Updated Recommendations for Influenza Vaccination

Posted on September 04, 2018

From the CDC and the ACIP

The CDC and the CDC’s Advisory Committee on Immunization Practices (ACIP) recently released updated recommendations regarding the influenza vaccine for the 2018-19 “flu season.” This report updates the 2017–18 ACIP recommendations. The ACIP continues to recommend that all persons 6 months and older to receive routine annual influenza vaccination with a licensed, recommended, and age-appropriate vaccine, unless they have specific contraindications. Two of the three viral strains for the 2018-19 trivalent vaccine are new compared with last year’s vaccine, one for the influenza A H3N2 strain, and one for the influenza B strain. Quadrivalent vaccines will contain these three viruses and an additional influenza B vaccine virus, which was included in last year’s quadrivalent vaccine.

Inactivated influenza vaccines (IIVs), recombinant influenza vaccine (RIV), and LAIV formulations are expected to be available for the upcoming season. Standard-dose, unadjuvanted, inactivated influenza vaccines will be available in trivalent (IIV3) and quadrivalent (IIV4) formulations. Recombinant influenza vaccine (RIV4) and LAIV4 will be available in quadrivalent formulations. High-dose inactivated influenza vaccine (HD-IIV3) and adjuvanted inactivated influenza vaccine (aIIV3) will be available in trivalent formulations. The ACIP makes no preferential recommendation for one influenza vaccine product over another for persons for whom more than one licensed, recommended, and appropriate product is available.

Note that for 2018-2019, the quadrivalent live attenuated influenza vaccine (LAIV4; FluMist Quadrivalent) is an option for appropriate individuals. This is a change from the past two years, when the ACIP recommended that the LAIV4 not be used, owing to concerns about effectiveness against H1N1 viruses.

Notable Contraindications for the LAIV4 Vaccine include:

• Children aged 2 through 4 years who have received a diagnosis of asthma or who have been told during the preceding 12 months that they had wheezing or asthma or whose medical record indicates a wheezing episode has occurred.
• Children and adults who are immunocompromised due to any cause (including immunosuppression caused by medications or by HIV infection)
• Close contacts and caregivers of severely immunosuppressed persons who require a protected environment
• Pregnancy

Notable Precautions for the LAIV4 Vaccine include:

• Asthma in persons aged ≥5 years
• Other underlying medical conditions that might predispose to complications after wild-type influenza infection (e.g., chronic pulmonary, cardiovascular [except isolated hypertension], renal, hepatic, neurologic, hematologic, or metabolic disorders [including diabetes mellitus])

The ACIP continues to advise that individuals with a history of egg allergy of any severity may receive any licensed, recommended and age-appropriate flu vaccine.