ACIP Updates Influenza Vaccine Recommendations

Laurie Barclay, MD

August 07, 2015

All persons at least 6 months of age should have routine annual influenza vaccination unless they have specific contraindications, according to updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for the 2015 to 2016 influenza season.

The updated recommendations were published in the August 6 issue of the Morbidity and Mortality Weekly Report.

"Optimally, vaccination should occur before onset of influenza activity in the community," write Lisa A. Grohskopf, MD, from the Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, and colleagues. "Health care providers should offer vaccination by October, if possible. Vaccination should continue to be offered as long as influenza viruses are circulating."

Of the various available seasonal influenza vaccine formulations, some are licensed for specific age groups, and some may be more suitable than others for persons with certain medical conditions. However, ACIP does not recommend the use of any specific formulation over another for persons in whom more than one type of vaccine is suitable and available.

The new guidelines update the 2014 ACIP recommendations concerning the use of seasonal influenza vaccines. They describe the antigenic and virus composition of the 2015 to 2016 influenza vaccines, with changes in the influenza A (H3N2) virus and the influenza B virus compared with the 2014 to 2015 season.

Recently approved influenza vaccines anticipated to be available this season are Afluria (inactivated influenza vaccine, bioCSL Inc), for intramuscular administration via the Stratis needle-free jet injector (PharmaJet Inc); Flublok (recombinant influenza vaccine, trivalent [RIV3]; Protein Sciences), which now has an expanded age indication for persons aged 18 years and older; and Fluzone Intradermal Quadrivalent (Sanofi Pasteur Inc), which will replace the previously available trivalent Fluzone Intradermal.

The new recommendations also contain an updated algorithm to determine the number of vaccine doses needed for children aged 6 months through 8 years.

The guidelines summarize evidence regarding use of live attenuated influenza vaccine (LAIV) and inactivated influenza vaccine (IIV) in children. On the basis of this evidence, the ACIP did not renew last season's preferential recommendation for use of LAIV in healthy children aged 2 through 8 years.

Other recommendations include the following:

  • Vaccination should not be delayed to obtain a specific vaccine preparation if a suitable formulation is already available.

  • There is no preference for LAIV or IIV for any person aged 2 through 49 years for whom either vaccine is appropriate, although an age-appropriate formulation of vaccine should be used.

  • LAIV should not be used in persons aged younger than 2 years or older than 49 years, persons with contraindications, children aged 2 through 17 years who are receiving aspirin, persons with severe allergic reactions to any influenza vaccine or its components, pregnant women, immunocompromised persons, persons who care for severely immunosuppressed persons, persons with a history of egg allergy, children aged 2 through 4 years with asthma or wheezing within the past 12 months, or persons who have taken influenza antiviral medications within the previous 48 hours.

  • The LAIV package insert describes other warnings and precautions.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2015;64:818-825. Full text

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