Influenza Vaccination Recommendations for 2018-2019 Flu Season

Alicia M. Fry, MD, MPH


October 16, 2018

Editorial Collaboration

Medscape &

Influenza Vaccination

Last flu season was a reminder of how severe flu can be. CDC estimates that there were more than 900,000 hospitalizations and 79,000 flu deaths last flu season. Our collective flu experience underscores how important it is to vaccinate against flu each year. Annual influenza vaccination is the best defense against influenza. Influenza vaccination can reduce influenza illnesses, doctor visits, and missed work and school due to influenza, as well as prevent influenza-related hospitalizations.

This article includes new and updated information for the 2018-2019 influenza season, including:

The full 2018-2019 influenza season recommendations are available on the CDC website.

Groups Recommended for Influenza Vaccination

For the 2018-2019 influenza season, CDC and the Advisory Committee on Immunization Practices (ACIP) continue to recommend annual influenza vaccination for everyone 6 months of age and older, with any licensed, appropriate influenza vaccine, including inactivated influenza vaccine (IIV), recombinant influenza vaccine (RIV), or live attenuated nasal spray influenza vaccine (LAIV4).

Vaccination is especially important for young children, older adults, pregnant women, and people of all ages with some chronic medical conditions, because they are at higher risk of developing influenza-related complications if they get sick with influenza. For more information, visit Who Should Get Vaccinated This Season.

2018-2019 Influenza Vaccine Composition

Influenza vaccines are formulated to protect against the three or four influenza viruses (depending on vaccine) that surveillance suggests will be most common during each upcoming influenza season. For 2018-2019, US-licensed trivalent vaccines will contain:

  • A/Michigan/45/2015 (H1N1)pdm09-like virus

  • A/Singapore/INFIMH-16-0019/2016 A(H3N2)-like virus (updated)

  • B/Colorado/06/2017-like (Victoria lineage) virus (updated)

Quadrivalent vaccines, which protect against a second lineage of B viruses, will also contain:

  • B/Phuket/3073/2013-like (Yamagata lineage) virus

Live Attenuated Influenza Vaccine-- An Option for 2018-2019

For the 2018-2019 season, the intranasally administered live attenuated influenza vaccine (LAIV) is an option for persons aged 2 through 49 years. LAIV is not recommended for pregnant women, those with weakened immune systems, and patients with certain chronic medical conditions. More information is available in the full 2018-2019 season recommendations.

ACIP reviewed data from previous seasons concerning LAIV effectiveness. While data from the 2010-2011 through the 2016-2017 influenza seasons indicate that LAIV was not effective against H1N1pdm09 influenza viruses in the United States among children aged 2 through 17 years, the vaccine was effective against influenza B and had effectiveness against H3N2, viruses similar to that of inactivated vaccines. Some data suggest that the new H1N1 virus strain included in the current LAIV will have improved effectiveness against circulating H1N1 viruses; however, no published effectiveness estimates are available yet.

Make a Strong Influenza Vaccine Recommendation

Ideally, healthcare providers should offer vaccination by the end of October, before the onset of influenza activity in the community. However, as long as flu viruses are circulating, vaccination should continue throughout the flu season, even in January or later. To avoid missed opportunities for vaccination, providers should offer vaccination to unvaccinated persons 6 months of age and older during routine healthcare visits and hospitalizations.

Your recommendation to your patients that they receive the influenza vaccine is critical and more effective in increasing acceptance of vaccination than any other influencing factor. CDC's SHARE method is a good way to make a strong recommendation and provide information to help patients make an informed decision about vaccination. To implement SHARE:

  • SHARE the reasons why the flu vaccine is right for the patient

  • HIGHLIGHT positive experiences with flu vaccines (personal or in practice) to reinforce the benefits and strengthen confidence in the vaccine

  • ADDRESS patient questions and concerns about the flu vaccine, including side effects, safety and effectiveness

  • REMIND patients that flu vaccines protect them and their loved ones from serious illness and related complications

  • EXPLAIN the potential costs of getting the flu

The CDC Influenza Free Resources page has brochures, posters, fact sheets, customizable reminder cards, and social media tools that are all designed to help healthcare providers educate and reach their patients with a reminder to get vaccinated.

For more information, visit CDC's website.