ACIP: Influenza Vaccination Recommendations for 2020-2021

Influenza vaccination should occur by the end of October, if possible.

The Advisory Committee on Immunization Practices (ACIP) has issued new guidelines for the prevention and control of seasonal influenza with vaccines for the 2020–2021 season. In general, routine annual vaccination is recommended for all patients ≥6 months of age who have no contraindications and should occur by the end of October.

As the influenza season will coincide with the ongoing coronavirus disease 2019 (COVID-19) pandemic, influenza vaccination can help reduce the prevalence of influenza illness and can also reduce symptoms that might be confused with COVID-19. Additionally, vaccination may help prevent outbreaks that may further strain the healthcare system. Updated guidance related to routine vaccination during the COVID-19 pandemic was recently issued by the Centers for Disease Control and Prevention (CDC).

For the 2020–2021 season, the following influenza vaccines will available:

  • Egg-based influenza vaccines:
    • Will contain hemagglutinin derived from an influenza A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus; an influenza A/Hong Kong/2671/2019 (H3N2)-like virus; and an influenza B/Washington/02/2019 (Victoria lineage)-like virus.
    • Quadrivalent vaccines will include an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus as well.
    • These include Afluria Quadrivalent, Fluarix Quadrivalent, FluLaval Quadrivalent, Fluzone Quadrivalent (all standard dose), Fluzone High-Dose Quadrivalent (high-dose formulation), Fluad Quadrivalent (standard dose with MF59 adjuvant), Fluad (standard dose trivalent vaccine with MF59 adjuvant), and FluMist Quadrivalent intranasal spray.
  • Cell culture based inactivated and recombinant influenza vaccines:
    • Will contain hemagglutinin derived from an influenza A/Hawaii/70/2019 (H1N1)pdm09-like virus; an influenza A/Hong Kong/45/2019 (H3N2)-like virus; an influenza B/Washington/02/2019 (Victoria lineage)-like virus; and an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus.
    • These include Flucelvax Quadrivalent (standard dose cell culture based) and Flublok Quadrivalent (recombinant).

Updates to the guidance for this upcoming influenza season include the following:

  • The Food and Drug Administration (FDA) approved Fluzone High-Dose Quadrivalent (Sanofi Pasteur) for patients aged ≥65 years and the product is expected to replace the previously available trivalent formulation. The vaccine contains 4 times the amount of hemagglutinin per vaccine virus in each dose compared with standard dose inactivated influenza vaccines (60μg vs 15μg per virus).
  • Fluad Quadrivalent (Seqirus) was approved for patients ≥65 years old. The vaccine contains the MF59 adjuvant, which is designed to enhance and prolong immune responses.
  • Contraindications and precautions to influenza vaccination have been updated. Anatomic and functional asplenia; active communication between cerebrospinal fluid (CSF) and oropharynx, nasopharynx, nose, or ear or any other cranial CSF leak; and cochlear implant have been added to the Contraindications and Precautions section related to live attenuated influenza vaccine use.
  • Information has been added concerning the use of live attenuated influenza vaccine in the setting of influenza antiviral medication use. Influenza antiviral medications may interfere with the action of this vaccine because it contains live virus; newer influenza antivirals (ie, peramivir and baloxavir) have longer half-lives. Peramivir might interfere if given from 5 days before through 2 weeks after vaccination. Baloxavir might interfere if given 17 days before through 2 weeks after vaccination.
  • Recommendations concerning vaccination of persons with egg allergy who receive either cell culture based inactivated or recombinant influenza  quadrivalent vaccine have been updated. Additional measures for those with a history of severe allergic reaction to egg are needed only if a vaccine other than cell culture based inactivated or recombinant influenza vaccine is used.

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The full report, which includes guidance for influenza vaccination of specific populations (ie, children, pregnant women, older patients, immunocompromised individuals), and situations (ie, history of Guillain-Barré Syndrome, egg allergy) can be found here.

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Grohskopf LA, Alyanak E, Broder KR, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices — United States, 2020–21 influenza season. MMWR Recomm Rep 2020;69(No. RR-8):1–24.

This article originally appeared on MPR