CDC's ACIP Updates Flu Vaccine Advice for Upcoming Flu Season

Megan Brooks

August 24, 2018

For the upcoming 2018-2019 influenza season, the quadrivalent live attenuated influenza vaccine (LAIV4; FluMist Quadrivalent) is an option for appropriate individuals, according to updated recommendations from the the US Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP).

That's a change from the past two influenza seasons (2016-2017 and 2017-2018), during which the ACIP recommended that LAIV4 not be used, owing to concerns about effectiveness against (H1N1)pdm09 viruses.

For the upcoming season, vaccination providers may choose to administer any licensed, age-appropriate influenza vaccine, the ACIP says.

The 2018-2019 ACIP recommendations for prevention and control of seasonal influenza with vaccines were published online August 24 in the Morbidity and Mortality Weekly Report.

The ACIP continues to recommend that all persons aged ≥6 months receive routine annual influenza vaccination with a licensed, recommended, and age-appropriate vaccine, unless they have specific contraindications.

Inactivated influenza vaccines (IIVs), recombinant influenza vaccine (RIV), and LAIV are expected to be available for the upcoming season, the ACIP says. Standard-dose, unadjuvanted, inactivated influenza vaccines will be available in quadrivalent (IIV4) and trivalent (IIV3) formulations. Recombinant influenza vaccine (RIV4) and LAIV4 will be available in quadrivalent formulations. High-dose inactivated influenza vaccine (HD-IIV3) and adjuvanted inactivated influenza vaccine (aIIV3) will be available in trivalent formulations.

"No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended, and appropriate product is available," the ACIP says.

For the 2018-2019 season, US trivalent influenza vaccines will contain the following:

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

  • An A/Singapore/INFIMH-16-0019/2016 (H3N2)–like virus; and

  • A B/Colorado/06/2017–like virus (Victoria lineage).

Quadrivalent vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage).

The ACIP continues to advise that individuals with a history of egg allergy of any severity may receive any licensed, recommended, and age-appropriate influenza vaccine (IIV, RIV4, or LAIV4). IIV and RIV4 have been previously recommended.

The updated recommendations also make note of two recent regulatory actions:

  • In August 2017, the US Food and Drug Administration (FDA) approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥18 years, Afluria Quadrivalent is now licensed for persons aged ≥5 years.

  • In January 2018, FDA approved an expanded age indication for Fluarix Quadrivalent (IIV4). Previously licensed for persons aged ≥3 years, Fluarix Quadrivalent is now licensed for persons aged ≥6 months. Children aged 6 through 35 months may receive Fluarix Quadrivalent at the same 0.5 mL per dose (containing 15 µg of hemagglutinin [HA] per vaccine virus) as is used for older children and adults. This licensure creates a third option for inactivated influenza vaccines for children aged 6 through 35 months, in addition to the previously available 0.5 mL per dose (containing 15 µg of HA per vaccine virus) presentation of FluLaval Quadrivalent (IIV4) and 0.25 mL per dose presentation (containing 7.5 µg of HA per vaccine virus) of Fluzone Quadrivalent (IIV4).

A summary of these recommendations and a background document containing additional information on influenza-associated illnesses and influenza vaccines are available online.

MMWR Morb Mortal Wkly Rep. Published online August 24, 2018. Full text

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