COMMENTARY

2017-2018 Influenza Vaccination Recommendations

Lisa Grohskopf, MD, MPH

Disclosures

September 20, 2017

The 2017-2018 Influenza Vaccination Recommendations

Hi. I'm Dr Lisa Grohskopf. I'm a medical officer in the Influenza Division at the Centers for Disease Control and Prevention. I am happy to speak with you today as part of the CDC Expert Commentary Series on Medscape. Today I'll discuss CDC's influenza vaccination recommendations for the 2017-2018 influenza season.

CDC recommends that everyone aged 6 months or older receive an influenza vaccine every year, by the end of October if possible. However, significant seasonal influenza virus activity can continue into May, so vaccination later in the season can still be beneficial.

Only injectable influenza vaccines are recommended for use during the 2017-2018 season. Live attenuated influenza vaccine (LAIV; also known as the nasal spray vaccine) is not recommended again this season because of concerns about effectiveness against (H1N1)pdm09 viruses. (See information about LAIV effectiveness in recent seasons.)

Recommended 2017-2018 influenza vaccines include a number of inactivated injectable vaccines as well as recombinant influenza vaccines. Both trivalent and quadrivalent injectable vaccines will be available this season. CDC and the Advisory Committee on Immunization Practices (ACIP) do not have a preferential recommendation for one influenza vaccine product over another. Don't delay vaccination if quadrivalent vaccine is not available. Both types of vaccine offer important protection from influenza.

Trivalent vaccines are designed to protect against three different influenza viruses. Quadrivalent influenza vaccines protect against the same three viruses plus an additional B virus from a different lineage of influenza B viruses. The composition of this season's vaccines has been updated to better match recently circulating influenza viruses.

For the 2017-2018 season, US trivalent influenza vaccines will contain:

  • An A/Michigan/45/2015 (H1N1)pdm09–like virus;

  • An A/Hong Kong/4801/2014 (H3N2)–like virus; and

  • A B/Brisbane/60/2008–like virus, which is from the Victoria lineage of B viruses.

Quadrivalent vaccines will include an additional vaccine virus strain, a B/Phuket/3073/2013–like virus from the Yamagata lineage. This composition reflects a change in the H1N1 component from the previous season.

Available Vaccines

Now I'll review other updates for the 2017-2018 season.

Regarding recombinant influenza vaccines, Flublok Quadrivalent was licensed by the US Food and Drug Administration (FDA) in 2016 for persons aged 18 years and older and will be available this season. The previously available trivalent formulation of Flublok is also expected to be available.

With respect to quadrivalent inactivated vaccine, the age indication for the 0.5-mL presentation of FluLaval Quadrivalent was extended from 3 years and older to 6 months and older in November 2016. This licensure creates another option for vaccination of children aged 6 through 35 months, in addition to the previously available 0.25-mL dosage presentation of Fluzone Quadrivalent.

There are updated recommendations concerning the trivalent formulation of the inactivated vaccine Afluria. Since 2010, ACIP had recommended that use of this vaccine be limited to ages 9 years and older, following reports of febrile reactions that occurred in Australia during the 2010 Southern Hemisphere season. After consideration of new data, ACIP now recommends Afluria trivalent for use in persons aged 5 years and older, consistent with FDA-approved labeling.

Vaccine manufacturers have projected that as many as 151 to 166 million doses of injectable flu vaccine will be available for the 2017-2018 season. See this list of available vaccines along with trade names, manufacturers, presentations, mercury content, age indications, and routes.

Special Populations

As of June 2017, pregnant women can receive any licensed, recommended, and age-appropriate influenza vaccine. This now includes quadrivalent and trivalent recombinant vaccines as options for pregnant women aged 18 years and older, in addition to age-appropriate inactivated influenza vaccines.

Now I'll talk briefly about an existing recommendation for young children. As in previous seasons, children aged 6 months through 8 years who have never been vaccinated against influenza, or for whom vaccination history is unknown, will require two doses of influenza vaccine, administered at least 4 weeks apart, for full protection. Similar to last year, if a child has received two or more doses of trivalent or quadrivalent influenza vaccine before July 1, 2017, only one dose of 2017-2018 flu vaccine is recommended. This is depicted in an algorithm.

Lastly, a word about recommendations for influenza vaccination of persons with egg allergy, which have not changed since last season. As a reminder, ACIP removed the recommendation that egg-allergic recipients should be observed for 30 minutes following vaccination for signs and symptoms of an allergic reaction. As a reminder, providers should consider observing all patients for 15 minutes after administration of any vaccine to decrease the risk for injury should the recipient experience syncope, per the General Best Practices Guidelines on Immunization. Also, persons with a history of severe allergic reaction to egg (ie, any symptom other than hives) should be vaccinated in an inpatient or outpatient medical setting under the supervision of a healthcare provider who is able to recognize and manage severe allergic conditions.

I will close by reminding you about the importance of your role in protecting the public against influenza. Studies have shown repeatedly that a healthcare provider's recommendation plays a critical role in a patient's decision to get a seasonal influenza vaccine.

Thank you for your attention.

Web Resources

CDC Influenza Vaccination Recommendations for the 2017-2018 Influenza Season

LAIV effectiveness in recent seasons

Influenza Vaccination Frequently Asked Questions

Flublok Quadrivalent

FluLaval Quadrivalent

Fluzone Quadrivalent

Afluria

Influenza vaccines — United States, 2017–18 influenza season

Influenza vaccine dosing algorithm for children aged 6 months through 8 years

Kroger AT, Duchin J, Vázquez M. Best practices guidance of the Advisory Committee on Immunization Practices (ACIP). Atlanta, GA: US Department of Health and Human Services, CDC; 2017.

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