Influenza Vaccination Administration Guidelines

Site Selection and Injection Technique

The Centers for Disease Control and Prevention (CDC) recommends injecting influenza vaccines into the deltoid muscle for adults and older children, or the anterolateral thigh for infants and young children, using a 90-degree angle with appropriate needle length, without aspiration 1, 2
The American Academy of Pediatrics and the CDC recommend the deltoid muscle as the injection site for adults and older children receiving intramuscular influenza vaccines 1, 2, 3
The anterolateral aspect of the thigh is the preferred site for infants and young children due to insufficient deltoid muscle mass in this age group 1, 2, 3, 4

The CDC recommends a standard dose of 0.5 mL for most intramuscular influenza vaccine products for children aged 36 months through 17 years and adults aged 18-64 years 2, 5
For adults aged ≥65 years, the standard dose is 0.5 mL for most products, but 0.7 mL for Fluzone High-Dose Quadrivalent 2, 5
The CDC recommends administering the remaining volume during the same visit if a smaller dose is inadvertently given to someone requiring 0.5 mL 2

The CDC states that a history of severe allergic reaction to any vaccine component or previous dose of any influenza vaccine is an absolute contraindication 1, 6, 7
Moderate or severe acute illness with or without fever, and a history of Guillain-Barré syndrome within 6 weeks of previous influenza vaccination, are precautions to consider 1, 6, 7

Persons with egg allergy may receive any licensed, age-appropriate influenza vaccine, but those with severe egg reactions should be vaccinated in a medical setting supervised by a provider able to manage severe allergic reactions 1, 6
The CDC recommends using appropriate needle length based on patient size and injection site per ACIP General Best Practice Guidelines 1, 2
Aspiration is not required before injection of influenza vaccines because no large blood vessels exist at the recommended injection sites 8

Inactivated influenza vaccines (IIV) are recommended to be given intramuscularly into the deltoid muscle for adults and older children, or into the anterolateral thigh for infants and young children — as advised by the Advisory Committee on Immunization Practices (ACIP) and the CDC. 9
Recombinant influenza vaccine (RIV) is also administered intramuscularly following the same site‑selection guidelines. 10

Fluzone Intradermal is the only influenza vaccine formulated for intradermal delivery; it is injected over the deltoid using a specialized delivery system supplied with the product. 11
Intradermal administration of this product is not equivalent to subcutaneous injection and requires the specific intradermal formulation. 12
The approved dose for the intradermal formulation is 0.1 mL. 12

The live attenuated influenza vaccine (LAIV, e.g., FluMist) is administered intranasally only and is not given by injection. 9