Vaccination Recommendations for the 2013-2014 Influenza Season

Joseph Bresee, MD


September 27, 2013

Editorial Collaboration

Medscape &

This feature requires the newest version of Flash. You can download it here.

Changes to This Season's Vaccine Recommendations

Hello. I am Dr. Joe Bresee from CDC's Influenza Division. I am pleased to speak with you today as part of the CDC Expert Commentary Series.

Today I will discuss vaccination recommendations for the 2013-2014 influenza season. Of greatest importance, CDC continues to recommend that everyone 6 months and older receive a yearly flu vaccine, with rare exceptions. But there are some changes to this season's recommendations, which is what I will be focusing on in this commentary. First I will discuss the vaccine options available in the United States. This season, some quadrivalent vaccines will be available, along with the trivalent vaccine, which has been available for decades. The trivalent flu vaccine contains 3 antigens: an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. The quadrivalent vaccine contains these 3 and a second B antigen. All nasal spray vaccines this season will be quadrivalent. Inactivated flu vaccines, which are administered as intramuscular and intradermal injections, will be available in both trivalent and quadrivalent formulations. Most of the flu shots available this season will be trivalent vaccines. There is no need to delay vaccination if the quadrivalent vaccine is not available, because both types of vaccine offer important protection from flu. Trivalent flu vaccines are available as:

A standard-dose injection approved for use in people ages 6 months and older, including those with high-risk medical conditions and pregnant women;

A high-dose injection approved for use in people 65 years and older;

An intradermal injection that is approved for use in people 18 through 64 years of age and uses a much smaller needle than the regular flu shot;

A standard-dose, cell-based flu shot for use in people 18 years and older;

A recombinant, egg-free shot approved for use in people between 18 and 49 years; and

A nasal spray (or intranasal) vaccine, approved for healthy people ages 2-49 who do not have an underlying medical condition, such as asthma or diabetes, that predisposes them to serious influenza complications.

For a complete list of available vaccines along with trade names, manufacturers, presentations, mercury content, age indications, and routes, see this list of seasonal vaccines. This year, vaccine shipments began in late July and will continue until all vaccine is distributed. Manufacturers have projected that they will produce between 135 million and 139 million doses of influenza vaccine for use in the United States this flu season.

There is no preferential recommendation for any type or brand of licensed influenza vaccine over another. Different formulations are available from various manufacturers, so clinicians should refer to the package inserts for the recommended age groups, contraindications, and precautions for each vaccine.