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Influenza Vaccination: A Summary for Clinicians

Who Should Get Vaccinated?

All persons 6 months and older should be vaccinated annually.

Persons at Risk for Medical Complications Attributable to Severe Influenza

Vaccination to prevent influenza is particularly important for persons who are at increased risk for severe complications from influenza, or at higher risk for influenza-related outpatient, ED, or hospital visits. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to the following persons (no hierarchy is implied by order of listing):

  • all children aged 6 through 59 months;
  • all persons aged 50 years and older;
  • adults and children who have chronic pulmonary (including asthma) or cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus);
  • persons who have immunosuppression (including immunosuppression caused by medications or by HIV infection);
  • women who are or will be pregnant during the influenza season;
  • children and adolescents (aged 6 months through 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye's syndrome after influenza virus infection;
  • residents of nursing homes and other long-term care facilities;
  • American Indians/Alaska Natives; and
  • persons who are obese, with a body mass index of 40 or greater.
Persons Who Live With or Care for Persons at High Risk for Influenza-Related Complications

All persons aged 6 months and older should be vaccinated annually. Continued emphasis should be placed on vaccination of persons who live with or care for persons at higher risk for influenza-related complications. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to persons at higher risk for influenza-related complications listed above, as well as these persons:

  • health-care personnel;
  • household contacts (including children) and caregivers of children aged 59 months and older (i.e., aged younger than 5 years) and adults aged 50 years and older, with particular emphasis on vaccinating contacts of children aged younger than 6 months; and
  • household contacts (including children) and caregivers of persons with medical conditions that put them at high risk for severe complications from influenza.

There are special considerations regarding vaccination of persons with history of egg allergy.

What are the influenza vaccine options this season?

CDC recommends use of injectable influenza vaccines (including inactivated influenza vaccines and recombinant influenza vaccines) during 2016-2017. The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during 2016-2017. 

Both trivalent (three-component) and quadrivalent (four-component) flu vaccines will be available.

Trivalent flu vaccines include:

Quadrivalent flu vaccines include:

  • Quadrivalent flu shots approved for use in different age groups.
  • An intradermal quadrivalent flu shot, which is injected into the skin instead of the muscle and uses a much smaller needle than the regular flu shot. It is approved for people 18 through 64 years of age.
  • A quadrivalent flu shot containing virus grown in cell culture, which is approved for people 4 years of age and older (new this season).  

Package inserts should be consulted for recommended age groups and possible contraindications for each vaccine in addition to information regarding additional components of various vaccine formulations.

In addition, the Advisory Committee on Immunization Practices (ACIP), Influenza Vaccine Recommendations, 2014-15 should be consulted.

Are any of the available flu vaccines recommended over others?

For the 2016-2017 flu season, the Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for everyone 6 months and older with either the inactivated influenza vaccine (IIV) or the recombinant influenza vaccine (RIV). The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during 2016-2017.There is no preference for one vaccine over another among the recommended, approved injectable influenza vaccines. There are  many vaccine options to choose from, but the most important thing is for all people 6 months and older to get a flu vaccine every year. If you have questions about which vaccine is best for you, talk to your doctor or other health care professional.

When should vaccination occur?

Optimally, vaccination should occur before onset of influenza activity in the community. Health care providers should offer vaccination by October, if possible. Vaccination should continue to be offered as long as influenza viruses are circulating. While seasonal influenza outbreaks can happen as early as October, most of the time influenza activity peaks between December and February, although activity can last as late as May. Since it takes about two weeks after vaccination for antibodies to develop in the body that protect against influenza virus infection, it is best that people get vaccinated so they are protected before influenza begins spreading in their community.

Some children 6 months through 8 years of age need 2 doses of influenza vaccine, which must be given at least 4 weeks apart. These children should receive their first dose as soon as possible after vaccine becomes available to allow enough time for both doses to be administered before or shortly after the onset of influenza activity.

To avoid missed opportunities for vaccination, doctors and other health care professionals should offer vaccination during routine health care visits or during hospitalizations if flu vaccine is available.

See Vaccine Dose Considerations for Children 6 Months through 8 Years of Age for more information.

Vaccination for Children

Children younger than 6 months old are the pediatric group at highest risk of serious influenza complications, but they are too young to get an influenza vaccine. The best way to protect young children is to make sure members of their household and their caregivers are vaccinated.

Influenza vaccination is recommended for all children 6 months of age and older.

Children 6 months through 8 years who have previously received 2 or more total doses of trivalent or quadrivalent influenza vaccine only need one dose for 2015-16. The two previous doses do not need to have been given during the same season or consecutive seasons.

Children 6 months through 8 years who have previously received only 1 dose of influenza vaccine, or who have never received influenza vaccine previously, need two doses of vaccine to be fully protected for the 2015-2016 season. The 2015-2016 ACIP recommendations has an algorithm to help guide clinician decision-making regarding vaccination of children 6 months through 8 years of age.

2 Dose Vaccination Instructions

The first dose should be given as soon as vaccine becomes available, and the second dose should be given at least 4 weeks after the first dose. The first dose “primes” the immune system; the second dose provides immune protection. Children who only get one dose but need two doses can have reduced or no protection from a single dose of flu vaccine. Two doses are necessary to protect these children. If your patient needs the two doses, begin the process early, so that children are protected before influenza starts circulating in your community. Make sure to remind the parent to follow up to get the child a second dose if they need one. It usually takes about two weeks after the second dose for protection to begin.

Children who require two doses of flu vaccine do not need to receive the same flu vaccine both times; live or inactivated vaccine can be used for either dose. (Within approved indications and recommendations, no preferential recommendation is made for any type or brand of licensed influenza vaccine over another.)

Vaccination for Adults

Everyone 6 months of age and older are recommended to get the flu vaccine, including even the healthiest adults. Vaccination is especially important for people at higher risk of serious influenza complications or people who live with or care for people at higher risk for serious complications.

Persons working in health care settings also should be vaccinated annually against influenza. Vaccination of health care professionals has been associated with reduced work absenteeism and with fewer deaths among nursing home patients.

People Who Should Not Be Vaccinated

People who have had a severe reaction to an influenza vaccination, and children younger than 6 months of age should not be vaccinated.

People who are moderately or severely ill with or without fever should usually wait until they recover before getting flu vaccine.

A history of Guillain-Barré Syndrome (GBS) within 6 weeks following receipt of influenza vaccine is a precaution for the use of influenza vaccine. Such individuals have a risk of recurrence of GBS with subsequent vaccination, and if not at high risk of severe influenza complications should generally not be vaccinated. However, while data are limited, the established benefits of influenza vaccination might outweigh the risks for many people who have a history of GBS and who also are at high risk for severe complications from influenza.

See Table 1: Influenza vaccines, contraindications and precautions in the 2015-2016 ACIP Influenza Vaccine Recommendations for more information.

Vaccination of People with a History of Egg Allergy

Most influenza vaccines are produced by growing influenza virus in embryonated chicken eggs, and therefore contain trace amounts of egg protein. See Influenza Vaccination of Persons with a History of Egg Allergy for complete information and an algorithm to guide decision-making for vaccination of persons with egg allergy.

All vaccines should be administered in settings in which personnel and equipment for rapid recognition and treatment of anaphylaxis are available.

A previous severe allergic reaction to influenza vaccine, regardless of the component suspected to be responsible for the reaction, is a contraindication to future receipt of the vaccine.

Special Consideration Regarding Egg Allergy

People who have ever had a severe allergic reaction to eggs can get recombinant flu vaccine if they are 18 years and older or they should get the regular flu shot (IIV) given by a medical doctor with experience in management of severe allergic conditions. People who have had a mild reaction to egg—that is, one which only involved hives—may get a flu shot with additional safety measures. Recombinant flu vaccines also are an option for people if they are 18 years and older and they do not have any contraindications to that vaccine. Make sure your doctor or health care professional knows about any allergic reactions. Most, but not all, types of flu vaccine contain a small amount of egg. 

Influenza Vaccines and Use of Influenza Antiviral Medications

  • Administration of inactivated influenza vaccine to persons receiving influenza antiviral drugs for treatment or chemoprophylaxis is acceptable.
  • Live-attenuated influenza vaccine should not be administered until 48 hours after cessation of influenza antiviral therapy.
  • If influenza antiviral medications are administered within 2 weeks after receipt of live-attenuated influenza vaccine, the vaccine dose should be repeated 48 or more hours after the last dose of antiviral medication.

Concurrent Administration of Influenza Vaccine With Other Vaccines

  • Inactivated vaccines do not interfere with the immune response to other inactivated vaccines or to live vaccines.
  • Inactivated or live vaccines can be administered simultaneously with live-attenuated influenza vaccine.
  • However, after administration of a live vaccine, at least 4 weeks should pass before another live vaccine is administered.

More Information

For Your Patients

VIS are information sheets produced by CDC that explain both the benefits and risks of a vaccine to vaccine recipients.

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