City Health Information
Volume 32 (2013) New York City Department of Health and Mental Hygiene No. 3; 11-18


Influenza Prevention and Control, 2013-2014
  • Vaccinate everyone aged 6 months and older against influenza as early as possible.
  • Give inactivated vaccine to all pregnant women in any trimester.
  • Get your flu vaccination as soon as vaccine becomes available and ensure that your staff does the same.



The 2013-14 influenza vaccine contains an A/California/7/2009-like (2009 H1N1)-virus, an A (H3N2) virus antigenically like the cell-propagated, or cell-grown, virus A/Victoria/361/2011 (A/Texas/50/2012), and a B/Massachusetts/2/2012-like (B/Yamagata lineage) virus. New quadrivalent vaccines will also contain a B/Brisbane/60/2008-like (B/Victoria lineage) virus (4).

Traditional trivalent influenza vaccines protect against 3 strains of influenza virus (2 influenza A and 1 influenza B strain). One of two B strain lineages may predominate each season, and between 2000 and 2012, the influenza B strain included in the vaccine did not match the circulating strain type in 6 of 12 seasons. New quadrivalent vaccines contain antigen from both B strain lineages and may offer additional protection against influenza-related adverse outcomes (31). Inactivated influenza vaccines will be available in both trivalent (IIV3) and quadrivalent (IIV4) forms this season, and will no longer be referred to as trivalent influenza vaccine (TIV). In this introductory season, limited quantities of inactivated quadrivalent vaccines will be available. However, the quadrivalent form of live attenuated influenza vaccine (LAIV4) will replace the trivalent form entirely (2).

In addition to quadrivalent vaccines, new vaccines will be available that are manufactured using cell-based technologies instead of traditional chicken eggs (Box 6). Recombinant influenza vaccine (RIV3) contains no egg protein and is recommended for use in patients with a history of allergy to egg protein (2). Cell culture-based influenza vaccine (ccIIV3) offers the potential for faster manufacturing since it is not dependent on the supply of eggs or influenza virus.

Providers may wish to choose LAIV4 over IIV for children because of better efficacy of the quadrivalent live vaccine (32-34), but vaccination should not be delayed if LAIV4 is not available. LAIV should not be administered to people with asthma; adults aged 50 years or older; pregnant women; children aged 6 through 23 months; children aged 2 through 4 years who had 1 or more episodes of wheezing in the past 12 months; people with any other underlying medical conditions that predispose them to influenza complications (Box 2) or a history of Guillain-Barré syndrome (GBS); close contacts and caregivers of severely immunosuppressed people who require a protected environment; and people with egg allergy (1,2). See the CDC's Advisory Committee on Immunization Practices' recommendations on vaccine dosing, formulation, and safety. Full prescribing information for all seasonal vaccines.

  • FluMist® Quadrivalent—Quadrivalent intranasal live attenuated vaccine (LAIV4) for healthy, nonpregnant people aged 2 to 49. Consider choosing LAIV over inactivated influenza vaccine (IIV) for young children.
  • Fluarix® Quadrivalent—Quadrivalent inactivated vaccine (IIV4) for people aged 3 years and older.
  • Flulaval® Quadrivalent—Quadrivalent inactivated vaccine (IIV4) for people aged 3 years and older. Available in multi-dose vials.
  • Fluzone® Quadrivalent—Quadrivalent inactivated vaccine (IIV4) for people aged 6 months and older. Limited quantities of the 0.25 mL dose for children 6-35 months and 0.5 mL dose for people 36 months and older will be available.
  • Flucelvax®—Trivalent cell culture-based inactivated vaccine (ccIIV3) for adults aged 18 and older; has considerably less egg protein than other IIVs.
  • Flublok®—Trivalent recombinant hemagglutinin vaccine (RIV3) for adults aged 18 through 49. The Advisory Committee on Immunization Practices recommends this vaccine for people in this age group with egg allergy of any severity because it is made without egg protein.a It is also free of latex and preservatives.

a RIV3 is contraindicated in people with known severe allergic reactions (eg, anaphylaxis) to any vaccine component, but is not contraindicated in people with anaphylaxis to egg.

Use of brand names is for informational purposes only and does not imply endorsement by the New York City Department of Health and Mental Hygiene.

PDF version of Box 6

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