Influvac Tetra

A colorless clear liquid, filled in single-dose syringes.
Influenza virus surface antigens (inactivated) (haemagglutinin and neuraminidase) of four strains* 15 micrograms HA** per strain per 0.5 ml dose.
*propagated in fertilized hens' eggs from healthy chicken flocks.
**hemagglutinin.
This vaccine complies with the World Health Organization (WHO) recommendation (southern hemisphere) and competent authority decision.
Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) may contain traces of eggs (such as ovalbumin, chicken proteins), formaldehyde, cetyltrimethylammonium bromide, polysorbate 80 or gentamicin, which are used during the manufacturing process (see Contraindications).
Excipients/Inactive Ingredients: Potassium chloride, potassium dihydrogen phosphate, disodium phosphate dihydrate, sodium chloride, calcium chloride dihydrate, magnesium chloride hexahydrate and water for injections.

Pharmacotherapeutic group: Influenza vaccine. ATC Code: J07BB02.
Pharmacology: Pharmacodynamics: Mechanism of action: Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) provides active immunization against four influenza virus strains: an A/(H1N1) strain, an A/(H3N2) strain, and two B strains (one from each lineage; B/(Austria) and B/(Phuket)). Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra), manufactured according to the same process as the Trivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac), induces humoral antibodies against the hemagglutinins. These antibodies neutralize influenza viruses.
Specific levels of hemagglutination-inhibition (HI) antibody titer post-vaccination with inactivated influenza virus vaccines have not been correlated with protection from influenza illness but the HI antibody titers have been used as a measure of vaccine activity.
An immune response is generally obtained within 2 to 3 weeks. The duration of postvaccinal immunity to homologous strains or to strains closely related to the vaccine strains varies but is usually 6-12 months.
Pharmacodynamic effects: Efficacy of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) in children 6-35 months of age: The efficacy of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) was evaluated in a randomized, observer-blind, non-influenza vaccine-controlled study (INFQ3003) conducted during 3 influenza seasons 2017 to 2019 in Europe and Asia. Healthy subjects aged 6-35 months received two doses of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) (N=1005) or non-influenza control vaccine (N=995) approximately 28 days apart. The efficacy of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) was assessed for the prevention of reverse transcription polymerase chain reaction (RT-PCR)-confirmed influenza A and/or B disease due to any influenza strain. All RT-PCR-positive specimens were further tested for viability in cell culture and to determine whether the circulating viral strains matched those in the vaccine. (See Table 1.)

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Immunogenicity of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) compared to Trivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac): Clinical studies performed in adults of 18 years of age and older (INFQ3001) and children of 3 to 17 years of age (INFQ3002) assessed the safety and immunogenicity of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) and its non-inferiority to Trivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac) for the postvaccination HI Geometric mean antibody titer (GMT).
In both studies the immune response elicited by Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) against the three strains in common was non-inferior to Trivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac). Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) elicited a superior immune response against the additional B strain included in Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) compared to Trivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac).
Adults 18 years of age and older: In clinical study INFQ3001, 1,535 adults of 18 years of age and older received a single dose of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) and 442 subjects received a single dose of Trivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac): See Table 2.

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Pediatric population: Children 3-17 years of age: In clinical study INFQ3002, 402 children of 3 to 17 years of age received one or two doses of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) and 798 children received one or two doses of Trivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac) based on their influenza vaccination history. (See Table 3.)

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Children 6 months-35 months of age: In clinical study INFQ3003 the immunogenicity of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) was evaluated in terms of seroconversion rates across 3 influenza seasons. (See Table 4.)

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Pharmacokinetics: Not applicable.
Toxicology: Preclinical safety data: Non-clinical data revealed no special hazard for humans based on conventional studies of repeat dose and local toxicity, reproductive and developmental toxicity and safety pharmacology studies.

Prophylaxis of influenza, especially those who run an increased risk of associated complications.
Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) is indicated in adults and children from 6 months of age.
The use of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) should be based on official recommendations.
Vaccination is particularly recommended for the following categories of patients, depending on national immunization policies: Persons aged ≥65 years, regardless their health condition.
Adults and children from 6 months of age with chronic disorders of the pulmonary or cardiovascular systems, including asthma.
Adults and children from 6 months of age with chronic metabolic diseases such as diabetes mellitus.
Adults and children from 6 months of age with chronic renal dysfunction.
Adults and children from 6 months of age with immunodeficiencies due to disease or immunosuppressant medication (e.g., cytostatics or corticosteroids) or radiotherapy.
Children from 6 months of age who receive long-term acetylsalicylic acid containing medication, and might therefore be at risk for developing Reye's syndrome following an influenza infection.

Posology: Adults: 0.5 ml.
Pediatric population: Children from 6 months to 17 years of age: 0.5 ml.
Children less than 9 years of age, who have not previously been vaccinated with a seasonal influenza vaccine: a second dose of 0.5 ml should be given after an interval of at least 4 weeks.
Infants less than 6 months of age: the safety and efficacy of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) in children have not been established.
Method of Administration: Immunization should be carried out by intramuscular or deep subcutaneous injection.
The preferred sites for intramuscular injection are the anterolateral aspect of the thigh (or the deltoid muscle if muscle mass is adequate) in children 6 months through 35 months of age, or the deltoid muscle in children from 36 months of age and adults.
Precautions to be taken before handling or administrating the medicinal product: For instructions for preparation of the medicinal product before administration, see Special precautions for disposal and other handling under Cautions for Usage.

Overdosage is unlikely to have any untoward effect.

Hypersensitivity to the active substances, to any of the excipients listed in Description or to any component that may be present as traces such as eggs (ovalbumin, chicken proteins), formaldehyde, cetyltrimethylammonium bromide, polysorbate 80 or gentamicin. Immunization shall be postponed in patients with febrile illness or acute infection.

Traceability: In order to improve the traceability of biological medicinal products, the name and the batch number of the administered product should be clearly recorded.
As with all injectable vaccines, appropriate medical treatment and supervision should always be readily available in case of an anaphylactic event following the administration of the vaccine.
Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) should under no circumstances be administered intravascularly.
As with other vaccines administered intramuscularly, Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) should be given with caution to individuals with thrombocytopenia or any coagulation disorder since bleeding may occur following an intramuscular administration to these subjects.
Anxiety-related reactions, including vasovagal reactions (syncope), hyperventilation or stress-related reactions can occur following, or even before, any vaccination as a psychogenic response to the needle injection. This can be accompanied by several neurological signs such as transient visual disturbance, paraesthesia and tonic-clonic limb movements during recovery. It is important that procedures are in place to avoid injury from faints.
Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) is not effective against all possible strains of influenza virus. Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) is intended to provide protection against those strains of virus from which the vaccine is prepared and to closely related strains.
As with any vaccine, a protective immune response may not be elicited in all vaccinees.
Antibody response in patients with endogenous or iatrogenic immunosuppression may be insufficient.
Interference with serological testing: see Interactions.
This medicine contains less than 1 mmol sodium (23 mg) per dose, i.e. essentially 'sodium-free'.
This medicine contains potassium, less than 1 mmol (39 mg) per dose, i.e. essentially "potassium- free".
Effects on ability to drive and use machines: Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) has no or negligible influence on the ability to drive and use machines.

Pregnancy: Inactivated influenza vaccines can be used in all stages of pregnancy. Larger datasets on safety are available for the second and third trimester, compared with the first trimester; however, data from worldwide use of influenza vaccine do not indicate any adverse fetal and maternal outcomes attributable to the vaccine.
Breast-feeding: Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) may be used during breast-feeding.
Fertility: No fertility data are available.

Summary of the safety profile: The safety of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) was assessed in three clinical trials.
In two clinical trials healthy adults 18 years of age and older, and healthy children 3 to 17 years of age were administered Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) or Trivalent influenza Vaccine (Surface Antigen, Inactivated) (Influvac).
In a third study, the safety of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) was assessed in healthy children from 6 months to 35 months of age administered Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) or a non-influenza vaccine control.
In both children studies, children from 6 months to 8 years of age received one or two doses of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) depending on their influenza vaccination history. Most reactions usually occurred within the first 3 days following vaccination and resolved spontaneously within 1 to 3 days after onset. The intensity of these reactions was generally mild.
In all age groups, the most frequently reported local adverse reaction after vaccination observed in the clinical studies for Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) was vaccination site pain. The most frequently reported general adverse reactions after vaccination observed in the clinical studies for Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) in adults and children from 6-17 years of age were fatigue and headache, for children from 3-5 years of age drowsiness, irritability and loss of appetite.
The most frequently reported general adverse reactions after vaccination observed in the clinical studies for Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) in children from 6 months to 35 months of age were irritability/fussiness.
Similar rates of solicited adverse reactions were observed in recipients of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) and Trivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac).
The rates of solicited systemic adverse reactions were similar in recipients of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) and the non-influenza vaccine, whereby the rates of solicited local adverse reactions were lower in recipients of Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra).
Tabulated summary of adverse reactions: The following undesirable effects are considered at least possibly related to Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) and have either been observed during the clinical trial with Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) or are resulting from post-marketing experience with Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) and/or the Trivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac).
The following frequencies apply: very common (≥1/10); common (≥1/100, <1/10); uncommon (≥1/1,000, <1/100); and not known (adverse reactions from post-marketing experience; cannot be estimated from the available data).
Adults and elderly: See Table 5.

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Pediatric population: See Table 6.

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Reporting of suspected adverse reactions: Reporting suspected adverse reactions after authorization of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions.

No interaction studies have been performed. If Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (Influvac Tetra) is given at the same time as other vaccines, immunization should be carried out on separate limbs. It should be noted that the adverse reactions may be intensified.
The immunological response may be diminished if the patient is undergoing immunosuppressant treatment.
Following influenza vaccination, false positive results in serology tests using the ELISA method to detect antibodies against HIV1, Hepatitis C and especially HTLV1 have been observed. The Western Blot technique disproves the false-positive ELISA test results. The transient false-positive reactions could be due to the IgM response by the vaccine.

Incompatibilities: In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products.
Special precautions for disposal and other handling: The vaccine should be allowed to reach room temperature before use. Shake before use. Inspect visually prior to administration.
Any unused product or waste material should be disposed of in accordance with local requirements.

Shelf life: 12 months.
Special precautions for storage: Store at 2°C-8°C. Do not freeze.
Store in the original package in order to protect from light.

Vaccines, Antisera & Immunologicals

J07BB02 - influenza, inactivated, split virus or surface antigen ; Belongs to the class of influenza viral vaccines.

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