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Flu Vaccine Recommendations and Ordering: Information for Health Care Providers

Flu Vaccine Links


Official recommendations from the Advisory Committee on Immunization Practices (ACIP) for the 2016-17 flu season have been released. You can read them here. The information is summarized below.


Vaccine Administration Recommendations

Principle recommendation changes for the 2016-2017 influenza season include:

  • Routine annual influenza vaccination of all persons aged 6 months and older continues to be recommended. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended product is otherwise appropriate.
  • All 2016-17 influenza trivalent (three-component) vaccines are made to protect against the following three viruses:
    • A/California/7/2009 (H1N1)pdm09-like virus
    • A/Hong Kong/4801/2014 (H3N2)-like virus
    • B/Brisbane/60/2008-like virus (Victoria lineage)
  • In addition to the three strains listed above, the quadrivalent vaccine also protects against B/Phuket/3073/2013-like virus (B/Yamagata lineage).
  • Live attenuated influenza vaccine (LAIV4) should not be used. This is an interim recommendation made in response to low effectiveness against influenza A(H1N1)pdm09 in the U.S. during the 2013-14 and 2015-16 seasons.
  • Children aged 6 months through 8 years who have previously received 2 or more doses of trivalent or quadrivalent influenza vaccine before July 1, 2016 require only 1 dose for 2016-17. Children in this age group who do not meet these criteria require 2 doses for the 2016-17 season. The interval between the 2 doses should be at least 4 weeks.
  • Newly licensed products for adult immunization include:

    • An MF59-adjuvanted trivalent inactivated influenza vaccine (allV3), Fluad (Seqirus, Holly Springs, North Carolina) was licensed by FDA in November, 2015 for persons aged 65 years or older. Click here for regulatory information. aIIV3 is an acceptable alternative to other vaccines licensed for this age group.
    • A quadrivalent formulation of Flucelvax (cell culture-based inactivated vaccine [ccIIV4], Seqirus, Holly Springs, North Carolina) was licensed by FDA in May, 2016 for persons 4 years and older. Click here for regulatory information. ccIIV4 is an acceptable alternative to other vaccines licensed for this age group.
  •  Recommendations for influenza vaccination of persons with egg allergies have been modified, including:
    • ACIP has removed the recommendation that egg-allergic recipients be observed for 30 minutes post-vaccination for signs and symptoms of an allergic reaction. Instead, providers should consider observing all patients for 15 minutes after vaccination to decrease the risk of injury from fainting.
    • Persons with a history of severe allergic reaction to egg (i.e. any symptom other than hives) should be vaccinated in an inpatient or outpatient medical setting such as a hospital, clinic, health department, or physician office, under the supervision of a health care provider who can recognize and manage severe allergic conditions.
  • Vaccination should begin as soon as vaccine is available with special emphasis on people with conditions that put them at increased risk for complications from influenza. This is still true for the 2016-2017 season, regardless of when a person received a flu vaccine during the previous season.


Vaccine Products

The 2016-2017 trivalent vaccine strains are: an A/California/7/2009 (H1N1)pdm09-like virus, A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008-like virus (Victoria lineage). In addition to the three strains in the trivalent vaccine, the quadrivalent vaccine also protects against B/Phuket/3073/2013-like virus (B/Yamagata lineage) virus component. You can review the detailed information in table format here. This information has also been compiled by the California Department of Public Health to reflect rules and regulations specific to California in downloadable PDF format


Rules and Regulations

Aerosol and Transmissible Diseases Standard

Effective September 1, 2010, the Aerosol and Transmissible Diseases Standard requires that vaccines including measles, mumps, and rubella (MMR), tetanus, diphtheria, and pertussis (Tdap), varicella, and influenza be offered to employees at no cost. If you are a health care worker, check with your institution to find out if you are eligible for these vaccines. If you are an institution and you would like more information about the ATD Standard, you can read it in detail by clicking here. If you have questions, please direct them to Cal/OSHA Consultation Service by calling 1-800-963-9424 or via email at .


SB 739 (Health and Safety Code Section 1288.7)

Effective July 1, 2007, SB 739 requires general acute care hospitals to:


  • Annually offer onsite flu vaccinations to all employees at no cost
  • Institute respiratory hygiene and cough etiquette protocols
  • Revise/develop disaster plans to include pandemic influenza components


The Mercury Free Act of 2004 - AB 2943

Added Article 9 to Part 2, Chapter 3 of Division 106 of the Health and Safety Code (entitled Personal Health Care). Health and Safety Code Section 124172.


  • Effective July 1, 2006. Affects children under three years and women who are "knowingly pregnant."

  • Restricts thimerosal content in vaccines.
    • Influenza vaccine:
    • All other vaccines: < 0.5 microgram/0.5mL

The Influenza Vaccine Identfication Guide indicates which vaccine products can be given to children under three years of age and pregnant women.


Seasonal Flu Vaccine Ordering Information

Providers should contact their regular distributors or the vaccine manufacturers. Providers who meet eligibility criteria (nonprofit providers who serve low-income, high-risk individuals) may qualify for free vaccine from our Influenza Vaccine Distribution program (see below).


Seasonal Flu Vaccine Distribution Program for Clinics Serving Low Income or Uninsured Clients


Open enrollment for the Flu Vaccine Distribution Program is limited to once per year. All 2016-2017 program applications are due by Wednesday, August 31, 2016. If your organization is interested in applying to receive vaccine from SFDPH, please review the program guidelines. If your organization meets the eligibility criteria, please complete the application form and usage agreement by the deadline. Questions about our flu program should be directed to (415) 554-2955.


Due dates for the 2016-2017 Flu Vaccine Distribution Program are as follows:


Prior to submitting your application, select staff must thoroughly read the 2016 Vaccine Management Plan. This Plan is a compilation of resources designed to help your clinic with vaccine administration, ordering, storage and handling. Submit this Signature Page to indicate that your Primary Vaccine Coordinator and two Back-Up Coordinators have read the Plan. To access the plan, visit Enter password "35to46"




Additional Resources

Please call the Communicable Disease Prevention Unit with any questions: (415) 554-2955

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