Influenza Vaccine Group

Table of Contents

Influenza Vaccine Group Evaluation and Forecasting Rules

The ICE Workgroup has not yet executed the CDC CDSi test cases for influenza against the implemented ICE rules; following that review, the ICE rules are subject to change.  

General Rules for Influenza

General rules are not series-specific; general rules apply to the entire vaccine group.

Rules Based on Patient's Age

  •  There is no maximum age for this vaccine group.

Influenza Vaccine Season Rules

  • Season Start and End Dates
    • The influenza current vaccine season default start date is July 1st and the default end date is June 30th. The default start date for the next season is July 1st.
      • Note: Rule Manager must provide a user the ability to set the influenza vaccine season start and end date for the current season, as well as the start date for the next season (for recommendation purposes).
  • Recommendation and Recommended Due Date
    • Influenza vaccine is due only during the influenza vaccine season.
    • The day after the influenza vaccine season ends (e.g., July 1st) all previously recommendation dates must be reset to the 1st day of the next influenza vaccine season or the date that the patient becomes the routine recommended age, whichever date is later. 
      • There is a 4 week recommended interval  between the last shot administered during the current influenza vaccine season and target dose 1 of the next influenza vaccine season, unless applying the Live Vaccine Interval rule.
    • If the recommended due date falls outside of the influenza vaccine season, no doses are recommended until the start of the next influenza vaccine season.1
    • All patients >= the recommended age for dose 1 (i.e., 6 months of age) are due an influenza vaccine each influenza season. The series is never complete.
  • Evaluation
    • Influenza shots administered outside the influenza vaccine season (e.g., during July, if the season has been defined as August 1st to June 30th) will be evaluated as Invalid with a reason code of OUTSIDE_FLU_VAC_SEASON.1
    • There is a 4 weeks - 4 days absolute minimum interval between the last shot administered during the previous influenza vaccine season and target dose 1 of the current influenza vaccine season, unless applying the Live Vaccine Interval rule.
    • There is no minimum interval between shots administered outside the influenza vaccine season and target dose 1 of the current influenza vaccine season, unless applying the Live Vaccine Interval rule.1
    • Influenza shots administered after the series is complete for the current influenza vaccine season will be evaluated as Accepted with a reason code of EXTRA_DOSE.
    • Rules for Evaluating Doses Administered During Prior Influenza Seasons
      • If rules have been established for an influenza vaccine season, then shots administered during that influenza vaccine season are evaluated based on the rules in effect at the time the shot was administered.
      • If no rules have been established for a prior influenza vaccine season, then shots administered during that prior influenza vaccine season are evaluated based on the following default rules:
        • Absolute minimum age of 6 months - 4 days
        • Absolute minimum interval of 24 days
        • Shots administered after 2 doses are evaluated as Accepted with a reason code of EXTRA_DOSE.
        • Shots administered July 1st of that year to June 30th of the next year are evaluated as within the influenza vaccine season.
  • If no rules have been established for the current influenza vaccine season, then use the rules from the preceding influenza vaccine season where rules have been defined unless otherwise noted.
  • When determining the recommended age for dose 1 in the next influenza vaccine season while still in the current influenza vaccine season (or in the "off season" if there is one defined), if no rules have been defined for the next season, then use the current influenza vaccine season's rules.

Live Vaccine Interval Rule

Select Adjuvant Product Interval

  • The Select Adjuvant Product Interval rule applies to CVX 168 and CVX 205. For rule details, see the Select Adjuvant Product Interval rule on the General ICE Rules page.
 

Notes

  • 1This rule applies if there is a defined "off season" for Influenza. For example, if the season start date is August 1st and the season end date is June 30th, then July 1 - July 31 would be considered the Influenza "off season".

Influenza Vaccines

CVX Code

Name

Absolute Minimum AgeAbsolute Maximum Age
15Influenza, split 6 months - 4 days
16Influenza, whole6 months - 4 days
88Influenza, unspecified formulation6 months - 4 days
111 (star)Influenza, live, intranasal6 months - 4 days 50 years - 1 day
135Influenza, high dose, seasonal6 months - 4 days

140

Influenza, seasonal, injectable, preservative free6 months - 4 days
141Influenza, seasonal, injectable6 months - 4 days
144Influenza, seasonal, intradermal, preservative free12 years - 4 days65 years - 1 day
149 (star)Influenza, live, intranasal, quadrivalent6 months - 4 days 50 years - 1 day
150Influenza, injectable, quadrivalent, preservative free6 months - 4 days
151 (star)Influenza, nasal, unspecified formulation6 months - 4 days 50 years - 1 day
153Influenza, injectable, MDCK, preservative free6 months - 4 days
155Influenza, recombinant, injectable, preservative free6 months - 4 days
158Influenza-IIV4, IM (>3yrs)6 months - 4 days
161 Influenza, injectable, quadrivalent, preservative free, pediatric6 months - 4 days 3 years - 1 day
166 Influenza, intradermal, quadrivalent, preservative free, injectable12 years - 4 days65 years - 1 day
168

Influenza, seasonal trivalent influenza vaccine, adjuvanted, preservative free 

6 months - 4 days
171

Influenza, injectable, Madin Darby Canine Kidney, preservative free, quadrivalent 

6 months - 4 days
185Influenza, recombinant, quadrivalent,injectable, preservative free6 months - 4 days
186Influenza, injectable, MDCK, quadrivalent6 months - 4 days
194Influenza, Southern Hemisphere, unspecified formulationN/A N/A 
197Influenza, high dose, quadrivalent6 months - 4 days
200Influenza, Southern Hemisphere, pediatric, preservative freeN/A N/A 
201Influenza, Southern Hemisphere, preservative freeN/AN/A 
202Influenza, Southern Hemisphere, quadrivalent, with preservativeN/A N/A 
205Influenza, seasonal vaccine, quadrivalent, adjuvanted6 months - 4 days

CVX Code Specific Rules

  • The Live Vaccine Interval rule applies to the CVX codes indicated with a star ((star)). For rule details, see the Live Vaccine Interval rule on the General ICE Rules page.
  • If one of the CVX codes in the table above is administered below the absolute minimum age for that CVX code, then the Evaluation is Invalid and the reason code is BELOW_MINIMUM_AGE_VACCINE.
  • CVX 161 (Influenza, injectable, quadrivalent, preservative free, pediatric) will be evaluated as:
    • Invalid (due to insufficient antigen) if administered to a patient who is >= 3 years old.
    • Valid (as long as minimum interval/minimum age requirements are met, where applicable) if administered to a patient who is < 3 years old.
  • If CVX 194, 200, 201, 202 are administered, evaluate the shot as Invalid/VACCINE_NOT_ALLOWED_IN_US (new reason code).

Combination Vaccines that Include Influenza

No combination vaccines exist, at this time, that include influenza.

Immunization Series and Selection Rules for 2015-2016, 2016-2017, 2017-2018, 2018-2019, 2020-2021, and 2021-2022 Influenza Vaccine Season

Series Name

  • Influenza 2-dose Series

  • Influenza 1-dose Series

Series Selection Rules for 2015-2016, 2016-2017, 2017-2018, 2018-2019, 2019-2020, 2020-2021, 2021-2022 Season

  • If the patient is >= 10 years of age then:

    • the 1-dose series applies.

  • If the patient is >= 9 and < 10 years of age then:

    • The 2-dose series applies if all of the following conditions are met:

      1. The patient received a dose of influenza at < 9 years of age during the current influenza vaccine season

      2. The patient DID NOT receive at least 2 doses of seasonal influenza vaccine during any prior seasons.

    • Otherwise, the 1-dose series applies

  • If the patient is < 9 years of age then

    • The 1-dose series applies if:

      • The child received at least 2 doses of seasonal influenza vaccine during any prior influenza seasons.  

    • Otherwise, the 2-dose series applies

Immunization Series and Selection Rules for 2014-2015 Influenza Vaccine Season

Series Name

  • Influenza 2-dose Series

  • Influenza 1-dose Series

Series Selection Rules for 2014-2015 Season

  • If the patient is >= 10 years of age then:

    • the 1-dose series applies.

  • If the patient is >= 9 and < 10 years of age then:

    • The 2-dose series applies if all of the following three conditions are met:

      1. The patient received a dose of influenza at < 9 years of age during the current influenza vaccine season

      2. The patient DID NOT receive at least 2 doses of seasonal influenza vaccine during prior influenza seasons, with at least one dose since July 2010

      3. The patient DID NOT receive at least 2 doses of seasonal influenza vaccine prior to July 2010 and at least one dose of monovalent 2009 H1N1 vaccine

    • Otherwise, the 1-dose series applies

  • If the patient is < 9 years of age then:

    • The 1-dose series applies if any of the following three conditions are met:

      1. The patient received at least 2 doses of seasonal influenza vaccine during prior influenza seasons, with at least one dose since July 2010

      2. The patient received at least 2 doses of seasonal influenza vaccine prior to July 2010 and at least one dose of monovalent 2009 H1N1 vaccine

      3. The patient received at least 1 dose of seasonal influenza vaccine during the 7/1/2013-6/30/2014 influenza vaccine season1

    • Otherwise, the 2-dose series applies

 

Notes

  • 1This new rule is the only ACIP recommendation change from the 2013-2014 season to the 2014-2015 season. This rule applies specifically to the 2014-2015 influenza vaccine season and is not intended to be used as a default rule for subsequent, e.g. 2015-2016, influenza vaccine seasons.

Immunization Series and Selection Rules for 2012-2013 and 2013-2014 Influenza Vaccine Seasons

Series Name

  • Influenza 2-dose Series
  • Influenza 1-dose Series

Series Selection Rules for 2012-2013 and 2013-2014 Seasons

  • If the patient is >= 10 years of age then:

    • the 1-dose series applies.

  • If the patient is >= 9 and < 10 years of age then:

    • The 2-dose series applies if all of the following three conditions are met:

      1. The patient received a dose of influenza at < 9 years of age during the current influenza vaccine season

      2. The patient DID NOT receive at least 2 doses of seasonal influenza vaccine during prior influenza seasons, with at least one dose since July 2010

      3. The patient DID NOT receive at least 2 doses of seasonal influenza vaccine prior to July 2010 and at least one dose of monovalent 2009 H1N1 vaccine

    • Otherwise, the 1-dose series applies

  • If the patient is < 9 years of age then:

    • The 1-dose series applies if either of the following two conditions are met:

      1. The patient received at least 2 doses of seasonal influenza vaccine during prior influenza seasons, with at least one dose since July 2010

      2. The patient received at least 2 doses of seasonal influenza vaccine prior to July 2010 and at least one dose of monovalent 2009 H1N1 vaccine

    • Otherwise, the 2-dose series applies


Immunization Series: Influenza 2-dose Series

The Influenza 2-dose series is complete for the current influenza vaccine season after 2 doses. See the Influenza Vaccine Group#Influenza Vaccine Season Rules section of this page for rules affecting evaluation and recommendation during and outside of the current influenza vaccine season.  

Vaccine Dose Parameters - Minimum and Routine Ages

Dose

Series Name

Absolute Minimum
 Age

Minimum Age

Routine
Age 

Valid CVX Code(s) per Dose for this SeriesInvalid CVX Code(s) per Dose for this Series

1

Influenza 2-dose

 6 months - 4 days

6 months

6 months

15, 16,  88, 111, 135, 140, 141, 144, 149, 150, 151, 153, 155, 158, 161, 166, 168, 171, 185, 186, 197, 205
N/A
2Influenza 2-doseN/AN/AN/A15, 16,  88, 111, 135, 140, 141, 144, 149, 150, 151, 153, 155, 158, 161, 166, 168, 171, 185, 186, 197, 205N/A

Vaccine Dose Parameters - Minimum and Recommended Intervals

Doses

Series Name

Absolute Minimum Interval

Minimum Interval

Minimum Recommended Interval

Dose 1 to 2

Influenza 2-dose

24 days

28 days

28 days

Series Special Rules 

  • There are no special rules for this series.

Immunization Series: Influenza 1-dose Series

The Influenza 1-dose series is complete for the current influenza vaccine season after 1 dose. See the Influenza Vaccine Group#Influenza Vaccine Season Rules section of this page for rules affecting evaluation and recommendation during and outside of the current influenza vaccine season.

Vaccine Dose Parameters - Minimum and Routine Ages

Dose

Series Name

Absolute Minimum
 Age

Minimum Age

Routine
Age 

Valid CVX Code(s) per Dose for this SeriesInvalid CVX Code(s) per Dose for this Series

1

Influenza 1-dose

 6 months - 4 days1

6 months

6 months

15, 16,  88, 111, 135, 140, 141, 144, 149, 150, 151, 153, 155, 158, 161, 166, 168, 171, 185, 186, 197, 205N/A

Series Special Rules 

  • There are no special rules for this series.

Notes

  • When creating test cases, note that the absolute minimum age1 will never be violated while applying the 1-dose series; patients below the absolute minimum age would not meet the criteria (i.e., 2 prior doses of influenza vaccine) for selecting the 1-dose series.