decision Summary - Flucelvax
Quad". Health Canada. October 23, 2014. Archived from
the original on June 7, 2022. Retrieved June 7, 2022.
5. ^ "Regulatory Decision Summary - Flucelvax
Quad". Health Canada. October 23, 2014. Archived from
6. ^ "Regulatory Decision Summary - Influvac
Tetra". Health Canada. October 23, 2014. Archived from
7. ^ Jump up to:a b c d e f g h i j World Health
Organization (November 2012). "Vaccines against
influenza WHO position paper". Weekly Epidemiological
Record. 87 (47): 461–
76. hdl:10665/241993. PMID 23210147. Lay
summary (PDF). {{cite journal}}: Cite uses
deprecated parameter |lay-url= (help)
8. ^ Manzoli L, Ioannidis JP, Flacco ME, De Vito C, Villari P
(July 2012). "Effectiveness and harms of seasonal and
pandemic influenza vaccines in children, adults and
elderly: a critical review and re-analysis of 15 meta-
analyses". Human Vaccines &
Immunotherapeutics. 8 (7): 851–
62. doi:10.4161/hv.19917. PMC 3495721. PMID 227770
99.
9. ^ Rolfes MA, Foppa IM, Garg S, Flannery B, Brammer L,
Singleton JA, et al. (December 9, 2016). "2015–2016
Estimated Influenza Illnesses, Medical visits, and
Hospitalizations Averted by Vaccination in the United
States". U.S. Centers for Disease Control and
Prevention (CDC). Archived from the original on
December 2, 2019. Retrieved December 24, 2017.
This article incorporates text from this source, which is in
the public domain.
10. ^ Centers for Disease Control and Prevention (January
16, 2020). "Benefits of Flu Vaccination During 2018-2019
Flu Season". Centers for Disease Control and
Prevention (CDC). Archived from the original on March
6, 2020. Retrieved April 10, 2020.
11. ^ Jump up to:a b c d e f Demicheli V, Jefferson T, Ferroni E,
Rivetti A, Di Pietrantonj C (February 2018). "Vaccines for
preventing influenza in healthy adults". Cochrane
Database of Systematic Reviews. 2020 (2):
CD001269. doi:10.1002/14651858.CD001269.pub6. PM
C 6491184. PMID 29388196.
12. ^ Jump up to:a b c Osterholm MT, Kelley NS, Sommer A,
Belongia EA (January 2012). "Efficacy and effectiveness
of influenza vaccines: a systematic review and meta-
analysis". The Lancet. Infectious Diseases. 12 (1): 36–
44. doi:10.1016/S1473-3099(11)70295-X. PMID 220328
44.
13. ^ Jump up to:a b Demicheli V, Jefferson T, Di Pietrantonj
C, Ferroni E, Thorning S, Thomas RE, Rivetti A
(February 2018). "Vaccines for preventing influenza in
the elderly". Cochrane Database of Systematic
Reviews. 2 (11):
CD004876. doi:10.1002/14651858.CD004876.pub4. PM
C 6491101. PMID 29388197.
14. ^ Compans RW (2009). Vaccines for pandemic
influenza. Dordrecht: Springer. p. 49. ISBN 978-
3540921653. Archived from the original on August 3,
2020. Retrieved September 9, 2017.
15. ^ Vaccine Analysis: Strategies, Principles, and Control.
Springer. 2014. p. 61. ISBN 978-
3662450246. Archived from the original on August 3,
2020. Retrieved September 9, 2017.
16. ^ World Health Organization (2019). World Health
Organization model list of essential medicines: 21st list
2019. Geneva: World Health
Organization. hdl:10665/325771.
WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA
3.0 IGO.
17. ^ Jump up to:a b c d "Who Should and Who Should NOT
get a Flu Vaccine". U.S. Centers for Disease Control and
Prevention (CDC). October 11, 2019. Archived from the
original on December 2, 2019. Retrieved December
2, 2019. This article incorporates text from this source,
which is in the public domain.
18. ^ World Health Organization (October 2017). The
immunological basis for immunization series: module 23:
influenza vaccines. World Health
Organization (WHO). hdl:10665/259211. ISBN 978-
9241513050.
19. ^ Jump up to:a b c d e f g h i j k l m n o p q r s Grohskopf LA,
Alyanak E, Ferdinands JM, Broder KR, Blanton LH,
Talbot HK, et al. (August 2021). "Prevention and Control
of Seasonal Influenza with Vaccines: Recommendations
of the Advisory Committee on Immunization Practices,
United States, 2021-22 Influenza
Season" (PDF). MMWR Recomm Rep. 70 (5): 1–
28. doi:10.15585/mmwr.rr7005a1. PMC 8407757. PMID
34448800. Archived (PDF) from the original on August
27, 2021. Retrieved August 29, 2021. This article
incorporates text from this source, which is in the public
domain.
20. ^ "Implementation of the Council Recommendation on
seasonal influenza vaccination
(2009/1019/EU)" (PDF). European Centre for Disease
Prevention and Control. January
2014. Archived (PDF) from the original on April 10, 2020.
Retrieved April 10, 2020. Lay summary. {{cite
web}}: Cite uses deprecated parameter |lay-
url= (help)
21. ^ Jump up to:a b c d e "Flu Vaccine and People with Egg
Allergies". U.S. Centers for Disease Control and
Prevention (CDC). November 25, 2019. Archived from
the original on December 2, 2019. Retrieved December
22. ^ "Intradermal Influenza (Flu) Vaccination". U.S. Centers
for Disease Control and Prevention (CDC). October 31,
2018. Archived from the original on October 14, 2019.
Retrieved October 14, 2019. This article incorporates
text from this source, which is in the public domain.
23. ^ "Influenza vaccines – United States, 2019–20 influenza
season". U.S. Centers for Disease Control and
Prevention (CDC). August 22, 2019. Archived from the
original on October 14, 2019. Retrieved October
14, 2019. This article incorporates text from this
source, which is in the public domain.
24. ^ "Influenza Virus Vaccine Inactivated". The American
Society of Health-System Pharmacists. November 19,
Retrieved October 13, 2019.
25. ^ Institute of Medicine (2005). Knobler SL, Mack A,
Mahmoud A, Lemon SM (eds.). The Threat of Pandemic
Influenza: Are We Ready? Workshop Summary. The
National Academies Press.
p. 62. doi:10.17226/11150. ISBN 978-0-309-09504-4. P
MID 20669448.
26. ^ Plotkin, S.L. and Plotkin, S.A. "A short history of
vaccination". In: Vaccines, Stanley A. Plotkin, Walter A.
Orenstein, Paul A. Offit, eds. Elsevier Health Sciences,
2008, pp. 6–7.
27. ^ Artenstein, A.W. "Influenza" In: Vaccines: A
Biography Andrew W. Artenstein, ed. pp. 191–205.
28. ^ Hampson AW (June 2008). "Vaccines for pandemic
influenza. The history of our current vaccines, their
limitations and the requirements to deal with a pandemic
threat". Annals of the Academy of Medicine,
Singapore. 37 (6): 510–17. PMID 18618064.
29. ^ Milián E, Kamen AA (2015). "Current and emerging
cell culture manufacturing technologies for influenza
vaccines". Biomed Res Int. 2015:
504831. doi:10.1155/2015/504831. PMC 4359798. PMI
D 25815321.
30. ^ Jump up to:a b "FDA approves first seasonal influenza
vaccine manufactured using cell culture
technology" (Press release). U.S. Food and Drug
Administration (FDA). Archived from the original on
January 2, 2013. This article incorporates text from
this source, which is in the public domain.
31. ^ "Cell-Based Flu Vaccines". U.S. Centers for Disease
Control and Prevention (CDC). October 11,
2019. Archived from the original on December 2, 2019.
Retrieved December 2, 2019. This article incorporates
32. ^ Jump up to:a b "FDA approves new seasonal influenza
vaccine made using novel technology" (Press release).
U.S. Food and Drug Administration (FDA). January 16,
the public domain.
33. ^ Landry N, Ward BJ, Trépanier S, Montomoli E, Dargis
M, Lapini G, Vézina LP (December 2010). "Preclinical
and clinical development of plant-made virus-like particle
vaccine against avian H5N1 influenza". PLOS
ONE. 5 (12):
e15559. Bibcode:2010PLoSO...515559L. doi:10.1371/jo
urnal.pone.0015559. PMC 3008737. PMID 21203523.
34. ^ Osterholm MT (May 2005). "Preparing for the next
pandemic". The New England Journal of
Medicine. 352 (18): 1839–
42. CiteSeerX 10.1.1.608.6200. doi:10.1056/NEJMp058
068. PMID 15872196. S2CID 45893174.
35. ^ "Swine Flu Epidemics". October 9, 1999. Archived
from the original on October 9, 1999.
36. ^ McCullers JA, Van De Velde LA, Allison KJ, Branum
KC, Webby RJ, Flynn PM (June 2010). "Recipients of
vaccine against the 1976 "swine flu" have enhanced
neutralization responses to the 2009 novel H1N1
influenza virus". Clinical Infectious Diseases. 50 (11):
1487–92. doi:10.1086/652441. PMC 2946351. PMID 20
415539.
37. ^ "First Quadrivalent Vaccine Against Seasonal Flu Wins
FDA Approval". March 2, 2012. Archived from the
original on March 4, 2012.
38. ^ "FDA approves first quadrivalent vaccine to prevent
seasonal influenza" (Press release). U.S. Food and Drug
December 21, 2012. This article incorporates text from
39. ^ "December 14, 2012 Approval Letter – Fluarix
Quadrivalent". U.S. Food and Drug
January 2, 2013. This article incorporates text from
40. ^ National Advisory Committee on Immunization (NACI)
(July 2014). Literature review on quadrivalent influenza
vaccines (PDF). Public Health Agency of Canada.
Ottawa. ISBN 978-1-100-24682-6. Cat.: HP40-
117/2014E-PDF Pub.: 140118. Archived (PDF) from the
original on August 1, 2020. Retrieved January 11, 2020.
41. ^ "What You Should Know for the 2018-2019 Influenza
Season". Centers for Disease Control and
Prevention (CDC). January 10, 2019. Archived from the
original on August 6, 2020. Retrieved February
42. ^ Jump up to:a b c d e f g Centers for Disease Control and
Prevention (CDC), National Center for Immunization and
Respiratory Diseases (NCIRD) (November 5,
2019). "Frequently Asked Influenza (Flu) Questions:
2019–2020 Season". U.S. Centers for Disease Control
and Prevention (CDC). Archived from the original on
December 1, 2019. Retrieved November 30, 2019.
the public domain.
43. ^ "Fluzone High-Dose Quadrivalent". U.S. Food and
Drug Administration (FDA). November 4, 2019. STN: BL
103914. Archived from the original on January 12, 2020.
Retrieved February 5, 2020. This article incorporates
44. ^ "FDA approves Fluzone High-Dose Quadrivalent
(Influenza Vaccine) for adults 65 years of age and
older". Sanofi (Press release). November 4,
2019. Archived from the original on August 1, 2020.
Retrieved February 5, 2020.
45. ^ Jump up to:a b c "Fluad Quadrivalent". U.S. Food and
Drug Administration (FDA). July 2, 2020. STN:
Retrieved August 25, 2020. This article incorporates
46. ^ "Seqirus Receives FDA Approval for Fluad
Quadrivalent for Adults 65 Years and
Older". Seqirus (Press release). February 24,
Retrieved August 25, 2020.
47. ^ "Seqirus Begins Shipping 2020/21 Influenza Vaccines
to U.S. Market". Seqirus (Press release). July 30,
48. ^ Jump up to:a b c d e f "Key Facts About Seasonal Flu
Vaccine". U.S. Centers for Disease Control and
Prevention (CDC). December 2, 2019. Archived from the
49. ^ Jump up to:a b "Flu vaccine". UK National Health
Service. May 13, 2022. Archived from the original on
October 26, 2021. Retrieved August 13, 2022.
50. ^ Osterholm MT, Kelley NS, Sommer A, Belongia EA
(January 2012). "Efficacy and effectiveness of influenza
vaccines: a systematic review and meta-analysis". The
Lancet. Infectious Diseases. 12 (1): 36–
44. doi:10.1016/s1473-3099(11)70295-x. PMID 2203284
4.
51. ^ MacIntyre CR, Mahimbo A, Moa AM, Barnes M
(December 2016). "Influenza vaccine as a coronary
intervention for prevention of myocardial
infarction". Heart. 102 (24): 1953–
1956. doi:10.1136/heartjnl-2016-309983. PMC 5256393.
PMID 27686519.
52. ^ "Past Seasons Vaccine Effectiveness
Estimates". U.S. Centers for Disease Control and
Prevention (CDC). January 29, 2020. Archived from the
original on February 12, 2020. Retrieved March
53. ^ Centers for Disease Control Prevention (CDC) (August
13, 2004). "Assessment of the effectiveness of the 2003-
04 influenza vaccine among children and adults--
Colorado, 2003". MMWR. Morbidity and Mortality Weekly
Report. Centers for Disease Control and
Prevention. 53 (31): 707–710. ISSN 1545-
861X. PMID 15306754. Archived from the original on
April 27, 2022. Retrieved April 27, 2022. At table.
54. ^ Centers for Disease Control Prevention (CDC)
(January 16, 2004). "Preliminary assessment of the
effectiveness of the 2003-04 inactivated influenza
vaccine--Colorado, December 2003". MMWR. Morbidity
and Mortality Weekly Report. Centers for Disease
Control and Prevention. 53 (1): 8–11. ISSN 1545-
861X. PMID 14724559. Archived from the original on
May 29, 2022. Retrieved April 25, 2022.
55. ^ "Past Weekly Surveillance Reports". Centers for
Disease Control and Prevention. April 29,
2022. Archived from the original on April 22, 2022.
Retrieved April 25, 2022.
56. ^ Chung JR (March 11, 2022). "Interim Estimates of
2021–22 Seasonal Influenza Vaccine Effectiveness —
United States, February 2022". MMWR. Morbidity and
Mortality Weekly Report. 71 (10): 365–
370. doi:10.15585/mmwr.mm7110a1. ISSN 0149-2195.
PMC 8911998. PMID 35271561. Archived from the
original on May 16, 2022. Retrieved May 25, 2022.
57. ^ Eamon N. Dreisbach (June 3, 2021). "CDC unable to
estimate flu vaccine effectiveness after historically mild
season". Healio. Archived from the original on October 8,
2021. Retrieved April 18, 2022.
58. ^ Fedson DS (1998). "Measuring protection: efficacy
versus effectiveness". Developments in Biological
Standardization. 95: 195–201. PMID 9855432.
59. ^ Jefferson T (October 2006). "Influenza vaccination:
policy versus evidence". BMJ. 333 (7574): 912–
15. doi:10.1136/bmj.38995.531701.80. PMC 1626345. P
MID 17068038.
60. ^ "2007–2008 Influenza (Flu) Season". U.S. Centers for
Disease Control and Prevention (CDC). June 26,
2008. Archived from the original on March 6, 2008.
the public domain.
61. ^ Carrat F, Flahault A (September 2007). "Influenza
vaccine: the challenge of antigenic
drift". Vaccine. 25 (39–40): 6852–
6862. doi:10.1016/j.vaccine.2007.07.027. PMID 177191
49.
62. ^ Sautto GA, Kirchenbaum GA, Ross TM (January 19,
2018). "Towards a universal influenza vaccine: different
approaches for one goal". Virology Journal. 15 (1):
17. doi:10.1186/s12985-017-0918-y. PMC 5785881. PM
ID 29370862.
63. ^ Jump up to:a b Chow EJ, Doyle JD, Uyeki TM (June 12,
2019). "Influenza virus-related critical illness: prevention,
diagnosis, treatment". Critical Care. 23 (1):
214. doi:10.1186/s13054-019-2491-9. PMC 6563376. P
MID 31189475.
64. ^ Krammer F, Smith GJ, Fouchier RA, Peiris M,
Kedzierska K, Doherty PC, Palese P, Shaw ML, Treanor
J, Webster RG, García-Sastre A (June 28,
2018). "Influenza". Nature Reviews Disease
Primers. 4 (1): 3. doi:10.1038/s41572-018-0002-
y. PMC 7097467. PMID 29955068.
65. ^ Dabestani NM, Leidner AJ, Seiber EE, Kim H, Graitcer
SB, Foppa IM, Bridges CB (September 2019). "A review
of the cost-effectiveness of adult influenza vaccination
and other preventive services". Preventive
Medicine. 126:
105734. doi:10.1016/j.ypmed.2019.05.022. PMC 677868
8. PMID 31152830.
66. ^ Jump up to:a b c Ghebrehewet S, MacPherson P, Ho A
(December 7, 2016). "Influenza". The BMJ. 355:
i6258. doi:10.1136/bmj.i6258. PMC 5141587. PMID 279
27672.
67. ^ Jump up to:a b Principi N, Esposito S (March 4,
2018). "Protection of children against influenza:
Emerging problems". Human Vaccines &
Immunotherapeutics. 14 (3): 750–
757. doi:10.1080/21645515.2017.1279772. PMC 58618
00. PMID 28129049.
68. ^ Thompson MG, Pierse N, Huang QS, Prasad N, Duque
J, Newbern EC, et al. (September 18, 2018). "Influenza
vaccine effectiveness in preventing influenza-associated
intensive care admissions and attenuating severe
disease among adults in New Zealand 2012–
2015". Vaccine. 36 (39): 5916–
5925. doi:10.1016/j.vaccine.2018.07.028. ISSN 0264-
410X. PMID 30077480. S2CID 51922011. Archived fro
m the original on May 27, 2022. Retrieved April
23, 2022.
69. ^ Tenforde MW, Talbot HK, Trabue CH, Gaglani M,
McNeal TS, Monto AS, et al. (December 30,
2020). "Influenza Vaccine Effectiveness Against
Hospitalization in the United States, 2019–2020". The
Journal of Infectious Diseases. 224 (5): 813–
820. doi:10.1093/infdis/jiaa800. ISSN 0022-1899. PMC
8408767. PMID 33378531. Archived from the original on
April 23, 2022. Retrieved April 23, 2022.
70. ^ Ferdinands JM, Thompson MG, Blanton L, Spencer S,
Grant L, Fry AM (June 23, 2021). "Does influenza
vaccination attenuate the severity of breakthrough
infections? A narrative review and recommendations for
further research". Vaccine. 39 (28): 3678–
3695. doi:10.1016/j.vaccine.2021.05.011. ISSN 0264-
410X. PMID 34090700. S2CID 235361401. Archived fro
m the original on April 23, 2022. Retrieved April
23, 2022.
71. ^ Jump up to:a b c "Vaccine Effectiveness: How Well Do
the Flu Vaccines Work?". U.S. Centers for Disease
Control and Prevention (CDC). October 12,
72. ^ Ramsay LC, Buchan SA, Stirling RG, Cowling BJ, Feng
S, Kwong JC, et al. (January 2019). "The impact of
repeated vaccination on influenza vaccine effectiveness:
a systematic review and meta-analysis". BMC
Med. 17 (1): 9. doi:10.1186/s12916-018-1239-
8. PMC 6327561. PMID 30626399.
73. ^ Belongia EA, Skowronski DM, McLean HQ, Chambers
C, Sundaram ME, De Serres G (July 2017). "Repeated
annual influenza vaccination and vaccine effectiveness:
review of evidence". Expert Rev Vaccines. 16 (7): 723–
36. doi:10.1080/14760584.2017.1334554. PMID 285621
11.
74. ^ Gemmill I, Young K (June 7, 2018). "Summary of the
NACI literature review on the comparative effectiveness
of subunit and split virus inactivated influenza vaccines in
older adults". Canada Communicable Disease
Report. 44 (6): 129–
133. doi:10.14745/ccdr.v44i06a02. ISSN 1481-8531. P
MC 6449119. PMID 31015805. Archived from the
original on May 17, 2020. Retrieved June 2, 2020.
75. ^ "Flu & People 65 Years and Older". Centers for
Disease Control and Prevention. August 26,
Retrieved April 21, 2022.
76. ^ Jump up to:a b "Influenza Historic Timeline | Pandemic
Influenza (Flu) | CDC". March 11, 2020. Archived from
the original on January 30, 2022. Retrieved January
27, 2022.
77. ^ Jump up to:a b "Influenza (Seasonal)". World Health
Organization (WHO). November 6, 2018. Archived from
the original on October 25, 2019. Retrieved October
24, 2019.
78. ^ "Study of Flu-Related Deaths in Children Shows
Healthy Children at Risk". U.S. Centers for Disease
Control and Prevention (CDC). February 12,
79. ^ Jump up to:a b Jefferson T, Rivetti A, Di Pietrantonj C,
Demicheli V (February 2018). "Vaccines for preventing
influenza in healthy children". Cochrane Database of
Systematic Reviews. 2018 (2):
CD004879. doi:10.1002/14651858.CD004879.pub5. PM
C 6491174. PMID 29388195.
80. ^ Steenhuysen J (January 22, 2018). "U.S. CDC director
urges flu vaccinations as pediatric deaths mount".
Reuters. Archived from the original on May 6, 2021.
Retrieved January 26, 2018.
81. ^ "Fluzone High-Dose Quadrivalent". U.S. Food and
Drug Administration (FDA). November 14,
Retrieved November 30, 2019. This article
domain.
82. ^ "Afluria Quadrivalent". U.S. Food and Drug
Administration (FDA). November 8, 2019. Archived from
the original on December 1, 2019. Retrieved November
83. ^ National Advisory Committee on Immunization (NACI)
(November 2018). "Supplemental Statement – Afluria
Tetra – An Advisory Committee Statement
(ACS)". Public Health Agency of Canada. Ottawa. Cat.:
HP37-25E-PDF Pub.: 180566. Archived from the original
on January 12, 2020. Retrieved January 11, 2020.
84. ^ Literature review on influenza vaccination in healthy 5–
18-year-olds (PDF) (Report). Ottawa: Public Health
Agency of Canada. July 2014. ISBN 978-1-100-24681-9.
Cat.: HP40-116/2014E-PDF Pub.:
140116. Archived (PDF) from the original on August 1,
2020. Retrieved January 12, 2020.
85. ^ Literature Review on Pediatric Fluad Influenza Vaccine
Use in Children 6–72 Months of Age (PDF) (Report).
Ottawa: Public Health Agency of Canada.
2015. Archived (PDF) from the original on May 17, 2020.
86. ^ Peleg N, Zevit N, Shamir R, Chodick G, Levy I
(January 2015). "Seasonal influenza vaccination rates
and reasons for non-vaccination in children with
gastrointestinal disorders". Vaccine. 33 (1): 182–
186. doi:10.1016/j.vaccine.2014.10.086. PMID 2544480
2.
87. ^ Jump up to:a b Burls A, Jordan R, Barton P, Olowokure
B, Wake B, Albon E, Hawker J (May 2006). "Vaccinating
healthcare workers against influenza to protect the
vulnerable – is it a good use of healthcare resources? A
systematic review of the evidence and an economic
evaluation". Vaccine. 24 (19): 4212–
21. doi:10.1016/j.vaccine.2005.12.043. PMID 16546308.
88. ^ Ahmed F, Lindley MC, Allred N, Weinbaum CM,
Grohskopf L (January 2014). "Effect of influenza
vaccination of healthcare personnel on morbidity and
mortality among patients: systematic review and grading
of evidence". Clinical Infectious Diseases. 58 (1): 50–
57. doi:10.1093/cid/cit580. PMID 24046301.
89. ^ Griffin MR (January 2014). "Influenza vaccination of
healthcare workers: making the grade for action". Clinical
Infectious Diseases. 58 (1): 58–
60. doi:10.1093/cid/cit590. PMID 24046312.
90. ^ Simonsen L, Viboud C, Taylor RJ, Miller MA, Jackson L
(October 2009). "Influenza vaccination and mortality
benefits: new insights, new
opportunities". Vaccine. 27 (45): 6300–
91. ^ Darvishian M, Bijlsma MJ, Hak E, van den Heuvel ER
(December 2014). "Effectiveness of seasonal influenza
vaccine in community-dwelling elderly people: a meta-
analysis of test-negative design case-control
studies". The Lancet. Infectious Diseases. 14 (12):
1228–39. doi:10.1016/S1473-3099(14)70960-0. PMID 2
5455990.
92. ^ Nichol KL, Nordin JD, Nelson DB, Mullooly JP, Hak E
(October 2007). "Effectiveness of influenza vaccine in
the community-dwelling elderly". The New England
Journal of Medicine. 357 (14): 1373–
81. doi:10.1056/NEJMoa070844. PMID 17914038. S2CI
D 14850833. Archived from the original on February 16,
2021. Retrieved December 2, 2019.
93. ^ Simonsen L, Taylor RJ, Viboud C, Miller MA, Jackson
LA (October 2007). "Mortality benefits of influenza
vaccination in elderly people: an ongoing
controversy". The Lancet. Infectious Diseases. 7 (10):
658–66. doi:10.1016/S1473-3099(07)70236-0. PMID 17
897608.
94. ^ Thompson WW, Shay DK, Weintraub E, Brammer L,
Cox N, Anderson LJ, Fukuda K (January 2003).
"Mortality associated with influenza and respiratory
syncytial virus in the United States". JAMA. 289 (2):
179–86. doi:10.1001/jama.289.2.179. PMID 12517228.
S2CID 5018362.
95. ^ "High Dose Flu Vaccine for the Elderly « Science-
Based Medicine". Sciencebasedmedicine.org. October
19, 2010. Archived from the original on May 8, 2013.
96. ^ "Fluzone High-Dose Seasonal Influenza Vaccine".
U.S. Centers for Disease Control and Prevention (CDC).
September 6, 2019. Archived from the original on
97. ^ DiazGranados CA, Dunning AJ, Kimmel M, Kirby D,
Treanor J, Collins A, et al. (August 2014). "Efficacy of
high-dose versus standard-dose influenza vaccine in
older adults". The New England Journal of
Medicine. 371 (7): 635–
45. doi:10.1056/NEJMoa1315727. PMID 25119609. S2
CID 205096393. Archived from the original on August
28, 2021. Retrieved December 2, 2019.
98. ^ Wells C, Grobelna A (January 8, 2019). "High Dose
Influenza Vaccine for Adults: A Review of Clinical
Effectiveness, Cost-Effectiveness, and
Guidelines" (PDF). Rapid Response Report. Ottawa:
Canadian Agency for Drugs and Technologies in Health
(CADTH). ISSN 1922-8147. PMID 31141324. Archived
(PDF) from the original on August 1, 2020.
99. ^ Mascagni P, Vicenzi E, Kajaste-Rudnitski A, Pellicciotta
G, Monti A, Cervi C, et al. (2012). "Assessment of
efficacy and safety of pandemic A/H1N1/2009 influenza
vaccine in a group of health care workers". La Medicina
del Lavoro. 103 (3): 220–29. PMID 22838300.
100. ^ "FDA approves first seasonal influenza vaccine
containing an adjuvant" (Press release). U.S. Food and
Drug Administration. November 24, 2015. Archived
from the original on July 22, 2017. Retrieved August
101. ^ Jump up to:a b "Flu Vaccine With
Adjuvant". U.S. Centers for Disease Control and
Prevention (CDC). September 4, 2019. Archived from
102. ^ "Fluad". U.S. Food and Drug Administration (FDA).
November 8, 2019. STN 125510. Archived from the
103. ^ "Influenza vaccine with squalene adjuvant: new
preparation. No better than available products". Prescrire
International. 13 (74): 206–08. December
2004. PMID 15599987.
104. ^ Camilloni B, Basileo M, Valente S, Nunzi E, Iorio AM
(2015). "Immunogenicity of intramuscular MF59-
adjuvanted and intradermal administered influenza
enhanced vaccines in subjects aged over 60: A literature
review". Human Vaccines & Immunotherapeutics. 11 (3):
553–63. doi:10.1080/21645515.2015.1011562. PMC 45
14405. PMID 25714138. Lay summary. {{cite
journal}}: Cite uses deprecated parameter |lay-
url= (help)
105. ^ Van Damme P, Arnou R, Kafeja F, Fiquet A, Richard
P, Thomas S, et al. (May 2010). "Evaluation of non-
inferiority of intradermal versus adjuvanted seasonal
influenza vaccine using two serological techniques: a
randomised comparative study". BMC Infectious
Diseases. 10: 134. doi:10.1186/1471-2334-10-
134. PMC 2895601. PMID 20504306.
106. ^ Haverkate M, D'Ancona F, Giambi C, Johansen K,
Lopalco PL, Cozza V, Appelgren E, VENICE project
gatekeepers contact points (May 2012). "Mandatory and
recommended vaccination in the EU, Iceland and
Norway: results of the VENICE 2010 survey on the ways
of implementing national vaccination programmes". Euro
Surveillance. 17 (22). doi:10.2807/ese.17.22.20183-en.
PMID 22687916.
107. ^ Field RI (November 2009). "Mandatory vaccination of
health care workers: whose rights should come first?". P
& T. 34 (11): 615–18. PMC 2810172. PMID 20140133.
108. ^ Kassianos G (2015). "Willingness of European
healthcare workers to undergo vaccination against
seasonal influenza: current situation and suggestions for
improvement". Drugs in Context. 4:
212268. doi:10.7573/dic.212268. PMC 4316812. PMID
25657810.
109. ^ Thomas RE, Jefferson T, Lasserson TJ (June
2016). "Influenza vaccination for healthcare workers who
care for people aged 60 or older living in long-term care
institutions". The Cochrane Database of Systematic
Reviews. 2016 (6):
CD005187. doi:10.1002/14651858.CD005187.pub5. PM
C 8504984. PMID 27251461.
110. ^ "Fluad Quad Australian prescription medicine
decision summary". Therapeutic Goods
Administration (TGA). December 13,
111. ^ "Fluad Tetra EPAR". European Medicines
Agency (EMA). March 24, 2020. Archived from the
original on August 1, 2020. Retrieved May 29, 2020.
112. ^ Fell DB, Sprague AE, Liu N, Yasseen AS, Wen SW,
Smith G, Walker MC (June 2012). "H1N1 influenza
vaccination during pregnancy and fetal and neonatal
outcomes". American Journal of Public
Health (Submitted manuscript). 102 (6): e33–
40. doi:10.2105/AJPH.2011.300606. PMC 3483960. PM
ID 22515877.
113. ^ Madhi SA, Cutland CL, Kuwanda L, Weinberg A,
Hugo A, Jones S, et al. (September 2014). "Influenza
vaccination of pregnant women and protection of their
infants". The New England Journal of
Medicine. 371 (10): 918–
31. doi:10.1056/NEJMoa1401480. hdl:2263/42412. PMI
D 25184864.
114. ^ "Flu shot". CDC. 2020. Archived from the original on
December 2, 2019. Retrieved September 24, 2020.
115. ^ "Misconceptions about flu vaccines". CDC.
Retrieved September 24, 2020.
116. ^ Haber P, Sejvar J, Mikaeloff Y, DeStefano F (2009).
"Vaccines and Guillain-Barré syndrome". Drug
Safety. 32 (4): 309–23. doi:10.2165/00002018-
200932040-00005. PMID 19388722. S2CID 33670594.
117. ^ "Reorganized text". JAMA Otolaryngology–Head &
Neck Surgery. 141 (5): 428. May
2015. doi:10.1001/jama.248.6.698. PMID 25996397.
118. ^ Stowe J, Andrews N, Wise L, Miller E (February
2009). "Investigation of the temporal association of
Guillain-Barre syndrome with influenza vaccine and
influenza-like illness using the United Kingdom General
Practice Research Database". American Journal of
Epidemiology. 169 (3): 382–
88. doi:10.1093/aje/kwn310. PMID 19033158.
119. ^ Jump up to:a b Sivadon-Tardy V, Orlikowski D,
Porcher R, Sharshar T, Durand MC, Enouf V, et al.
(January 2009). "Guillain-Barré syndrome and influenza
virus infection". Clinical Infectious Diseases. 48 (1): 48–
56. doi:10.1086/594124. PMID 19025491.
120. ^ Vellozzi C, Burwen DR, Dobardzic A, Ball R, Walton
K, Haber P (March 2009). "Safety of trivalent inactivated
influenza vaccines in adults: background for pandemic
influenza vaccine safety monitoring". Vaccine. 27 (15):
2114–20. doi:10.1016/j.vaccine.2009.01.125. PMID 193
121. ^ Reinberg S (February 2, 2011). "Last Year's H1N1
Flu Vaccine Was Safe, Study Finds". U.S. News & World
Report. Archived from the original on April 25, 2013.
122. ^ Jump up to:a b c d Roberts L (March 27,
2021). "Australia's first cell-based influenza vaccines to
roll out this flu season". ABC News. Archived from the
original on April 27, 2021. Retrieved April 28, 2021.
123. ^ National Advisory Committee on Immunization
(NACI) (August 2012). "Statement on Seasonal Influenza
Vaccine for 2012–2013" (PDF). Canada Communicable
Disease Report. Ottawa. 38. Archived from the
original (PDF) on January 17, 2013. Retrieved July
18, 2013.
124. ^ Turner PJ, Southern J, Andrews NJ, Miller E,
Erlewyn-Lajeunesse M (December 2015). "Safety of live
attenuated influenza vaccine in young people with egg
allergy: multicentre prospective cohort study". BMJ. 351:
h6291. doi:10.1136/bmj.h6291. PMC 4673102. PMID 26
645895.
125. ^ Greenhawt M (December 2015). "Live attenuated
influenza vaccine for children with egg
allergy". BMJ. 351:
h6656. doi:10.1136/bmj.h6656. PMID 26657778. S2CID
37037904.
126. ^ Jump up to:a b "Novartis receives FDA approval for
Flucelvax, the first cell-culture vaccine in US to help
protect against seasonal influenza" (Press release).
Novartis. November 20, 2012. Archived from the original
on November 28, 2012.
127. ^ Jump up to:a b "Supemtek EPAR". European
Medicines Agency (EMA). September 15,
2020. Archived from the original on January 10, 2021.
Retrieved November 27, 2020.
128. ^ Technical Report: Narcolepsy in association with
pandemic influenza vaccination (PDF). Stockholm,
Sweden: European Centre for Disease Prevention and
Control (ECDC). 2012. ISBN 978-92-9193-388-4.
Archived from the original (PDF) on December 31, 2013.
Retrieved December 30, 2013.
129. ^ Yong E (2013). "Narcolepsy confirmed as
autoimmune
disease". Nature. doi:10.1038/nature.2013.14413. S2CI
D 74850662.
130. ^ "Thimerosal in Flu Vaccine". U.S. Centers for
Disease Control and Prevention. October 16,
131. ^ "Thimerosal in Vaccines Thimerosal – Concerns –
Vaccine Safety". U.S. Centers for Disease Control and
Prevention. October 27, 2015. Archived from the original
on November 2, 2019. Retrieved December 2, 2019.
the public domain.
132. ^ Offit PA (September 2007). "Thimerosal and
vaccines – a cautionary tale". The New England Journal
of Medicine. 357 (13): 1278–
79. doi:10.1056/NEJMp078187. PMID 17898096. S2CI
D 36318722. Archived from the original on August 28,
2021. Retrieved December 2, 2019.
133. ^ Global Advisory Committee on Vaccine Safety (July
14, 2006). "Thiomersal and vaccines". World Health
Organization (WHO). Archived from the original on
November 6, 2009. Retrieved November 20, 2007.
134. ^ Plotkin SA, Orenstein WA (1988). Vaccines.
Philadelphia: W.B. Saunders Company.
p. 424. ISBN 978-0-7216-1946-0. Retrieved September
7, 2020.
135. ^ Product Monograph: Flumist (PDF), Astrazeneca
Canada Inc., June 20, 2014, archived (PDF) from the
original on September 30, 2020, retrieved September
5, 2020
136. ^ To KW, Lai A, Lee KC, Koh D, Lee SS (October
2016). "Increasing the coverage of influenza vaccination
in healthcare workers: review of challenges and
solutions". The Journal of Hospital Infection. 94 (2):
133–42. doi:10.1016/j.jhin.2016.07.003. PMID 27546456
.
137. ^ Jump up to:a b c d Rubin GJ, Potts HW, Michie S
(March 2011). "Likely uptake of swine and seasonal flu
vaccines among healthcare workers. A cross-sectional
analysis of UK telephone survey data". Vaccine. 29 (13):
77402.
138. ^ "Seasonal Flu Shot". U.S. Centers for Disease
Control and Prevention (CDC). December 9,
Retrieved January 12, 2020. This article incorporates
139. ^ "Vaccine use". World Health Organization (WHO).
Archived from the original on December 15, 2012.
140. ^ "Influenza (Seasonal) Fact sheet". World Health
Organization (WHO). November 2016. Archived from the
original on November 30, 2014. Retrieved January
15, 2017.
141. ^ "Influenza (Seasonal)". WHO. November 6,
142. ^ "Methods for assessing influenza vaccination
coverage in target groups (2016)". WHO/Europe. March
19, 2018. Archived from the original on October 14,
2019. Retrieved October 14, 2019.
143. ^ "Recommendations on influenza vaccination during
the 2019–2020 winter season". WHO/Europe.
October 14, 2019. Retrieved October 14, 2019.
144. ^ Jump up to:a b Canadian Immunization Guide Chapter
on Influenza and Statement on Seasonal Influenza
Vaccine for 2019–2020 (PDF) (Report). Public Health
Agency of Canada. May 2019. Cat.: HP37-25E-PDF;
Pub.: 180883. Archived (PDF) from the original on July
16, 2020. Retrieved June 2, 2020.
145. ^ "Risk groups for severe influenza". European Centre
for Disease Prevention and
Control (ECDC). Archived from the original on October
22, 2019. Retrieved October 22, 2019.
146. ^ "ECDC Reviews – New WHO recommendations on
seasonal influenza ..." European Centre for Disease
Prevention and Control (ECDC). Archived from the
original on May 10, 2017. Retrieved December 25, 2016.
147. ^ "ECDC Guidance: Priority risk groups for influenza
vaccination" (PDF). European Centre for Disease
Prevention and Control (ECDC). pp. 7–8. Archived
from the original (PDF) on December 25, 2016.
Retrieved December 25, 2016.
148. ^ Jump up to:a b c "Children & Influenza (Flu)".
October 23, 2019. Archived from the original on
November 11, 2019. This article incorporates text from
149. ^ "Live Attenuated Influenza Vaccine [LAIV] (The Nasal
Spray Flu Vaccine)". U.S. Centers for Disease Control
and Prevention (CDC). September 16,
150. ^ "Influenza Vaccination: A Summary for Clinicians –
Health Professionals – Seasonal Influenza (Flu)".
February 24, 2008. This article incorporates text from
151. ^ "Fluzone, Fluzone High-Dose and Fluzone
Intradermal". U.S. Food and Drug Administration (FDA).
July 11, 2017. Archived from the original on July 22,
2017. Retrieved June 1, 2020.
152. ^ Couch RB, Winokur P, Brady R, Belshe R, Chen WH,
Cate TR, et al. (November 2007). "Safety and
immunogenicity of a high dosage trivalent influenza
vaccine among elderly subjects". Vaccine. 25 (44):
7656–63. doi:10.1016/j.vaccine.2007.08.042. PMC 2243
220. PMID 17913310.
153. ^ Lee JK, Lam GK, Shin T, Kim J, Krishnan A,
Greenberg DP, et al. (May 2018). "Efficacy and
effectiveness of high-dose versus standard-dose
influenza vaccination for older adults: a systematic
review and meta-analysis". Expert Rev Vaccines. 17 (5):
435–443. doi:10.1080/14760584.2018.1471989. PMID 2
9715054. S2CID 21688517.
154. ^ Robertson CA, DiazGranados CA, Decker MD, Chit
A, Mercer M, Greenberg DP (December 2016). "Fluzone
High-Dose Influenza Vaccine". Expert Rev
Vaccines. 15 (12): 1495–
1505. doi:10.1080/14760584.2016.1254044. PMID 2781
3430.
155. ^ Literature review update on the efficacy and
effectiveness of high-dose (Fluzone High-Dose) and
MF59-adjuvanted (Fluad) trivalent inactivated influenza
vaccines in adults 65 years of age and
older (PDF) (Report). Ottawa: Public Health Agency of
Canada. May 2018. HP40-210/2018E-
PDF. Archived (PDF) from the original on July 21, 2020.
Retrieved June 1, 2020.
156. ^ Tanner L (January 13, 2013). "Hospitals crack down
on workers who refuse flu shots". NBC
News. Archived from the original on December 3, 2013.
Retrieved July 24, 2014.
(December 2010). "Seasonal influenza and 2009 H1N1
influenza vaccination coverage among pregnant women
– 10 states, 2009–10 influenza season" (PDF). Morbidity
and Mortality Weekly Report (MMWR). 59 (47): 1541–
45. PMID 21124293. Archived (PDF) from the original
on June 25, 2017. This article incorporates text from
158. ^ Jump up to:a b Altman LK (February 28, 2008). "Panel
Advises Flu Shots for Children Up to Age 18". The New
York Times. Archived from the original on January 22,
2015.
159. ^ "ACIP votes down use of LAIV for 2016–2017 flu
season" (Press release). U.S. Centers for Disease
Control and Prevention (CDC). June 22,
2016. Archived from the original on November 25, 2016.
Retrieved November 26, 2016. This article
domain.
160. ^ "Immunization Schedules". U.S. Centers for Disease
Control and Prevention (CDC). Archived from the
original on November 5, 2014. Retrieved November
161. ^ Getting flu with Covid makes you twice as likely to
die, says UK health chief Archived October 10, 2021, at
the Wayback Machine The Guardian
162. ^ "Flu vaccine FAQs". Healthdirect, Department of
Health, Government of Australia. April 1,
163. ^ "Influenza fact sheet". Healthdirect, Department of
Health, Government of Australia. April 1,
164. ^ "Health care use – Influenza vaccination rates –
OECD Data". theOECD. Archived from the original on
August 8, 2020. Retrieved April 24, 2020.
165. ^ Jump up to:a b Han YK, Michie S, Potts HW, Rubin GJ
(March 2016). "Predictors of influenza vaccine uptake
during the 2009/10 influenza A H1N1v ('swine flu')
pandemic: Results from five national surveys in the
United Kingdom". Preventive Medicine. 84: 57–
61. doi:10.1016/j.ypmed.2015.12.018. PMC 4766366. P
MID 26757401.
166. ^ Bish A, Yardley L, Nicoll A, Michie S (September
2011). "Factors associated with uptake of vaccination
against pandemic influenza: a systematic
review". Vaccine. 29 (38): 6472–
167. ^ Brien S, Kwong JC, Buckeridge DL (February 2012).
"The determinants of 2009 pandemic A/H1N1 influenza
vaccination: a systematic review". Vaccine. 30 (7):
14889.
168. ^ Thomas RE, Lorenzetti DL (May
2018). "Interventions to increase influenza vaccination
rates of those 60 years and older in the community". The
Cochrane Database of Systematic Reviews. 5:
CD005188. doi:10.1002/14651858.CD005188.pub4. PM
C 6494593. PMID 29845606.
(October 2009). "Update on influenza A (H1N1) 2009
monovalent vaccines" (PDF). Morbidity and Mortality
Weekly Report (MMWR). 58 (39): 1100–
170. ^ La Torre G, Di Thiene D, Cadeddu C, Ricciardi W,
Boccia A (December 2009). "Behaviours regarding
preventive measures against pandemic H1N1 influenza
among Italian healthcare workers, October 2009". Euro
Surveillance. 14 (49). PMID 20003908.
171. ^ Amodio E, Anastasi G, Marsala MG, Torregrossa MV,
Romano N, Firenze A (February 2011). "Vaccination
against the 2009 pandemic influenza A (H1N1) among
healthcare workers in the major teaching hospital of
Sicily (Italy)". Vaccine. 29 (7): 1408–
172. ^ Chor JS, Ngai KL, Goggins WB, Wong MC, Wong
SY, Lee N, et al. (August 2009). "Willingness of Hong
Kong healthcare workers to accept pre-pandemic
influenza vaccination at different WHO alert levels: two
questionnaire surveys". BMJ. 339:
b3391. doi:10.1136/bmj.b3391. PMC 2731837. PMID 19
706937.
173. ^ Schnirring L (August 18, 2011). "CDC updates flu
vaccination recommendations". Center for Infectious
Disease Research and Policy (CIDRAP). Archived from
24, 2019.
(August 2011). "Influenza vaccination coverage among
health-care personnel – United States, 2010–11
influenza season" (PDF). Morbidity and Mortality Weekly
Report (MMWR). 60 (32): 1073–
on May 25, 2017. This article incorporates text from
(September 2012). "Influenza vaccination coverage
among health-care personnel: 2011–12 influenza
season, United States" (PDF). Morbidity and Mortality
Weekly Report (MMWR). 61: 753–
176. ^ Bull AL, Bennett N, Pitcher HC, Russo PL, Richards
MJ (February 2007). "Influenza vaccine coverage among
health care workers in Victorian public hospitals". The
Medical Journal of Australia. 186 (4): 185–
86. doi:10.5694/j.1326-5377.2007.tb00858.x. PMID 173
09419. S2CID 25091208. Archived from the original on
August 28, 2021. Retrieved December 2, 2019.
177. ^ Jump up to:a b Abbasi J (November 2019). "The
Search for a Universal Flu Vaccine Heats
Up". JAMA. 322 (20): 1942–
1944. doi:10.1001/jama.2019.16816. PMID 31693060. S
2CID 207903441.
178. ^ Jump up to:a b c Greenfieldboyce N (November 8,
2007). New and Old Ways to Make Flu Vaccines (Radio
broadcast). NPR. Archived from the original on October
24, 2019. Retrieved October 23, 2019.
179. ^ Nachbagauer R, Krammer F (April 2017). "Universal
influenza virus vaccines and therapeutic
antibodies". Clinical Microbiology and Infection. 23 (4):
222–228. doi:10.1016/j.cmi.2017.02.009. PMC 5389886.
PMID 28216325.
180. ^ Balfour H (June 2, 2021). "First-in-human universal
flu vaccine trial begins". European Pharmaceutical
Review. Archived from the original on March 29, 2022.
Retrieved February 6, 2022. The Phase I trial
(NCT04896086) will assess the safety and
immunogenicity of the experimental vaccine, FluMos-v1
181. ^ Bernstein DI, Guptill J, Naficy A, Nachbagauer R,
Berlanda-Scorza F, Feser J, et al. (January
2020). "Immunogenicity of chimeric haemagglutinin-
based, universal influenza virus vaccine candidates:
interim results of a randomised, placebo-controlled,
phase 1 clinical trial". The Lancet. Infectious
Diseases. 20 (1): 80–91. doi:10.1016/S1473-
3099(19)30393-7. PMC 6928577. PMID 31630990.
182. ^ Nachbagauer R, Feser J, Naficy A, Bernstein DI,
Guptill J, Walter EB, et al. (January 2021). "A chimeric
hemagglutinin-based universal influenza virus vaccine
approach induces broad and long-lasting immunity in a
randomized, placebo-controlled phase I trial". Nature
Medicine. 27 (1): 106–114. doi:10.1038/s41591-020-
1118-7. PMID 33288923.
183. ^ "Influenza Vaccine Strategies for Broad Global
Access". Path. October 2007. Archived from the original
on October 14, 2019. Retrieved September 16, 2009.
184. ^ Jump up to:a b "how it's made" (PDF). Archived
from the original (PDF) on July 5, 2010.
185. ^ "Influenza vaccine viruses and reagents". World
Health Organization (WHO). Archived from the
original on May 27, 2013.
186. ^ "Recommendations for the production and control of
influenza vaccine (inactivated)" (PDF). World Health
Organization (WHO). Archived (PDF) from the original
on October 28, 2013. Retrieved May 27, 2013.
187. ^ Jump up to:a b Racaniello V (December
2009). "Influenza virus growth in eggs". Virology
Blog. Archived from the original on December 25, 2014.
188. ^ Izzat F (April 2012). "Viral Cultivation in Chicken
Embryo". Youtube. Archived from the original on May 26,
2015.
189. ^ Jump up to:a b "How Influenza (Flu) Vaccines Are
Made". U.S. Centers for Disease Control and
Prevention (CDC). November 26, 2019. Archived from
190. ^ Bright RA, Carter DM, Daniluk S, Toapanta FR,
Ahmad A, Gavrilov V, et al. (May 2007). "Influenza virus-
like particles elicit broader immune responses than whole
virion inactivated influenza virus or recombinant
hemagglutinin". Vaccine. 25 (19): 3871–
191. ^ "Priming with DNA vaccine makes avian flu vaccine
work better (NIH News)". October 3, 2011. Archived from
the original on September 27, 2012.
192. ^ Clinical trial number NCT00776711 for "Vaccine for
Prevention of Bird Flu" at ClinicalTrials.gov
193. ^ Clinical trial number NCT01086657 for "An Open-
Label, Randomized Phase I Study in Healthy Adults of
the Safety and Immunogenicity of Prime-Boost Intervals
with Monovalent Influenza Subunit Virion (H5N1)
Vaccine, A/Indonesia/05/2005 (Sanofi Pasteur, Inc),
Administered Alone or Following Recombinant DNA
Plasmid (H5) Vaccine, VRC-AVIDNA036-00-VP (VRC,
NIAID)" at ClinicalTrials.gov
194. ^ Center for Biologics Evaluation and
Research. "Approved Products – November 20, 2012
Approval Letter – Flucelvax". U.S. Food and Drug
December 3, 2012. This article incorporates text from
195. ^ "Seqirus receives FDA approval for Flucelvax
Quadrivalent (Influenza Vaccine) for people four years of
age and older" (Press release). Seqirus. May 23, 2016.
Archived from the original on January 16, 2017.
196. ^ Roos R (October 14, 2019). "FDA approves first flu
vaccine grown in insect cells". Center for Infectious
Disease Research and Policy (CIDRAP). Archived from
14, 2019.
197. ^ "Flublok". U.S. Food and Drug Administration (FDA).
February 26, 2018. STN 125285. Archived from the
198. ^ "Flublok Quadrivalent". U.S. Food and Drug
Administration (FDA). August 2, 2019. STN
199. ^ Jump up to:a b "Supemtek: Pending EC
decision". European Medicines Agency (EMA).
September 23, 2020. Retrieved September
21, 2020. Text was copied from this source which is ©
European Medicines Agency. Reproduction is authorized
provided the source is acknowledged.
200. ^ Jump up to:a b Sparrow E, Wood JG, Chadwick C,
Newall AT, Torvaldsen S, Moen A, Torelli G (January
2021). "Global production capacity of seasonal and
pandemic influenza vaccines in 2019". Vaccine. 39 (3):
512–520. doi:10.1016/j.vaccine.2020.12.018. PMC 7814
984. PMID 33341308.
201. ^ Jit M, Newall AT, Beutels P (April 2013). "Key issues
for estimating the impact and cost-effectiveness of
seasonal influenza vaccination strategies". Human
Vaccines & Immunotherapeutics. 9 (4): 834–
40. doi:10.4161/hv.23637. PMC 3903903. PMID 233578
59.
202. ^ Postma MJ, Baltussen RP, Palache AM, Wilschut JC
(April 2006). "Further evidence for favorable cost-
effectiveness of elderly influenza vaccination". Expert
Review of Pharmacoeconomics & Outcomes
Research. 6 (2): 215–
27. doi:10.1586/14737167.6.2.215. PMID 20528557. S2
CID 12765724.
203. ^ Newall AT, Kelly H, Harsley S, Scuffham PA (2009).
"Cost effectiveness of influenza vaccination in older
adults: a critical review of economic evaluations for the
50- to 64-year age group". PharmacoEconomics. 27 (6):
439–50. doi:10.2165/00019053-200927060-00001. PMI
D 19640008. S2CID 20855671.
204. ^ Newall AT, Viboud C, Wood JG (June
2010). "Influenza-attributable mortality in Australians
aged more than 50 years: a comparison of different
modelling approaches". Epidemiology and
Infection. 138 (6): 836–
42. doi:10.1017/S095026880999118X. PMID 19941685.
S2CID 29939376. Archived from the original on August
28, 2021. Retrieved December 2, 2019.
205. ^ Newall AT, Dehollain JP, Creighton P, Beutels P,
Wood JG (August 2013). "Understanding the cost-
effectiveness of influenza vaccination in children:
methodological choices and seasonal
variability". PharmacoEconomics. 31 (8): 693–
702. doi:10.1007/s40273-013-0060-7. PMID 23645539.
S2CID 8616720.
206. ^ Newall AT, Scuffham PA (December
2011). "Uncertainty and variability in influenza cost-
effectiveness models". Australian and New Zealand
Journal of Public Health. 35 (6): 576, author reply 576–
77. doi:10.1111/j.1753-6405.2011.00788.x. PMID 22151
168. S2CID 22402257.
207. ^ Gatwood J, Meltzer MI, Messonnier M, Ortega-
Sanchez IR, Balkrishnan R, Prosser LA (January 2012).
"Seasonal influenza vaccination of healthy working-age
adults: a review of economic evaluations". Drugs. 72 (1):
35–48. doi:10.2165/11597310-000000000-00000. PMID
22191794. S2CID 46305863.
208. ^ Newall AT, Jit M, Beutels P (August 2012).
"Economic evaluations of childhood influenza
vaccination: a critical
review". PharmacoEconomics. 30 (8): 647–
60. doi:10.2165/11599130-000000000-00000. PMID 227
88257. S2CID 38289883.
209. ^ Newall AT, Wood JG, Oudin N, MacIntyre CR
(February 2010). "Cost-effectiveness of pharmaceutical-
based pandemic influenza mitigation
strategies". Emerging Infectious Diseases. 16 (2): 224–
30. doi:10.3201/eid1602.090571. PMC 2957998. PMID
20113551.
210. ^ "Influenza Genome Sequencing Project – Overview".
National Institutes of Health – National Institute of Allergy
and Infectious Diseases. Archived from the original on
June 27, 2011. Retrieved May 27, 2013.
211. ^ Lampos V, Yom-Tov E, Pebody R, Cox IJ
(2015). "Assessing the impact of a health intervention via
user-generated Internet content" (PDF). Data Mining and
Knowledge Discovery. 29 (5): 1434–
57. doi:10.1007/s10618-015-0427-9. S2CID 215415165.
Archived from the original on August 28, 2021.
212. ^ Wagner M, Lampos V, Yom-Tov E, Pebody R, Cox IJ
(December 2017). "Estimating the Population Impact of a
New Pediatric Influenza Vaccination Program in England
Using Social Media Content". Journal of Medical Internet
Research. 19 (12):
e416. doi:10.2196/jmir.8184. PMC 6257312. PMID 2926
9339.
213. ^ "Acute Respiratory Infections (Update September
2009)". World Health Organization (WHO). September
2009. Archived from the original on September 29, 2009.
214. ^ "Tables on the Clinical trials of pandemic influenza
prototype vaccines". World Health Organization (WHO).
July 2009. Archived from the original on March 6, 2009.
215. ^ "FDA Approves Vaccines for 2009 H1N1 Influenza
Virus" (Press release). September 15, 2009. Archived
from the original on October 15, 2009.
216. ^ Keown A (February 4, 2020). "FDA Approves
Seqirus' Audenz as Vaccine Against Potential Flu
Pandemic". BioSpace. Archived from the original on
February 5, 2020. Retrieved February 5, 2020.
217. ^ "Audenz". U.S. Food and Drug Administration (FDA).
January 31, 2020. STN: 125692. Archived from the
original on August 6, 2020. Retrieved February
218. ^ Jump up to:a b c Cho A, Wrammert J (April
2016). "Implications of broadly neutralizing antibodies in
the development of a universal influenza
vaccine". Current Opinion in Virology. 17: 110–
115. doi:10.1016/j.coviro.2016.03.002. PMC 4940123. P
MID 27031684.
219. ^ Okuno Y, Isegawa Y, Sasao F, Ueda S (May
1993). "A common neutralizing epitope conserved
between the hemagglutinins of influenza A virus H1 and
H2 strains". Journal of Virology. 67 (5): 2552–
2558. doi:10.1128/JVI.67.5.2552-2558.1993. PMC 2375
75. PMID 7682624.
220. ^ Jump up to:a b c d Soema PC, Kompier R, Amorij JP,
Kersten GF (August 2015). "Current and next generation
influenza vaccines: Formulation and production
strategies". European Journal of Pharmaceutics and
Biopharmaceutics. 94: 251–
263. doi:10.1016/j.ejpb.2015.05.023. PMID 26047796.
221. ^ Deng L, Cho KJ, Fiers W, Saelens X (February
2015). "M2e-Based Universal Influenza A
Vaccines". Vaccines. 3 (1): 105–
36. doi:10.3390/vaccines3010105. PMC 4494237. PMID
26344949.
222. ^ Gottlieb T, Ben-Yedidia T (November 2014).
"Epitope-based approaches to a universal influenza
vaccine". Journal of Autoimmunity. 54: 15–
20. doi:10.1016/j.jaut.2014.07.005. PMID 25172355.
223. ^ Toussi DN, Massari P (April 2014). "Immune
Adjuvant Effect of Molecularly-defined Toll-Like Receptor
Ligands". Vaccines. 2 (2): 323–
53. doi:10.3390/vaccines2020323. PMC 4494261. PMID
26344622.
224. ^ Sederstrom J (July 19, 2019). "Researchers
Exploring Oral Flu Vaccine and Treatment Options". Drug
Topics. Archived from the original on June 8, 2020.
225. ^ Jasty M, Bragdon CR, Schutzer S, Rubash H, Haire
T, Harris WH (December 1989). "Bone ingrowth into
porous coated canine total hip replacements.
Quantification by backscattered scanning electron
microscopy and image analysis". Scanning
Microscopy. 3 (4): 1051–6, discussion 1056–
57. doi:10.1016/s1473-3099(15)00252-2. PMID 263333
1.
226. ^ Liebowitz D, Gottlieb K, Kolhatkar NS, Garg SJ,
Asher JM, Nazareno J, et al. (April 2020). "Efficacy,
immunogenicity, and safety of an oral influenza vaccine:
a placebo-controlled and active-controlled phase 2
human challenge study". The Lancet. Infectious
Diseases. Elsevier. 20 (4): 435–444. doi:10.1016/S1473-
3099(19)30584-5. PMID 31978354. S2CID 210892802.
227. ^ Triggle N (October 8, 2021). "Flu jab vital this winter
along with Covid vaccine". BBC News. Archived from
the original on November 14, 2021. Retrieved August
13, 2022.
228. ^ Callaway E (May 16, 2022). "Flu vaccine could cut
COVID risk". Nature. 605 (7911): 602–
602. doi:10.1038/d41586-022-01315-9.
229. ^ Brownlee S (November 1, 2009). "Does the Vaccine
Matter?". The Atlantic. Archived from the original on
230. ^ Rabin RC (November 5, 2012). "Reassessing Flu
Shots as the Season Draws Near". The New York
Times. Archived from the original on November 10,
2016. Retrieved December 30, 2016. 'We have
overpromoted and overhyped this vaccine,' said Michael
T. Osterholm, director of the Center for Infectious
Disease Research and Policy, as well as its Center of
Excellence for Influenza Research and Surveillance. 'It
does not protect as promoted. It's all a sales job: it's all
public relations.'
231. ^ Influenza Report (online book) Archived May 10,
2016, at the Wayback Machine chapter Avian
Influenza by Timm C. Harder and Ortrud Werner
232. ^ equiflunet_vaccines Archived January 10, 2006, at
the Wayback Machine
233. ^ "UAE Equestrian & Racing Federation". March 22,
234. ^ "FEI guidelines" (PDF). Archived (PDF) from the
original on October 26, 2007.
235. ^ McNeil Jr DG (May 2, 2006). "Turning to Chickens in
Fight With Bird Flu". The New York
Times. Archived from the original on November 14,
2012.
236. ^ "Bird flu warning over partial protection of flocks".
August 16, 2006. Archived from the original on
September 26, 2007.
237. ^ "FAO Recommendations on the Prevention, Control
and Eradication of Highly Pathogenic Avian Influenza
(HPAI) in Asia" (PDF). Archived (PDF) from the original
on February 2, 2010. Retrieved September 16, 2009.
238. ^ Yen HL, Peiris JS (May 2012). "Virology: bird flu in
mammals". Nature. 486 (7403): 332–
33. Bibcode:2012Natur.486..332Y. doi:10.1038/nature11
192. PMID 22722190. S2CID 205229301.
239. ^ "Swine Flu Virus Turns Endemic". September 15,
240. ^ "Custom Vaccines: Swine". Archived from the
original on April 30, 2009.
241. ^ Karaca K, Dubovi EJ, Siger L, Robles A, Audonnet
JC, Jiansheng Y, et al. (February 2007). "Evaluation of
the ability of canarypox-vectored equine influenza virus
vaccines to induce humoral immune responses against
canine influenza viruses in dogs". American Journal of
Veterinary Research. 68 (2): 208–
12. doi:10.2460/ajvr.68.2.208. PMID 17269888.
242. ^ "Global Influenza Surveillance and Response System
(GISRS)". World Health Organization. Archived from the
22, 2019.
243. ^ "Spotlight: Influenza". World Health
Organization. Archived from the original on October 18,
2019. Retrieved October 22, 2019.
244. ^ "Global influenza surveillance". WHO. Archived
from the original on April 30, 2003.
245. ^ Brown D (February 18, 2008). "Keeping ahead of flu
comes down to guessing game". Knoxville News
Sentinel. The Washington Post. Archived from the
original on January 11, 2009. Retrieved December
22, 2015.
246. ^ World Health Organization (2000). WHO Report on
Global Surveillance of Epidemic-prone Infectious
Diseases – Influenza. World Health
Organization (WHO). hdl:10665/66485.
WHO/CDS/CSR/ISR/2000/1.
247. ^ Jump up to:a b "Recommended composition of
influenza virus vaccines for use in the 2020–2021
northern hemisphere influenza season". World Health
Organization (WHO). February 28, 2020. Archived
from the original on March 12, 2020. Retrieved August
25, 2020.
248. ^ Jump up to:a b c "Influenza Vaccine for the 2020-2021
Season". U.S. Food and Drug Administration (FDA). July
10, 2020. Archived from the original on August 3, 2020.
Retrieved July 12, 2020. This article incorporates text
from this source, which is in the public domain.
249. ^ Jump up to:a b c d "EU recommendations for 2020/2021
seasonal flu vaccine composition". European Medicines
Agency (EMA). April 1, 2020. Archived from the original
on October 22, 2020. Retrieved August 26, 2020.
250. ^ "Recommended composition of influenza virus
vaccines for use in the 2021 southern hemisphere
influenza season". World Health Organization.
October 3, 2020. Retrieved April 29, 2021.
251. ^ "Flu vaccine". SA Health. Archived from the original
on April 29, 2021. Retrieved April 29, 2021.
252. ^ Jump up to:a b c d "EU recommendations for 2021/2022
original on July 9, 2021. Retrieved June 30, 2021. Text
was copied from this source which is © European
Medicines Agency. Reproduction is authorized provided
the source is acknowledged.
253. ^ https://www.ema.europa.eu/en/documents/regulatory-
procedural-guideline/biologics-working-party-bwp-ad-hoc-
influenza-working-group-amended-european-union-
recommendations/2022_en-0.pdf Archived June 30,
2021, at the Wayback Machine[bare URL PDF]
Season". U.S. Food and Drug Administration (FDA).
March 5, 2021. Archived from the original on August 15,
2022. Retrieved August 14, 2022. This article
domain.
vaccines for use in the 2021 southern hemisphere
influenza season". World Health Organization.
March 9, 2022. Retrieved March 9, 2022.
vaccines for use in the 2022-2023 northern hemisphere
influenza season". World Health Organization (WHO).
February 25, 2022. Archived from the original on March
29, 2022. Retrieved March 29, 2022.
257. ^ Jump up to:a b c "EU recommendations for 2022-2023
original on March 30, 2022. Retrieved March
29, 2022. Text was copied from this source which is ©
European Medicines Agency. Reproduction is authorized
provided the source is acknowledged.
258. ^ https://www.ema.europa.eu/documents/regulatory-
procedural-guideline/biologics-working-party-bwp-ad-hoc-
influenza-working-group-eu-recommendations-seasonal-
influenza/2023_en.pdf Archived August 15, 2022, at
the Wayback Machine[bare URL PDF]
Season". U.S. Food and Drug Administration (FDA).
March 3, 2022. Archived from the original on August 12,
2022. Retrieved August 13, 2022. This article
domain.
Further reading[edit]
 World Health Organization (October 2017). The
immunological basis for immunization series:
module 23: influenza vaccines. World Health
Organization (WHO). hdl:10665/259211. ISBN
978-9241513050.
 Ramsay M (ed.). "Chapter 19:
Influenza". Immunisation against infectious
disease. Public Health England.
 Hamborsky J, Kroger A, Wolfe S, eds.
(2015). "Chapter 12: Influenza". Epidemiology
and Prevention of Vaccine-Preventable
Diseases (13th ed.). Washington D.C.:
U.S. Centers for Disease Control and
Prevention (CDC). ISBN 978-0990449119.
 Budd A, Blanton L, Grohskopf L, Campbell A,
Dugan V, Wentworth DE, et al. (March 29,
2019). "Chapter 6: Influenza". In Roush SW,
Baldy LM, Hall MA (eds.). Manual for the
surveillance of vaccine-preventable diseases.
Atlanta GA: U.S. Centers for Disease Control
and Prevention (CDC).
 National Advisory Committee on Immunization
(May 2020). "Canadian Immunization Guide
Chapter on Influenza and Statement on
Seasonal Influenza Vaccine for 2020–
2021" (PDF). Public Health Agency of Canada.
Cat.: HP37-25F-PDF; Pub.: 200003. Lay
summary. {{cite web}}: Cite uses deprecated
parameter |lay-url= (help)
 National Advisory Committee on Immunization
(NACI) (May 2018). NACI literature review on
the comparative effectiveness and
immunogenicity of subunit and split virus
inactivated influenza vaccines in adults 65 years
of age and older (PDF). Government of
Canada. ISBN 9780660264387. Cat.: HP40-
213/2018E-PDF; Pub.: 180039. Lay
summary. {{cite book}}: Cite uses deprecated
parameter |lay-url= (help)
 Rajaram S, Wojcik R, Moore C, Ortiz de
Lejarazu R, de Lusignan S, Montomoli E, et al.
(August 2020). "The impact of candidate
influenza virus and egg-based manufacture on
vaccine effectiveness: Literature review and
expert consensus". Vaccine. 38 (38): 6047–
6056. doi:10.1016/j.vaccine.2020.06.021. PMID
32600916.
External links[edit]
Wikiquote has quotations related to Influenza vaccine.
 Inactivated Influenza Vaccine Information

Statement, US Centers for Disease Control and
Prevention (CDC)
 Live, Intranasal Influenza Vaccine Information
Statement, US Centers for Disease Control and
Prevention (CDC)
 Seasonal Influenza (Flu) Vaccination and
Preventable Disease, US Centers for Disease
Control and Prevention (CDC)
 Misconceptions about Seasonal Flu and Flu
Vaccines, US Centers for Disease Control and
Prevention (CDC)
 "Influenza Vaccine". Drug Information Portal.
U.S. National Library of Medicine.
 Influenza Vaccines at the US National Library of
Medicine Medical Subject Headings (MeSH)
show
Influenza
show
Artificial induction of immunity / Immunization: Vaccines, Vaccination, Infection, Inoculation (J07)

Portals:
Medicine Viruses
Israel
ntrol: National
United States
libraries
Latvia
Categories:
 Influenza vaccines
 Live vaccines
 World Health Organization essential medicines
(vaccines)
 Inactivated vaccines
Navigation menu
 Not logged in
 Talk
 Contributions
 Create account
 Log in
 Article
 Talk
 Read
 Edit
 View history
Search
Search Go
 Main page
 Contents
 Current events
 Random article
 About Wikipedia
 Contact us
 Donate
Contribute
 Help
 Learn to edit
 Community portal
 Recent changes
 Upload file
Tools
 What links here
 Related changes
 Special pages
 Permanent link
 Page information
 Cite this page
 Wikidata item
Print/export
 Download as PDF
 Printable version
In other projects
 Wikimedia Commons
 Wikiquote
Languages
 ‫العربية‬
 Español
 Bahasa Indonesia
 മലയാളം
 Bahasa Melayu
 日本語
 ଓଡ଼ିଆ
 Русский
 中文
31 more
Edit links
 This page was last edited on 24 October 2022, at 20:05 (UTC).
 Text is available under the Creative Commons Attribution-ShareAlike License 3.0; additional terms may apply. By
using this site, you agree to the Terms of Use and Privacy Policy. Wikipedia® is a registered trademark of
the Wikimedia Foundation, Inc., a non-profit organization.
 Privacy policy
 About Wikipedia
 Disclaimers
 Contact Wikipedia
 Mobile view
 Developers
 Statistics
 Cookie statement

Influenza Vaccine

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Influenza Vaccine

Uploaded by

Copyright:

Available Formats

Influenza vaccine

From Wikipedia, the free encyclopedia

US Navy crew member receiving an influenza vaccination

Target Influenza virus

Vaccine type inactivated, attenuated, recombinant

Trade names Afluria, Fluarix, Fluzone, others

ATC code J07BB01 (WHO) J07BB02 (WHO), J07BB03 (WHO),

Legal status AU: S4 (Prescription only) [1][2]

CA: Rx-only / Schedule D [3][4][5][6]

In general: ℞ (Prescription only)

Influenza vaccines, also known as flu shots, are vaccines that protect against

A vaccine is assessed by its efficacy – the extent to which it reduces risk of disease

A US Navy hospital corpsman administers a flu shot aboard the USS Theodore Roosevelt (CVN-71) in

Although most influenza vaccines are produced using egg-based techniques,

 a trivalent or quadrivalent intramuscular injection (IIV3,

 people aged 50 years of age or older[19]

 Children aged 6–59 months

 People at high risk of influenza-related complications or

 In raising the upper age limit to 18 years, the aim is

 children aged six months to five years;

Country Region % aged 65+

Republic of Korea Asia 83

United Kingdom Europe 73

United States Americas 68

New Zealand Oceania 65

Czech Republic Europe 20

Slovak Republic Europe 13

Schematic of influenza vaccine creation

Research continues into the idea of a "universal"

Avian flu vaccine development by reverse genetics technique

As of November 2007, both the conventional injection

1. Protection from clinical disease

 an A/Hawaii/70/2019 (H1N1)pdm09-like virus

 an A/Hawaii/70/2019 (H1N1)pdm09-like virus;

Egg-based or live attenuated trivalent vaccines

 an A/Hawaii/70/2019 (H1N1)pdm09-like virus;

 an A/Victoria/2570/2019 (H1N1)pdm09-like virus;

 a B/Phuket/3073/2013 (B/Yamagata lineage)-like

Egg-based or live attenuated trivalent vaccines

 an A/Victoria/2570/2019 (H1N1)pdm09-like virus;

 an A/Victoria/2570/2019 (H1N1) pdm09-like

 an A/Wisconsin/588/2019 (H1N1) pdm09-like

 A/Victoria/2570/2019 (H1N1)pdm09-like virus;

 A/Wisconsin/588/2019 (H1N1)pdm09-like virus;

 A/Victoria/2570/2019 (H1N1)pdm09-like virus;

 A/Wisconsin/588/2019 (H1N1)pdm09-like virus;

Quadrivalent egg-based or live attenuated vaccines

 an A/Victoria/2570/2019 (H1N1)pdm09-like virus;

 an A/Victoria/2570/2019 (H1N1)pdm09-like virus;

Wikiquote has quotations related to Influenza vaccine.

 Inactivated Influenza Vaccine Information

Artificial induction of immunity / Immunization: Vaccines, Vaccination, Infection, Inoculation (J07)

You might also like