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Fluzone or Flulaval: What Does the CDC say?


Winter is coming and so is influenza. Does the CDC recommend Fluzone or Flulaval for pediatric patients?

[[{"type":"media","view_mode":"media_crop","fid":"63237","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_6989755086773","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"8069","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 277px; width: 300px; float: right;","title":" ","typeof":"foaf:Image"}}]]Fans of the HBO series Game of Thrones are familiar with the phrase “winter is coming.” And if winter is coming, so is our annual influenza outbreak. It usually starts in the fall and continues through early spring, but is always present in the winter.

This year, providers caring for children under the age of 3 years have two options for an approved flu vaccine: Fluzone and Flulaval. Dosing is different, however. For Fluzone, a child under age 3 should receive 0.25 cc and for Flulaval, 0.5 cc, which is the adult dose as well. Both vaccines have the same amount of antigen in a 0.5 cc dose. This means a toddler getting Flulaval gets twice the dose of antigen as compared to a child receiving Fluzone. A concern with the bigger dose is that it might be more reactogenic. On the other hand, it might result in higher antibody levels.

What does the CDC say?

1. According to the CDC, which of the following is true with regard to flu vaccination in the 6- to 36-month age range?

A. 0.5 cc of Flulaval is both more reactogenic and immunogenic than 0.25 cc of Fluzone.

B. Both vaccines have a similar side effect profile and immunologic response.

C. Both vaccines have a similar side effect profile but Flulaval had a better immunologic response.

D. Flulaval was more reactogenic and had an equivalent immunological response.

Please click here for answer, discussion, and next question.

Image: ©Nikolayev Natalia/Shutterstock.com


The correct answer is C. Both vaccines have a similar side effect profile but Flulaval had a better immunologic response.

In a head-to-head study comparing 0.5 cc of Flulaval with 0.25 cc of Fluzone the side effect profile (fever, irritability, swelling, etc.) was very similar. Antibody levels following Flulaval tended to be higher than following Fluzone for the two B components in the quadravalent vaccine. Higher antibody levels were also noted in unprimed children receiving their first dose of a flu vaccine. Children under age 8 need to have two doses from previous seasons to be adequately primed. Unfortunately, a good percentage of children needing two doses only get one, leaving them poorly protected.

2. Given the above information, is the following statement True or False?

The CDC recommends the use of Flulaval over Fluzone for children aged 6-36 months.

A. T

B. F

Please click here for answer and discussion



The correct answer is B.False

The CDC specifically states that it does not have a preference for one vaccine over the other. Similarly, the CDC does not recommend quadravalent vaccines over trivalent ones despite the greater overall efficacy of the quadravalent forms. Presumably this is because the differences are small and the CDC does not want to drive any flu vaccine suppliers out of the market.

The final question: Winter is coming; which vaccine would you give your child or grandchild?

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Image: ©Velishchuk Natalia/Shutterstock.com



CDC’s 2017-18 flu season recommendations

Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2017–18 Influenza Season. MMWR Recomm Rep 2017;66(No. RR-2):1–20. DOI: http://dx.doi.org/10.15585/mmwr.rr6602a1

FDA report on Flulaval

Biologics Licencse Application Clinical Review Memorandum

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