What flu vaccines are available in India?

Flu Vaccines Available in India

Quadrivalent influenza vaccines (QIVs) are the primary flu vaccines available in India, with several formulations suitable for different age groups. These vaccines are recommended to be administered just before the onset of the rainy season (June to August in most regions, October to December in Tamil Nadu) 1.

Available Influenza Vaccine Types in India

Quadrivalent Inactivated Influenza Vaccines (QIVs)

• Influvac® Tetra (Abbott) - subunit, inactivated influenza vaccine 2
• VaxiFlu-4 (Zydus Cadila Healthcare) - split virion, inactivated influenza vaccine 2
• Fluzone® Quadrivalent (Sanofi Pasteur) - split-virion inactivated vaccine for individuals aged ≥6 months 3

Key Features of Available Vaccines

• All current seasonal influenza vaccines in India are quadrivalent, containing two influenza A strains and two influenza B strains 4
• These vaccines provide protection against both circulating B lineages (Victoria and Yamagata), offering broader protection than older trivalent vaccines 4
• The vaccines are updated annually to match circulating virus strains as recommended by WHO and regulatory authorities 4

Age-Specific Recommendations

Dosing by Age Group

• Children 6-35 months:

  • 0.25 mL or 0.5 mL dose depending on the specific vaccine formulation 4
  • Fluzone® can be administered as either 0.25 mL or 0.5 mL for this age group 3

• Children 3 years and older:

  • 0.5 mL dose for all available vaccines 4

• Children requiring two doses:

  • Children 6 months through 8 years receiving influenza vaccine for the first time or who have received only 1 dose before July 1 of the previous year should receive 2 doses 4 weeks apart 4

Administration Timing and Technique

• Optimal timing: Just before the onset of rainy season (June-August in most regions, October-December in Tamil Nadu) 1
• Administration route: Intramuscular injection into the anterolateral thigh for infants/young children and deltoid muscle for older children/adults 4
• Storage requirements: Vaccines should be stored at 2°C to 8°C (36°F to 46°F); vaccines that are inadvertently frozen should not be used 4

Safety Profile

• Common side effects:

  • Injection site pain and tenderness are most common local reactions 3, 5
  • Fever is common in children under 2 years 4, 5
  • Myalgia is more common in older children and adolescents 3
  • Most reactions are mild (grade 1 or 2) and resolve within 3 days 3

• Contraindications:

  • History of severe allergic reaction to any component of the vaccine or previous dose 6
  • Current guidelines allow most patients with egg allergy to receive influenza vaccines with appropriate precautions 6

Effectiveness and Immunogenicity

• Indian studies have demonstrated good immunogenicity of QIVs across all age groups:
  • Seroprotection rates >90% for A strains and 43-60% for B strains in adults and elderly 2
  • In children 6-35 months, seroprotection rates range from 41.2% to 91.2% depending on the strain 5
  • In children/adolescents 3-17 years, seroprotection rates range from 73.7% to 100% 5

Special Considerations for India

• The Indian Academy of Pediatrics (IAP) recommends influenza vaccination for children with risk factors but not as a universal measure 1
• IAP has prioritized different target groups based on disease burden, severity, and vaccine effectiveness 1
• Limited influenza activity is seen throughout the year in India with clear peaking during the rainy season 1

Common Pitfalls to Avoid

• Timing errors: Administering vaccine too late (after onset of rainy season) reduces effectiveness
• Storage errors: Using vaccines that have been frozen or improperly stored
• Dosing errors: Using incorrect dose volume for age group
• Incomplete vaccination: Failing to provide second dose to children who require two doses

Remember that annual vaccination is necessary due to waning immunity and viral antigenic drift, even for previously vaccinated individuals 6.