Frequently Asked Influenza (Flu) Questions: 2021-2022 Season
A few things are different for the 2021-2022 influenza (flu) season, including:
- The composition of flu vaccines has been updated.
- All flu vaccines will be quadrivalent (four component), meaning designed to protect against four different flu viruses. For more information: Quadrivalent Influenza Vaccine | CDC.
- Licensure on one flu vaccine has changed. Flucelvax Quadrivalent is now approved for people 6 months and older.
- Flu vaccines and COVID-19 vaccines can be given at the same time.
- More detailed guidance about the recommended timing of flu vaccination for some groups of people is available.
- Guidance concerning contraindications and precautions for the use of two flu vaccines – Flucevax Quadrivalent and Flublok Quadrivalent – were updated.
- There were some changes to CDC’s flu surveillance systems.
There are many different flu viruses, and they are constantly changing. The composition of US flu vaccines is reviewed annually and updated as needed to match circulating flu viruses. This season, all flu vaccines will be designed to protect against the four viruses that research indicates will be most common. Each year, the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) makes the recommendation for the flu vaccine composition for US flu vaccines.
For 2021-2022, recommendations were made for egg-based, cell-based, and recombinant flu vaccines as listed below:
Egg-based vaccine composition recommendations:
- an A/Victoria/2570/2019 (H1N1) pdm09-like virus;
- an A/Cambodia/e0826360/2020 (H3N2)-like virus;
- a B/Washington/02/2019- like virus (B/Victoria lineage);
- a B/Phuket/3073/2013-like virus (B/Yamagata lineage)
Cell- or recombinant-based vaccine composition recommendations:
- an A/Wisconsin/588/2019 (H1N1) pdm09-like virus;
- an A/Cambodia/e0826360/2020 (H3N2)-like virus;
- a B/Washington/02/2019- like virus (B/Victoria lineage);
- a B/Phuket/3073/2013-like virus (B/Yamagata lineage).
These recommendations include two updates compared with 2020-2021 US flu vaccines. Both the influenza A(H1N1) and the influenza A(H3N2) vaccine virus components were updated. Compared with the Southern Hemisphere flu vaccine recommendation, this recommendation represents one update and that is to the influenza A(H3N2) component.
For more information, visit Influenza Vaccine for the 2021-2022 Season | FDAexternal icon
All available flu vaccines in the United States this flu season are quadrivalent (four-component) flu vaccines that are designed to protect against the four flu viruses that research indicates are most likely to spread and cause illness among people during the upcoming flu season. In its role as a World Health Organization (WHO) Collaborating Center, CDC conducts year-round surveillance of circulating flu viruses and uses this and other data to assess population risk and to recommend the vaccine viruses to include in vaccine production for both the Southern and Northern Hemispheres. Flu viruses constantly change and, based on the available data on how flu viruses are currently changing, CDC flu experts anticipate that the flu viruses that circulate this season may have small changes in comparison to each of the four major virus components used in the vaccine. Despite these changes, the flu vaccine is still expected to provide good protection for the majority of flu viruses that are likely to circulate in the United States during the upcoming flu season. Since flu viruses change rapidly, some changes can result in decreased similarity between circulating viruses and one of the vaccine’s four components. The similarity of the vaccine’s four components to the flu viruses that circulated during previous seasons is just one of several types of data used to inform the recommendations for the composition of flu vaccines. Other data include the extent and location of flu virus circulation and the level of immunity in the population provided by the prior season’s vaccine against recent circulating flu viruses. CDC constantly reviews the composition of flu vaccines and suggests updates when needed to keep up with the latest flu viruses. Sometimes, updates to the composition of the flu vaccine represent minor, incremental improvements. Other times, the updates to the vaccine can represent more significant changes intended to provide optimal protection against flu viruses that have evolved to evade people’s existing immunity.
In general, updates to the composition of Southern Hemisphere flu vaccines should not be interpreted to mean that the composition of Northern Hemisphere flu vaccines is mismatched to circulating flu viruses. The flu season occurs at different times in each hemisphere. Typically flu season lasts from October to May in the Northern Hemisphere and from April to September in the Southern Hemisphere. Decisions on the composition of flu vaccines must be made months prior to the flu season in each hemisphere so that flu vaccines can be produced and made available in time for the season. Since flu viruses are always changing, different flu viruses can circulate in different geographic areas of the world at different times of the year. As a result, separate recommendations are made for the flu vaccines produced in the Northern and Southern Hemispheres based on the data available at the time vaccine composition recommendations are made. The flu vaccines for each hemisphere are optimized to protect against the flu viruses that research indicates will circulate during the upcoming flu season in each hemisphere.
Several flu vaccine formulations are approved for use in people 65 and older, including two “enhanced” flu vaccines: the high-dose flu vaccine and the adjuvanted flu vaccine, both of which are designed to create a stronger immune response in people 65 years and older. Also, a recent studyexternal icon showed that recombinant flu vaccine can produce a stronger immune response in people 65 years and older. Additionally, there are standard dose flu vaccines that can be used in people 65 and older. It’s important to note that CDC does not have a preferential recommendation for any flu vaccine over another, and vaccination should not be delayed for a specific vaccine product when another vaccine licensed for use in people 65 and older is available.
CDC recommends use of any licensed, age-appropriate flu vaccine during the 2021-2022 flu season, including inactivated flu vaccine, high-dose flu vaccine, adjuvanted flu vaccine, recombinant flu vaccine, and nasal spray flu vaccine. Vaccination should not be delayed for a specific vaccine product when another age-appropriate vaccine is available.
CDC has annual educational campaigns to increase awareness about the importance of seasonal flu vaccination. For the 2021-2022 season, CDC will continue to emphasize the importance of flu vaccination beginning in September and for the entire flu season. The agency will conduct targeted communication outreach to specific groups of people who are at higher risk for developing serious complications from flu. Communication strategies for providers and the public will include:
- Educational outreach activities by CDC, including social media, press conferences, web page spotlights, radio media tours, op-eds, and other publications,
- Special educational efforts and a digital campaign to inform the general population, people with underlying health conditions, and African American and Hispanic audiences about the importance of flu vaccination, and
- Updated vaccination websites for the public and providers that highlight the safety precautions being implemented in health care facilities during the COVID-19 pandemic.
In addition, as part of its new Partnering for Vaccine Equity program, CDC is providing more than $150 million in funding to support national, state, local, and community-level partners working to increase confidence in COVID-19 and flu vaccines among adults in racial and ethnic minority groups.
It’s best to be vaccinated before flu begins spreading in your community. September and October are generally good times to be vaccinated against flu. Ideally, everyone should be vaccinated by the end of October. However, even if you are not able to get vaccinated until November or later, vaccination is still recommended because flu most commonly peaks in February and significant activity can continue into May.
Additional considerations concerning the timing of vaccination for certain groups include:
- Adults, especially those 65 years and older, should generally not get vaccinated early (in July or August) because protection may decrease over time, but early vaccination can be considered for any person who is unable to return at a later time to be vaccinated.
- Children can get vaccinated as soon as vaccine becomes available, even if this is in July or August. Some children need two doses of flu vaccine. For those children it is recommended to get the first dose as soon as vaccine is available, because the second dose needs to given at least 4 weeks after the first.
- Early vaccination can also be considered for people who are in the third trimester of pregnancy, because this can help protect their infants during the first months of life (when they are too young to be vaccinated).
No. You should not wait for flu activity to be rising or high in your community to get a flu vaccine. September and October are generally good times to be vaccinated and ideally, everyone should be vaccinated before the end of October. While flu activity may be low in your community now, it could begin increasing at any time. Remember, after you are vaccinated, your body takes about two weeks to develop antibodies that protect against flu. Ideally, you should get vaccinated against flu by the end of October.
First, CDC is adding a surveillance component that will track laboratory-confirmed influenza in long-term care facilities. Approximately 15,400 Centers for Medicare and Medicaid Services (CMS)-certified long-term care facilities from all 50 states and U.S. territories are reporting COVID-19- and flu-positive test results among residents and staff to CDC’s National Hospital Surveillance Network (NHSN). The number of LTCFs reporting at least one new influenza-positive test among residents each week will be reported at the national and HHS region levels in FluView. Additional information about CDC’s NHSN Long-term Care Facility COVID-19 Module, including collection forms, form instructions, trainings, and future updates are available here.
Second, CDC also is adding another surveillance system that will track flu hospitalizations in the United States. Hospitals in all 50 states and U.S. territories are reporting on laboratory testing, capacity and utilization, and patient flows for COVID-19 and influenza. This system is designed to facilitate the public health response to the 2019 Novel Coronavirus (COVID-19) pandemic. The detailed list of reported data elements are provided hereexternal icon.
Finally, CDC is retiring the map depicting “State and Territorial Epidemiologists Reports of Geographic Spread of Flu.” This map had been used to capture an assessment of the geographic spread influenza within each state and jurisdiction. This weekly estimate was suspended for the 2020-2021 influenza season because the ongoing COVID-19 pandemic impacted the data systems used to generate those estimates. Testing practices and health care seeking behaviors were so different that the previous seasons methods/definitions would not have worked. After discussions with public health partners during the summer of 2021, the decision was made to permanently retire this surveillance component due in part to the fact that the systems used to determine the level of spread remain significantly altered and a measure of geographic spread was not necessary anymore given improvements in national influenza surveillance systems in recent years. These improvements include more testing, new surveillance system components, and presenting more data at the state level and sub-state level.
More information on flu surveillance methodology and these updates is available online.
CDC made two changes to the ILINet system for the 2021-2022 season. About 200 additional providers were enrolled in the ILINet system, which will now capture approximately 2 million patient visits each week during the 2021-2022 season. Additionally, the definition of ILI (fever plus cough or sore throat) was modified so it no longer includes “without a known cause other than influenza.” This change was made to improve the consistency with which the definition is applied across reporting sites.
CDC also has recently begun working with a new network of emergency departments on a surveillance system that should be functional later in the 2021-2022 season. This network will provide laboratory, symptom, diagnosis, past medical history and disposition information for patients who present to the emergency department for an acute respiratory illness.
Flu Vaccine Coverage
CDC’s Weekly National Influenza (Flu) Vaccination Dashboard provides preliminary, within-season, weekly flu vaccination data including coverage estimates throughout the 2021-2022 flu season. These data will be updated weekly or monthly, depending on the data source. All data are preliminary and may be updated during the season as new data become available.
Flu vaccination coverage among children is assessed through the National Immunization Survey-Flu (NIS-Flu), which provides weekly flu vaccination coverage estimates for children 6 months–17 years old. NIS-Flu is a national random-digit-dialed cellular telephone survey of households conducted during the flu season (October-June). Additional information about NIS-Flu methods and estimates from 2019-2020 season are available at FluVaxView. Visit CDC’s Weekly Flu Vaccination Dashboard for more information.
Flu vaccination coverage estimates among pregnant people are available via CDC’s Weekly Flu Vaccination Dashboard. These estimates are based on electronic health record (EHR) data from the Vaccine Safety Datalink (VSD), a collaboration between CDC’s Immunization Safety Office and nine integrated health care organizations. Of note, because these estimates are based on data from nine integrated health care systems, they may not be representative of all pregnant persons in the U.S.
CDC is tracking the number of flu vaccines administered at pharmacies and doctor’s offices by utilizing new sources of vaccination data, including IQVIAexternal icon data for vaccinations administered in retail pharmacies (e.g., chain, mass merchandise, food stores, and independent pharmacies) and doctors’ offices. Visit CDC’s Weekly Flu Vaccination Dashboard for more information.
Each flu season since 2009-2010, CDC has estimated annual flu vaccination coverage for the United States by utilizing data from several nationally representative surveys: the Behavioral Risk Factor Surveillance System (BRFSS), the National Health Interview Survey (NHIS), and the National Immunization Survey-Flu (NIS-Flu). Internet panel surveys of adults, health care personnel, and pregnant persons are also used.
Click here for vaccination coverage estimates from past flu season. CDC will continue to provide end-of-season estimates of flu vaccination coverage from these data sources.
CDC’s Weekly Flu Vaccination Dashboard, provides preliminary, within-season, weekly influenza vaccination data which will be updated during the season as more data become available. Visit the National Flu Vaccination Dashboard for more information. CDC continues to explore other sources of data to provide national and jurisdiction level vaccination data.
Seasonal Flu and COVID-19
Flu and COVID-19 are both contagious respiratory illnesses, but they are caused by different viruses. COVID-19 is caused by infection with a coronavirus (called SARS-CoV-2) and seasonal flu (most often just called “flu”) is caused by infection with one of many influenza viruses that spread annually among people.
Because some symptoms of flu and COVID-19 are similar, people may need to be tested to tell what virus is causing their illness. People can be infected with both a flu virus and the virus that causes COVID-19 at the same time. In general, COVID-19 seems to spread more easily than flu and causes more serious illnesses in some people. Compared with people who have flu infections, people who have COVID-19 can take longer to show symptoms and be contagious for longer. This FAQ page compares COVID-19 and flu, given the best available information to date.
While it’s not possible to say with certainty what will happen in the fall and winter, CDC believes it’s likely that flu viruses and the virus that causes COVID-19 will both be spreading at that time. Relaxed COVID-19 mitigation measures (such as stay-at-home orders, or mask mandates) may result in an increase in flu activity during the upcoming 2021–2022 flu season. Common respiratory viruses such as respiratory syncytial virus (RSV) and human coronaviruses (not SARS-CoV-2) did not spread as much as usual during the 2020-2021 flu season as in past seasons. However, data from the National Respiratory and Enteric Surveillance System (NREVSS) showed an increase in these viruses’ activity during the summer, outside of their usual seasonal increases. This information is summarized in a Morbidity and Mortality Weekly Report, Changes in Influenza and Other Respiratory Virus Activity During the Pandemic.
During the 2020-2021 flu season, because of historically low flu activity, flu and SARS-CoV-2 coinfections were relatively rare. As flu viruses circulate in greater numbers along with SARS-CoV-2 in the 2021-2022 winter season, we would expect to see more coinfections. CDC is using surveillance data to help determine how common it is in the 2021-2022 winter season for people to be infected with flu and SARS-CoV-2 at the same time. CDC will provide updates as more information becomes available.
Yes. CDC is able to track influenza and SARS-CoV-2 through its surveillance systems:
- CDC uses the Influenza- and COVID-19-Associated Hospital Surveillance Networks (called FluSurv-NET and COVID-NET, respectively) to see how many people who are hospitalized with flu also test positive for SARS-CoV-2.
- CDC can look at laboratory data submitted weekly by public health laboratories to see how many of the respiratory samples that are positive for influenza also test positive for SARS-CoV-2.
So far, based on preliminary data, influenza associated hospitalizations with SARS-CoV-2 coinfections during the 2021-2022 flu season are uncommon.
- In the Influenza- and COVID-19-Associated Hospital Surveillance Networks called FluSurv-NET and COVID-NET, from Oct. 1, 2021, to April 30, 2022, 2.5% of patients hospitalized with flu also tested positive for SARS-CoV-2. The proportion is published weekly in the FluSurv-NET section of FluView.
- Since Oct. 3, 2021, of the 10,943 influenza positive specimens reported this season by the public health labs that were also tested for SARS-CoV-2, 520 (4.8%) were also positive for SARS-CoV-2. This number also is published weekly in the Virologic Surveillance section of FluView.
The difference between the two proportions of coinfections between surveillance systems is relatively small and not unexpected, because data sources and populations covered are different.
The data from these systems provide a range for the proportion of influenza positive specimens that are also positive for COVID. The specific proportion may vary by geographic location and over time.
Because COVID-19 is still a relatively new illness, we have little information about how flu illness might affect a person’s risk of getting COVID-19. We do know that people can be infected with flu viruses and the virus that causes COVID-19 at the same time. Getting a flu vaccine is the best protection against flu and its potentially serious complications, and getting a COVID-19 vaccine is the best protection against COVID-19.
Yes. There are tests that will check for seasonal influenza A and B viruses and SARS-CoV-2, the virus that causes COVID-19. Testing for these viruses at the same time gives public health officials important information about how flu and COVID-19 are spreading and what prevention steps people should take. These tests also help public health laboratories save time and testing materials, and possibly return test results faster. More information for laboratories is available.
No. Flu vaccines do not protect against COVID-19. Flu vaccination reduces the risk of flu illness, hospitalization and death in addition to other important benefits.
Likewise, getting a COVID-19 vaccine is the best protection against COVID-19, but those vaccines do not protect against flu. Visit the CDC’s Frequently Asked Questions page for information about COVID-19 vaccinations.
No. There is no evidence that getting a flu vaccination raises your risk of getting sick from COVID-19 or any other coronavirus. (Common human coronaviruses usually cause mild to moderate upper-respiratory tract illnesses, like the common cold.)
Health care professionals may have different practices for diagnosing and treating flu during the COVID-19 pandemic, such as wearing masks in a health care setting or offering telemedicine. If you have flu symptoms and are at higher risk of serious flu complications, you should call your health care professional as soon as possible to tell them about your symptoms. They may decide to treat you with flu antiviral medications. Follow your health care professional’s and CDC’s recommendations for doctor visits.
Flu and COVID-19 can both cause serious illness and hospitalization in children. CDC found that the annual hospitalization rate associated with COVID-19 was higher than hospitalization rates associated with flu during each of the three seasons prior to the pandemic—but there were differences by age group. Compared with COVID, the flu-associated hospitalization rate was lower among adolescents 12–17 years old, but similar or higher among children younger than 12 years old.
- During October 1, 2020–September 30, 2021, the annual pediatric COVID-19-associated hospitalization rate was 48.2 per 100,000.
- During October 1–April 30, for the 2017–2018, 2018–2019, and 2019–2020 flu seasons, pediatric flu-associated hospitalization rates ranged from 33.5 per 100,000 during the 2017–2018 flu season to 41.7 per 100,000 during the 2019–2020 flu season.
- COVID-19-associated hospitalization rates among children ages 0–4 years and children ages 5–11 years were similar to flu-associated hospitalization rates for children in the same age groups during the 2017–2018 and 2018–2019 flu seasons. However, COVID-19-associated hospitalization rates were lower than flu-associated hospitalization rates for children in the same age groups during the 2019–2020 flu season.
- COVID-19-associated hospitalization rates among children ages 12–17 years were higher than flu-associated hospitalization rates for children in the same age groups during all three flu seasons prior to the COVID-19 pandemic.
Notably, flu-associated hospitalizations for the 2020-2021 season were exceedingly low, with a rate of 0.1 per 100,000 for all pediatric age groups. This rate was much lower than the pediatric COVID-19-associated hospitalization rate of 47.6 per 100,000 during the same time period.
During the 2020–2021 flu season, prevention measures such as physical distancing, mask-wearing, and virtual learning were in place. These prevention measures likely contributed to the historically low levels of flu circulation and thus flu-associated hospitalizations during the 2020–2021 flu season in the United States and globally. The COVID-19- and flu-associated hospitalization rates among children during 2020–2021 would likely have both been higher without mitigation measures. It’s also important to note that this study took place before the COVID-19 Omicron variant was prevalent.
- Flu vaccine can help prevent illness and lessen severity of flu disease; COVID-19 vaccine can help lessen severity of COVID-19 illness. However, COVID-19 vaccines are not yet approved for children younger than 5 years old.
- CDC recommends everyone ages 5 years and older get a COVID-19 vaccine and get boosted when eligible. Proven prevention measures, like vaccination of family members, can provide added protection from COVID-19 for young children. Families with children too young to get vaccinated may choose to take additional precautions, especially in areas where the COVID-19 Community Level is high. CDC also recommends everyone 6 months and older get an annual flu vaccine each fall.
- Both vaccines are safe and can be given at the same time.
- These data come from the Influenza Hospitalization Surveillance Network (FluSurv-NET) for influenza-associated hospitalizations and the Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET) for COVID-19-associated hospitalizations in the United States.
- FluSurv-NET, a longstanding platform that was leveraged to create COVID-NET, conducts population-based surveillance for flu-associated hospitalizations from October 1–April 30 each year (the typical U.S. flu season).
- FluSurv-NET has a similar surveillance area to that of COVID-NET and uses similar methods.
- To compare COVID-19 and flu-associated hospitalization rates, the COVID-19-associated hospitalization rate was calculated for a one-year period (October 1, 2020–September 30, 2021). This annual rate was compared with flu-associated hospitalization rates from October 1–April 30 during the 2017–2018 through 2020–2021 seasons.
A CDC studyexternal icon that first appeared in a draft on MedRxivexternal icon found that among children, the annual hospitalization rate associated with COVID-19 was higher than hospitalization rates associated with flu during each of the three seasons prior to the COVID-19 pandemic—but there were differences by age group. That study has been updated in Clinical Infectious Diseases. The updated analysis includes preliminary flu- and COVID-19-associated hospitalization rates during the current flu season, October 2021–April 2022. Compared with children hospitalized with flu during each of the five most recent flu seasons, more children were hospitalized with COVID-19 from October 2021 to April 2022, when Omicron was the main variant of concern. COVID-19 data also show more children were hospitalized with COVID-19 when Omicron was the predominant variant compared with data from October 2020 to September 2021. Flu has long been recognized as a cause of severe respiratory illness in children in the United States and globally. This study provides further evidence that COVID-19 also can cause severe disease among children.
Getting a Flu Vaccine During the COVID-19 Pandemic
Yes. Getting a flu vaccine is an essential part of protecting your health and your family’s health every year. Take recommended precautions to protect yourself from COVID-19 while getting your flu vaccine.
Yes. Wearing a mask and physical distancing can help protect you and others from respiratory viruses, like flu and the virus that causes COVID-19. However, the best way to reduce your risk of flu illness and its potentially serious complications is for everyone 6 months and older to get a flu vaccine each year. By getting a flu vaccine, you may also be protecting people around you who are more vulnerable to serious flu complications.
Even though both vaccines can be given at the same visit, people should follow the recommended schedule for either vaccine: If you haven’t gotten your currently recommended doses of COVID-19 vaccine, get a COVID-19 vaccine as soon as you can, and ideally get a flu vaccine by the end of October.
While limited data exist on giving COVID-19 vaccines with other vaccines, including flu vaccines, experience with giving other vaccines together has shown the way our bodies develop protection and possible side effects are generally similar whether vaccines are given alone or with other vaccines.
If you have concerns about getting both vaccines at the same time, you should speak with a health care provider.
Yes, children ages 5 years and older who are eligible for COVID-19 vaccination can get a COVID-19 vaccine and a flu vaccine at the same visit. However, each injection is administered at a different injection site
If your child is 5 years and older, get their COVID-19 vaccine and annual flu vaccine as soon as possible. You can get both vaccines at the same time, but don’t delay either vaccination in order to get them both at the same visit. Both vaccines are recommended, and your child should get the recommended doses for each vaccine.
All children 6 months and older should get a flu vaccine. Most children will only need one dose of flu vaccine. Your child’s healthcare provider can tell you if your child needs two doses of flu vaccine.
Administering Flu Vaccine during the COVID-19 Pandemic
Curbside and drive-through vaccination clinics may provide the best option for staff and patient safety during the COVID-19 pandemic in communities with high transmission. Read CDC’s guidance on drive-through vaccination clinics.
No. Flu vaccination should be deferred for people with suspected or confirmed COVID-19, whether or not they have symptoms, until they have met the criteria to discontinue their isolation. While mild illness is not a contraindication to flu vaccination, vaccination visits for these people should be postponed to avoid exposing healthcare personnel and other patients to the virus that causes COVID-19. When scheduling or confirming appointments for flu vaccination, patients should be instructed to notify the health care professional’s office or clinic in advance if they currently have or develop any symptoms of COVID-19.
Flu vaccination should be deferred until a patient is no longer acutely ill. This may be different for patients who are already being cared for in a medical setting than it is for patients who are isolating at home. In a medical setting, the timing for vaccination is a matter of clinical discretion. In general, patients who are isolating at home should wait until they meet criteria for leaving isolation (even if they have no symptoms) to come to a vaccination setting in order to avoid spreading COVID-19 to others. CDC has guidance for when people can be around others after having COVID-19.
CDC released Interim Guidance for Immunization Services During the COVID-19 Pandemic. This guidance is intended to help vaccination providers in a variety of clinical and alternative settings with the safe administration of vaccines during the COVID-19 pandemic. This guidance will be continually reassessed and updated based on the evolving epidemiology of COVID-19 in the United States. Healthcare professionals who give vaccines should also consult guidance from state, local, tribal, and territorial health officials.
Clinicians, for more information visit, Seasonal Influenza Vaccine Dosage & Administration | CDC
Yes. If a patient is eligible, both influenza and COVID-19 vaccines can be administered at the same visit, without regard to timing as recommended by CDC and its Advisory Committee on Immunizations Practices (ACIP). If a patient is due for both vaccines, providers are encouraged to offer both vaccines at the same visit. Coadministration of all recommended vaccines is important because it increases the probability that people will be fully vaccinated. It is also an important part of immunization practice if a health care provider is uncertain that a patient will return for additional doses of vaccine.
Best practices for administering more than one vaccine, including COVID-19 vaccines and influenza vaccines, include:
- When preparing more than one vaccine, label each with the name and dosage (amount) of vaccine, lot number, the initials of the preparer, and the exact beyond-use time, if applicable.
- Always inject vaccines into different injection sites. Separate injection sites by 1 inch or more, if possible so that any local reactions can be differentiated. Each muscle (deltoid, vastus lateralis) has multiple injection sites.
- If administered at the same time, COVID-19 vaccines and vaccines that might be more likely to cause a local injection site reaction (for example, high-dose and adjuvanted inactivated influenza vaccines) should be administered in different limbs, if possible.
- Inject vaccines rapidly without aspiration since aspiration is not recommended before administering a vaccine.
- There are many existing resources on administration and co-administration of vaccines relevant for health care providers, including:
- Pink Book: Vaccine Administration | CDC
- You Call The Shots: Vaccinating Adolescents (cdc.gov)pdf icon
- Vaccine Administration Training Module (cdc.gov)
- Vaccine Administration: Needle Gauge and Length (cdc.gov)pdf icon
- Vaccine Administration: Intramuscular (IM) Injection Children 7 through 18 years of agepdf icon and Vaccine Administration: Intramuscular (IM) Injection Adults 19 years of age and olderpdf icon
- Intramuscular (IM) Injection: Sites – YouTube
- Live, Attenuated Influenza Vaccine (LAIV) – YouTube
- https://www.medpagetoday.com/meetingcoverage/acip/93283external icon
- King G, Hadler S. Simultaneous administration of childhood vaccines: an important public health policy that is safe and efficacious. Pediatr Infect Dis J 1994;13(5):394–407external icon
- COCA Call: 2021-2022 Influenza Vaccination Recommendations and Guidance on Coadministration with COVID-19 Vaccines
You can get your flu vaccine as you normally do, whether that’s through your health care provider or your local pharmacist. CDC has been working with health care providers and state and local health departments on how to vaccinate people against flu without increasing their risk of exposure to respiratory viruses, like the virus that causes COVID-19, and has released Interim Guidance for Immunization Services During the COVID-19 Pandemic. More information is available in the ‘Administering Flu Vaccines during the COVID-19 Pandemic’ section below. This guidance is current for this season.
Applying infection prevention practices to all patient encounters is very important, including physical distancing (at least 6 feet) when possible, wearing masks, hand hygiene, surface decontamination, and source control while in a health care facility. The potential for asymptomatic spread of the virus that causes COVID-19 underscores the importance of these practices. Immunization providers should refer to the guidance developed to prevent the spread of COVID-19 in health care settings, including outpatient and ambulatory care settings.
Yes. Guidance has been developed for giving vaccines at pharmacies, temporary, off-site, or satellite clinicspdf iconexternal icon, and large-scale influenza clinics. Other approaches for vaccination during the COVID-19 pandemic may include drive-through immunization services at fixed sites, curbside clinics, mobile outreach units, and home visits.
- The general principles outlined for health care facilities should also be applied to alternative vaccination sites, with additional precautions for physical distancing that are particularly relevant for large-scale clinics in communities with high levels of COVID-19 transmission. Read more in the Interim Guidance for Immunization Services During the COVID-19 Pandemic. More information is also available in the ‘Administering Flu Vaccines during the COVID-19 Pandemic’ section below.
Yes. CDC recently conducted a poll to try to better understand consumer attitudes toward flu vaccination amidst the COVID-19 pandemic and whether consumers would be open to getting both vaccines at the same time. Findings were broken down by people who reported having been vaccinated against COVID-19 versus people who reported they had not been vaccinated, as well as those who intend on getting the flu shot this year vs not. Seventy percent of COVID-19 vaccinated consumers agreed with a statement that they intended on getting a flu shot this year, compared to 25% of unvaccinated consumers. Seventy-one percent of COVID-19 vaccinated consumers who intended on getting a flu shot agreed with a statement that they would be willing to get a flu shot at the same time as a COVID-19 vaccine shot while 11% disagreed. (Note: 1,004 adults 18 years and older were surveyed and answered questions relating to COVID-19 and flu. There were 643 vaccinated and 334 unvaccinated participants in the survey.)
Testing and Treatment of Respiratory Illness when SARS-CoV-2 and Influenza Viruses are Co-circulating
While waiting on results of testing, non-hospitalized persons with acute respiratory symptoms should self-isolate at home. Even if people test negative for both SARS-CoV-2 and influenza viruses, they should self-isolate because of the potential for false negative testing results – depending upon what kind of test was done (e.g., antigen test, molecular test) and the level of SARS-CoV-2 and influenza virus transmission in the community. Persons not hospitalized with suspected or confirmed influenza who are at increased risk for complications from influenza should receive antiviral treatment for influenza as soon as possible, regardless of illness duration.
For hospitalized patients, empiric oseltamivir treatment should be started as soon as possible for patients with suspected influenza without waiting for influenza testing results. Get more information on testing and treatment when SARS-CoV-2 and flu viruses are co-circulating.
FDA-approved antiviral medications for treatment of influenza have no activity against SARS-CoV-2 viruses, nor do they interact with medications used for treatment of COVID-19 patients. If a patient who is at higher risk for influenza complications is diagnosed with SARS-CoV-2 and influenza virus co-infection, they should receive antiviral treatment for influenza.
CDC estimates that flu has resulted in 12,000 – 52,000 deaths each year during flu seasons prior to the COVID-19 pandemic (2010-2011 to 2019-2020).
The most severe season in the last decade was the 2017-2018 flu season, during which CDC estimates 52,000 people died from flu. During that season, flu deaths peaked in week 1 (the week ending January 6, 2018), during which CDC estimates 731 people died from flu each day.
During the 2011-2012 flu season (the least severe season in the decade between 2010 and 2020), CDC estimates there were 12,000 flu deaths. During that season’s peak week, (week 11, the week ending March 17, 2012), CDC estimates 219 people died from flu each day.
CDC estimates that flu has resulted in 140,000 – 710,000 hospitalizations each year during flu seasons prior to the COVID-19 pandemic (2010-2011 to 2019-2020).
During the most severe flu season in the last decade (2017-2018), CDC estimates there were 710,000 flu-associated hospitalizations. During that season, flu hospitalizations peaked in week 1 (the week ending January 6, 2018), during which CDC estimates 10,062 people were hospitalized with flu each day.
During the 2011-2012 flu season (the least severe season in the decade between 2010 and 2020), CDC estimates there were 140,000 flu-associated hospitalizations. During that season’s peak week, (week 11, the week ending March 17, 2012), CDC estimates 2,457 people were hospitalized with flu each day.
Every year, CDC usually generates estimates of the number of illnesses, medical visits, hospitalizations and deaths that happen during a flu season—these estimates are used to collectively describe the annual burden of flu. To produce these estimates, CDC uses a mathematical model that is based in part on the number of people that are hospitalized with flu in our hospitalization surveillance network. During the 2020-2021 season, however; the number of people hospitalized with influenza was too low to generate stable burden estimates as is done for a typical flu season.
We do know that flu activity last season was the lowest it has been since current reporting began in 1997. We also know that flu illnesses, hospitalizations and deaths were very low last season, probably well below the estimates for the 2011/2012 season, which was the mildest flu season in the decade between 2010 and 2020.
One measure to help understand how low flu activity was during 2020-2021 is the cumulative number (or percent of specimens testing positive) of clinical lab-confirmed flu infections for Week 34 from the past two flu seasons.
|Season (up to Week 34)||Specimens tested by clinical labs||Total Positive Specimens|
Another measure would be the FluSurv-NET cumulative hospitalization rates from 2020-21 and 2019-20.
- The overall cumulative hospitalization rate for the 2020-21 flu season was 0.8 per 100,000.
- For the 2019-20 flu season, the overall cumulative end-of-season hospitalization rate was 66.2 per 100,000.
- It’s important to note that FluSurv-NET covers approximately 9% of the U.S. population and rates may not necessarily be representative of the entire country.
Another measure would be the total number of hospitalizations reported through FluSurv-NET.
- During 2020-21, 230 lab-confirmed hospitalizations were reported through FluSurv-NET.
- During 2019-20, 19,302 lab-confirmed hospitalization were reported through FluSurv-NET.
- It’s important to note that this is not a comprehensive count of all flu hospitalizations in the United States. This is just a small subset reported to CDC for surveillance purposes.
- FluSurv-NET covers approximately 9% of the U.S. population and rates may not necessarily be representative of the entire country