Flucelvax Quadrivalent

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  • Vaccines

Flucelvax Quadrivalent Generic Name & Formulations

General Description

Quadrivalent, inactivated, "subunit" influenza vaccine (virus types A and B); contains a total of 60mcg of hemagglutinin per 0.5mL dose; formulation changes annually; susp for IM inj; antibiotic-free.

Pharmacological Class

Influenza vaccine.

How Supplied

Single-dose prefilled syringe 0.5mL (preservative-free)—10 (without needles); Multi-dose vial 5mL (contains thimerosal)—1

Storage

  • Store this product refrigerated at 2°C to 8°C (36ºF to 46ºF). Between uses, return the multi-dose vial to the recommended storage conditions. Do not freeze. Protect from light. Do not use after the expiration date.

Manufacturer

Generic Availability

NO

Mechanism of Action

Frequent development of antigenic variants through antigenic drift is the virologic basis for seasonal epidemics and the reason for the usual change of one or more strains in each year's influenza vaccine. Therefore, inactivated influenza vaccines are standardized to contain the hemagglutinin of influenza virus strains representing the influenza viruses likely to circulate in the United States in the upcoming winter.

Flucelvax Quadrivalent Indications

Indications

Influenza immunization.

Flucelvax Quadrivalent Dosage and Administration

Adults and Children

<6months: not established. Each dose is 0.5mL by IM inj once in the deltoid (or anterolateral thigh in younger children). 6months–8yrs: 1 or 2 doses at least 4wks apart (depending on vaccination history as per annual ACIP recommendation). ≥9yrs: 1 dose.

Flucelvax Quadrivalent Contraindications

Not Applicable

Flucelvax Quadrivalent Boxed Warnings

Not Applicable

Flucelvax Quadrivalent Warnings/Precautions

Warnings/Precautions

Use current formulation only. Have appropriate medical treatment and supervision readily available. Guillain-Barre syndrome within 6 weeks of previous flu vaccine. Immunosuppressed. Pregnancy. Nursing mothers.

Warnings/Precautions

Guillain-Barré Syndrome

  • Carefully consider the potential benefits and risks to give Flucelvax Quadrivalent if Guillain-Barré Syndrome (GBS) has occurred after receiving a previous influenza vaccination.

  • Evidence for a causal relation of GBS with subsequent vaccines prepared from other influenza viruses is unclear. If influenza vaccine does pose a risk, it is probably slightly more than one additional case per 1 million persons vaccinated.

Preventing and Managing Allergic Reactions

  • Appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of the vaccine.

Syncope

  • Syncope may occur after administration. Procedures should be in place to avoid injury from falling.

Altered Immunocompetence

  • Immune response may be diminished if Flucelvax Quadrivalent is given to immunocompromised individuals, including those receiving immunosuppressive therapy.

Limitations of Vaccine Effectiveness

  • Flucelvax Quadrivalent may not protect all individuals.

Pregnancy Considerations

Risk Summary

  • No evidence of a vaccine-associated increase in the risk of major birth defects and miscarriages when Flucelvax Quadrivalent is administered during any trimester of pregnancy

Clinical Considerations

  • Disease-associated Maternal and/or Embryo-Fetal Risk: Pregnant women are at increased risk for severe illness due to influenza compared to nonpregnant women. Pregnant women with influenza may be at increased risk for adverse pregnancy outcomes, including preterm labor and delivery.

Nursing Mother Considerations

  • It is not known whether Flucelvax Quadrivalent is excreted in human milk.

  • No data available to determine the effects of Flucelvax Quadrivalent on the breastfed infant or on milk production/excretion.

  • Consider the developmental and health benefits of breastfeeding along with the mother's clinical need for Flucelvax Quadrivalent and any potential adverse effects on the breastfed child from Flucelvax Quadrivalent or from the underlying maternal condition.

Pediatric Considerations

  • Safety and effectiveness have not been established in children less than 6 months of age.

Geriatric Considerations

  • Antibody responses to Flucelvax Quadrivalent were lower in the geriatric (adults 65 years and older) population than in younger adults.

Flucelvax Quadrivalent Pharmacokinetics

See Literature

Flucelvax Quadrivalent Interactions

Interactions

Concomitant vaccines: insufficient data (see full labeling). Immunosuppressants: may get suboptimal response.

Flucelvax Quadrivalent Adverse Reactions

Adverse Reactions

Local reactions (eg, pain, erythema, induration, tenderness, ecchymosis), headache, fatigue, myalgia, sleepiness, irritability, loss of appetite, diarrhea, change of eating habits; syncope.

Flucelvax Quadrivalent Clinical Trials

Clinical Trials

Efficacy against Culture-Confirmed Influenza

Study 4

  • The efficacy experience with Flucelvax is relevant to Flucelvax Quadrivalent.

  • The multinational (US, Finland, and Poland), randomized, observer-blind, placebo-controlled trial evaluated the efficacy and safety of Flucelvax during the 2007-2008 influenza season in 11,404 adults 18 through 49 years of age. Patients received either Flucelvax, Agriflu, or placebo. 

  • Flucelvax efficacy was assessed by the prevention of culture-confirmed symptomatic influenza illness caused by viruses antigenically matched to those in the vaccine and prevention of influenza illness caused by all influenza viruses compared to placebo.

  • Vaccine efficacy of Flucelvax against culture-confirmed influenza caused by antigenically matched strains was 83.8%. The vaccine efficacy of Flucelvax against all culture-confirmed influenza was 69.5%.

  • Vaccine efficacy of Flucelvax against culture-confirmed influenza by influenza viral subtype was:

    • Antigenically Matched Strains – A/H3N2: N/A

    • Antigenically Matched Strains – A/H1N1: 88.2%

    • Antigenically Matched Strains – B: N/A

    • All Culture-Confirmed Influenza – A/H3N2: 75.6%

    • All Culture-Confirmed Influenza – A/H1N1: 89.3%

    • All Culture-Confirmed Influenza – B: 49.9%

 

Efficacy of Flucelvax Quadrivalent in Children and Adolescents 2 through 17 Years of Age

Study 2

  • The multinational, randomized, non-influenza vaccine comparator-controlled efficacy, immunogenicity and safety study evaluated the absolute efficacy of Flucelvax Quadrivalent in 4514 children and adolescents 2 through 17 years of age. Patients were randomly assigned to receive either Flucelvax Quadrivalent or a non-influenza comparator vaccine (meninogococcal [groups A, C, Y, and W-135] oligosaccharide diphtheria CRM197 conjugate).

  • Children 2 through 8 years of age received either 1 or 2 doses (separated by 4 weeks) of Flucelvax Quadrivalent or comparator vaccine depending on the subject’s prior influenza vaccination history.

  • Children and adolescents 9 through 17 years of age received a single dose of Flucelvax Quadrivalent or non-influenza comparator vaccine.

  • The overall vaccine efficacy for the entire study population (2 through 17 years) was 54.6% (95% CI 45.7 – 62.1), which met predefined success criteria. In addition, vaccine efficacy was 50.5% (95% CI 38.4 – 60.2) in children 2 through 8 years of age and 61.9% (95% CI 47.4 – 72.3) in those 9 through 17 years of age. 

 

Immunogenicity of Flucelvax Quadrivalent in Adults 18 years of age and above

Study 3

  • The randomized, double-blind, controlled study evaluated the immunogenicity of Flucelvax Quadrivalent in adults 18 years of age and older. Patients received Flucelvax Quadrivalent or one of the two formulations of comparator trivalent influenza vaccine (TIV1c or TIV2c). The immune response to each of the vaccine antigens was assessed 21 days after vaccination.

  • The immunogenicity endpoints were geometric mean antibody titers (GMTs) of hemagglutination inhibition (HI) antibodies response and percentage of adults who achieved seroconversions, defined as a pre-vaccination HI titer of < 1:10 with a post-vaccination titer ≥ 1:40 or a prevaccination HI titer > 1:10 and at least 4-fold increase in serum HI antibody titer.

  • Flucelvax Quadrivalent was noninferior to TIVc, which was assessed by ratios of GMTs and the differences in the percentages of adults achieving seroconversion at 3 weeks following vaccination. The antibody response to influenza B strains contained in Flucelvax Quadrivalent was superior to the antibody response after vaccination with TIVc containing an influenza B strain from the alternate lineage. 

 

Immunogenicity in Children and Adolescents 6 months through 17 years of age

Study 1

  • The randomized, observer-blind, multicenter study evaluated the immunogenicity of Flucelvax Quadrivalent in children 6 months through 3 years of age. Patients received Flucelvax Quadrivalent or a US-licensed comparator quadrivalent influenza vaccine.

  • The immunogenicity endpoints were geometric mean antibody titers (GMTs) and percentage of subjects who achieved seroconversion, defined as a pre-vaccination HI or microneutralization (MN) titer of < 1:10 with a post-vaccination titer ≥ 1:40 or with a pre-vaccination HI or MN titer ≥ 1:10 and a minimum 4-fold increase in serum antibody titer.

  • Flucelvax Quadrivalent was noninferior to the comparator QIV, which was assessed by ratios of GMTs and the differences in the percentages of adults achieving seroconversion at 4 weeks following vaccination.

Study 5

  • The randomized, double-blind, controlled study evaluated the immunogenicity of Flucelvax Quadrivalent in 1159 children 4 through 17 years of age. All patients received Flucelvax Quadrivalent.

  • The immunogenicity endpoints were geometric mean antibody titers (GMTs) and percentage of subjects who achieved seroconversion, defined as a pre-vaccination HI or microneutralization (MN) titer of < 1:10 with a post-vaccination titer ≥ 1:40 or with a pre-vaccination HI or MN titer ≥ 1:10 and a minimum 4-fold increase in serum antibody titer.

  • For all four influenza strains, the 95% LBCI seroconversion rates were ≥ 40% and the percentage of children and adolescents who achieved HI titer ≥ 1:40 post vaccination were ≥ 70% (95% LBCI).

Flucelvax Quadrivalent Note

Not Applicable

Flucelvax Quadrivalent Patient Counseling

Patient Counseling

  • Inform vaccine recipients of the potential benefits and risks of immunization with Flucelvax Quadrivalent. 

  • Educate vaccine recipients regarding the potential side effects; clinicians should emphasize that (1) Flucelvax Quadrivalent contains non-infectious particles and cannot cause influenza and (2) Flucelvax Quadrivalent is intended to provide protection against illness due to influenza viruses only and cannot provide protection against other respiratory illnesses. 

  • Instruct vaccine recipients to report adverse reactions to their healthcare provider.

  • Provide vaccine recipients with the Vaccine Information Statements which are required by the National Childhood Vaccine Injury Act of 1986. These materials are available free of charge at the Centers for Disease Control and Prevention (CDC) website (www.cdc.gov/vaccines).