Summary of medicine characteristics - Fluad Tetra
1. NAME OF THE MEDICINAL PRODUCT
Fluad Tetra, suspension for injection in pre-filled syringe
Influenza vaccine (surface antigen, inactivated, adjuvanted)
2. QUALITATIVE AND QUANTITATIVE COMPOSITION
Influenza virus surface antigens (haemagglutinin and neuraminidase), inactivated, of the following strains*:
| Per 0.5 ml dose | |
| A/Victoria/2570/2019 (H1N1)pdm09 – like strain (A/Victoria/2570/2019 IVR-215) | 15 micrograms HA |
| A/Cambodia/e0826360/2020 (H3N2) – like strain (A/Cambodia/e0826360/2020 IVR-224) | 15 micrograms HA |
| B/Washington/02/2019 – like strain (B/Victoria/705/2018 BVR-11) | 15 micrograms HA |
| B/Phuket/3073/2013 – like strain (B/Phuket/3073/2013 BVR-1B) | 15 micrograms HA |
*propagated in fertilised hens’ eggs from healthy chicken flocks and adjuvanted with MF59C.1
**haemagglutinin
Adjuvant MF59C.1 containing per 0.5 ml dose: squalene (9.75 mg), polysorbate 80 (1.175 mg), sorbitan trioleate (1.175 mg), sodium citrate (0.66 mg) and citric acid (0.04 mg).
This vaccine complies with the WHO recommendations (Northern Hemisphere) and EU recommendation for the 2021/2022 season.
Fluad Tetra may contain traces of eggs such as ovalbumin or chicken proteins, kanamycin and neomycin sulphate, formaldehyde, hydrocortisone, cetyltrimethylammonium bromide (CTAB) which are used during the manufacturing process (see section 4.3).
For the full list of excipients, see section 6.1.
3. PHARMACEUTICAL FORM
Suspension for injection in pre-filled syringe (injection).
Milky-white suspension.
4. CLINICAL PARTICULARS4.1 Therapeutic indications
Prophylaxis of influenza in the elderly (65 years of age and older).
Fluad Tetra should be used in accordance with official recommendations.
4.2 Posology and method of administration
Posology
One 0.5 ml dose.
Paediatric population
The safety and efficacy of Fluad Tetra in children from birth to less than 18 years has not been established. Currently available safety and immunogenicity data in children from 6 months to less than 6 years of age are described in sections 4.8 and 5.1 but no recommendation on posology can be made.
Method of administration
For intramuscular injection only.
The preferred injection site is the deltoid muscle of the upper arm.
The vaccine must not be injected intravenously, subcutaneously or intradermally and must not be mixed with other vaccines in the same syringe.
For instructions for preparation of the medicinal product before administration, see section 6.6.
4.3 Contraindications
Hypersensitivity to the active substances, to any of the components of the adjuvant, to any of the excipients listed in section 6.1, or to possible trace residues such as ovalbumin, kanamycin and neomycin sulphate, formaldehyde, cetyltrimethylammonium bromide (CTAB) and hydrocortisone.
A severe allergic reaction (e.g. anaphylaxis) to previous influenza vaccination.
4.4 Special warnings and precautions for use
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.
Appropriate medical treatment and supervision should always be readily available in case of an anaphylactic event following the administration of the vaccine.
Vaccination should be postponed in patients with acute febrile illness until the fever is resolved.
As with all injectable vaccines, Fluad Tetra must be administered with caution to individuals with thrombocytopenia or a bleeding disorder since bleeding may occur following an intramuscular administration.
Syncope (fainting) 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.
Antibody response in patients with endogenous or iatrogenic immunosuppression may be insufficient to prevent influenza.
A protective immune response may not be elicited in all vaccine recipients.
4.5 Interaction with other medicinal products and other forms of interaction
No clinical data on concomitant administration of Fluad Tetra with other vaccines are available. If Fluad Tetra is to be used at the same time as another vaccine, it should be administered at separate injection sites and preferably on different limbs. It should be noted that the adverse reactions may be intensified by any co-administration.
4.6 Fertility, pregnancy and lactation
Women of childbearing potential
This medicine is not indicated in women of childbearing potential (see section 4.1). It is not to be used in women who are, or may be, pregnant or breast-feeding.
Pregnancy
There are no data from the use of Fluad Tetra in pregnant women. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity.
4.7 Effects on ability to drive and use machines
Fluad Tetra has no or negligible influence on the ability to drive and use machines.
4.8 Undesirable effects
Summary of the safety profile
Elderly population
The safety of Fluad Tetra in elderly subjects 65 years of age and older was evaluated in two clinical studies (V118_20 and V118_18), in which 4269 received Fluad Tetra.
Solicited local and systemic adverse reactions were collected for 7 days after vaccination. Unsolicited adverse reactions were collected for 21 days after vaccination.
The most commonly reported (>10%) adverse reactions across both studies were injection site pain (16.3% and 31.9%), fatigue (10.5% and 16.0%) and headache (10.8% and 12.0%) (for V118_18 and V118_20, respectively). Most solicited reactions were reported as mild or moderate in intensity and resolved within the first 3 days after vaccination.
Paediatric population
Fluad Tetra is not indicated for use in children, see section 4.2. Safety information in the paediatric population is presented in section 5.1.
Tabulated list of adverse reactions
Adverse reactions reported are listed according to the following frequency categories: Very common (>1/10); Common (>1/100 – <1/10); Uncommon (>1/1,000 – <1/100).
Table 1: Adverse reactions reported following vaccination in elderly subjects 65 years and older in clinical trials
| MedDRA System Organ class | Very common (>1/10) | Common (>1/100 to <1/10) | Uncommon (>1/1,000 to <1/100) |
| Metabolism and nutrition disorders | Loss of appetite | ||
| Nervous system disorders | Headache | ||
| Gastrointestinal disorders | Nausea, Diarrhoea | Vomiting | |
| Musculoskeletal and connective tissue disorders | Myalgia, Arthralgia | ||
| General disorders and administration site conditions | Injection site pain, Fatigue | Ecchymosis*, Chills, Erythema, Induration, Influenza-like illness | Fever (> 38oC) |
*Or Injection site bruising
Adverse reactions reported from post-marketing surveillance
There are currently no post-marketing data available for Fluad Tetra. However, the post-marketing experience with Fluad (trivalent formulation) is relevant to Fluad Tetra because both vaccines are manufactured using the same process and have overlapping compositions. The following adverse reactions were reported from post marketing surveillance with Fluad (trivalent formulation):
Blood and lymphatic system disorders
Thrombocytopenia (some very rare cases were severe with platelet counts less than 5,000 per mm3), lymphadenopathy
General disorders and administration site conditions
Extensive swelling of injected limb lasting more than one week, injection-site cellulitis-like reaction (some cases of swelling, pain, and redness extending more than 10 cm and lasting more than 1 week)
Immune system disorders
Allergic reactions including anaphylactic shock (in rare cases), anaphylaxis, and angioedema
Musculoskeletal and connective tissue disorders
Muscular weakness
Nervous system disorders
Encephalomyelitis, Guillain-Barré syndrome, convulsions, neuritis, neuralgia, paraesthesia
Skin and subcutaneous tissue disorders
Generalised skin reactions including erythema multiforme, urticaria, pruritus or non-specific rash
Vascular disorders
Vasculitis that may be associated with transient renal involvement
Paediatric population
There are no post-marketing data available for Fluad Tetra and limited data for Fluad (trivalent formulation) in the paediatric population.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation 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 via the national reporting system listed in
4.9 Overdose
Overdosage is unlikely to have any untoward effect.
5. PHARMACOLOGICAL PROPERTIES5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Influenza vaccine, ATC code: J07BB02
Mechanism of action
Fluad Tetra provides active immunisation against four influenza virus strains (two A subtypes and two B types) contained in the vaccine. Fluad Tetra induces humoral antibodies against the haemagglutinins. These antibodies neutralise influenza viruses.
Specific levels of haemagglutination inhibition (HI) antibody titres post-vaccination with inactivated influenza vaccine have not been correlated with protection from influenza virus, but the HI antibody titres have been used as a measure of vaccine efficacy.
Antibody against one influenza virus type or subtype confers limited or no protection against another. Furthermore, antibody to one antigenic variant of influenza virus might not protect against a new antigenic variant of the same type or subtype.
Fluad Tetra contains the adjuvant MF59C.1 (MF59), which is designed to increase and broaden the antigen-specific immune response and to extend the duration of the immune response.
Annual revaccination is recommended because immunity declines during the year after vaccination and circulating strains of influenza virus change from year to year.
Pharmacodynamic effects
Elderly population (65 years and older)
Immunogenicity
The immunogenicity of Fluad Tetra was evaluated in clinical study V118_20, a multicentre, randomised, double-blind, comparator controlled study conducted during the 2017–2018 Northern Hemisphere influenza season. Elderly subjects 65 years of age and older were randomised (2:1:1) to receive Fluad Tetra, the licensed adjuvanted trivalent influenza vaccine (Fluad, aTIV-1) or an adjuvanted trivalent influenza vaccine containing the alternate B strain (aTIV-2).
Eligible subjects were men or women >65 years of age who were healthy or had comorbidities that increased their risk of influenza complications. The mean age of subjects at enrolment who received Fluad Tetra was 72.4 years. Female subjects represented 58.2% of the study population.
The immunogenicity endpoints assessed 3 weeks after vaccination were haemagglutination inhibition (HI) geometric mean antibody titre (GMT) and HI seroconversion rate (pre-vaccination HI titre <1:10 and post-vaccination HI titre > 1:40 or at least a 4-fold increase in HI from pre-vaccination HI titre
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> 1:10). Fluad Tetra met non-inferiority for all 4 influenza strains and superiority to the alternate B strain not included in the Fluad aTIV comparators. The non-inferiority data are summarised in Table 2.
Table 2: Post-vaccination GMT and seroconversion rates in elderly subjects 65 years of age and older
| GMT (95% CI) | GMT Ratioa | |||
| Strain | Fluad Tetra N=872 | aTIV-1 (B-Victoria) N=436 | aTIV-2 (B-Yamagata) N=433 | aTIVd/Fluad Tetra (95% CI) |
| A/H1N1 | 65.0 (57.8; 73.1) | 75.2 (66.7; 84.7) | 1.2 (1.1; 1.3) | |
| A/H3N2 | 294.9 (261.9; 332.1) | 293.3 (259.9; 331.0) | 1.0 (0.9; 1.1) | |
| B/Yamagata | 24.7 (22.7; 26.8) | NA | 24.3 (22.0; 26.8) | 1.0 (0.9; 1.1) |
| B/Victoria | 30.8 (28.3; 33.5) | 30.1 (27.3; 33.2) | NA | 1.0 (0.9; 1.1) |
| Seroconversion %c (95% CI) | Seroconversion Differenceb | |||
| Strain | Fluad Tetra N=872 | aTIV-1 (B-Victoria) N=436 | aTIV-2 (B-Yamagata) N=433 | aTIVd – Fluad Tetra (95% CI) |
| A/H1N1 | 35.2 (32.0; 38.5) | 38.4 (35.2; 41.8) | 3.2 (-1.3; 7.8) | |
| A/H3N2 | 39.3 (36.1; 42.7) | 39.7 (36.4; 43.0) | 0.4 (-4.2; 5.0) | |
| B/Yamagata | 16.4 (14.0; 19.0) | NA | 15.5 (12.2; 19.2) | –0.9 (-5.1; 3.3) |
| B/Victoria | 13.4 (11.2; 15.9) | 12.2 (9.2; 15.6) | NA | –1.3 (-5.1; 2.6) |
Abbreviations: GMT= Geometric Mean antibody titre; CI= Confidence Interval; NA= Not Applicable.
aTIV-1: licensed MF59-adjuvanted trivalent subunit inactivated egg-derived influenza vaccine, FLUAD TIV containing B-Victoria; aTIV-2: MF59-adjuvanted trivalent subunit inactivated egg-derived influenza vaccine containing B-Yamagata N= the number of vaccinated subjects with available data from the immunogenicity endpoint listed (Per Protocol Set).
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a Non-inferiority for the GMT ratio was defined as: the upper bound of the two-sided 95% CI for the ratio of the GMTs did not exceed 1.5.
5.2 Pharmacokinetic properties
Not applicable.
5.3 Preclinical safety data
Non-clinical data reveal no special hazard for humans based on conventional studies of repeated-dose toxicity, reproductive and developmental toxicity, local tolerance and sensitisation.
6. PHARMACEUTICAL PARTICULARS6.1 List of excipients
For adjuvant: see also section 2.
Sodium chloride
Potassium chloride
Potassium dihydrogen phosphate
Disodium phosphate dihydrate
Magnesium chloride hexahydrate
Calcium chloride dihydrate
Water for injections
6.2 Incompatibilities
In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products.
6.3 Shelf life
12 months
6.4 Special precautions for storage
Store in a refrigerator (2 °C – 8 °C). Do not freeze. Discard if the vaccine has been frozen. Keep the pre filled syringe in the outer carton in order to protect from light.
6.5 Nature and contents of container
0.5 ml of suspension for injection in pre-filled syringe (type I glass) with a plunger stopper (bromobutyl rubber), presented with or without needle.
Pack of 1 pre-filled syringe with needle
Pack of 1 pre-filled syringe without needle
Pack of 10 pre-filled syringes with needles
Pack of 10 pre-filled syringes without needles
Not all pack sizes may be marketed.
6.6 Special precautions for disposal and other handling
Gently shake before use.
After shaking, the normal appearance of the vaccine is a milky-white suspension.
Visually inspect the contents of each pre-filled syringe for particulate matter and/or variation in appearance prior to administration. If either condition is observed, do not administer the vaccine. Do not use if the vaccine has been frozen. Any unused product or waste material should be disposed of in accordance with local requirements.
When using a pre-filled syringe supplied without a needle, remove the tip cap from the syringe and then attach a suitable needle for administration. For Luer Lock syringes, remove the tip cap by unscrewing it in a counter-clockwise direction. Once the tip cap is removed, attach a needle to the syringe by screwing it on in a clockwise direction until it locks. Once the needle is locked in place, remove the needle protector and administer the vaccine.
7. MARKETING AUTHORISATION HOLDER
Seqirus Netherlands B.V.
Paasheuvelweg 28
1105 BJ Amsterdam
The Netherlands
8. MARKETING AUTHORISATION NUMBER(S)
EU/1/20/1433/001
EU/1/20/1433/002
EU/1/20/1433/003
EU/1/20/1433/004
9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
Date of first authorisation: 20 May 2020