Flu Vaccine 2020-2021 Recommendations

Lisa Grohskopf, MD, MPH


October 02, 2020

Editorial Collaboration

Medscape &

Each influenza season, millions of Americans are affected by influenza, at times severely. In the United States during the 2016-2017 through 2018-2019 seasons, the Centers for Disease Control and Prevention (CDC) estimates that influenza caused 29-45 million illnesses, 14-21 million medical visits, 490,000-810,000 hospitalizations, and 34,000-61,000 deaths each season. Annual influenza vaccination is the best defense. This fall, with COVID-19 expected to co-circulate alongside influenza, getting an influenza vaccine will be more important than ever.

Here is a quick summary of this season's vaccination information. The full 2020-2021 influenza season recommendations are available on the CDC website.

Who Should Get an Influenza Vaccination?

CDC and the Advisory Committee on Immunization Practices (ACIP) continue to recommend annual influenza vaccination for everyone 6 months of age or older who does not have contraindications. Any licensed influenza vaccine appropriate for age and health status can be used.

Vaccination is especially important for young children, older adults, pregnant women, and people of all ages with a chronic medical condition. For more information, visit Who Should Get Vaccinated This Season.

What's New This Season?

Two new influenza vaccines have been licensed for use in people aged 65 years and older: a quadrivalent high-dose influenza vaccine and a quadrivalent adjuvanted influenza vaccine. Previously, high-dose and adjuvanted influenza vaccines were only available in trivalent formulations.

What If Your Patient Has COVID-19?

For patients with confirmed or suspected COVID-19 who are already in a medical care setting, clinicians can consider delaying vaccination until the patient is no longer acutely ill. Moderate to severe acute illness due to any cause, with or without fever, is a precaution for vaccination. People with suspected or confirmed COVID-19 who are isolating at home or in other nonmedical settings (regardless of whether they have symptoms) should not go to medical settings for routine vaccinations until they meet criteria to come off isolation, in order to avoid exposing others in the vaccination setting.

Timing of Vaccination

CDC and ACIP recommend that vaccination be offered by the end of October.

Children aged 6 months through 8 years who need two doses should receive their first dose as soon as possible after the vaccine becomes available to allow the second dose (which must be administered at least 4 weeks later) to be received by the end of October.

While vaccination should optimally occur before the onset of influenza activity in the community, providers should continue to offer and encourage vaccination during all routine healthcare visits and hospitalizations as long as influenza viruses are circulating and unexpired vaccine is available.

Children 6 Months Through 8 Years of Age

As in previous seasons, some children 6 months through 8 years of age will need two doses of influenza vaccine this season. Children in this age group who have not previously received two or more total doses of any trivalent or quadrivalent influenza vaccine (including live attenuated influenza vaccine) before July 1, 2020, or whose vaccination history is not known need two doses of 2020-2021 influenza vaccine administered at least 4 weeks apart. For 8-year-olds who are determined to need two doses, the second dose is recommended even if the child turns 9 years of age between receipt of the first dose and the second dose. Children in this age group who have received two or more total doses of trivalent or quadrivalent influenza vaccine before July 1, 2020, need only one dose for this season.

2020-2021 Influenza Vaccine Composition

For 2020-2021, trivalent egg-based vaccines will contain:

  • A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus (updated)

  • A/Hong Kong/2671/2019 (H3N2)-like virus (updated)

  • B/Washington/02/2019 (B/Victoria lineage)-like virus (updated)

Quadrivalent egg-based vaccines, which protect against a second lineage of B viruses, will contain:

  • The three recommended viruses above, plus B/Phuket/3073/2013 (B/Yamagata lineage)-like virus

For 2020-2021, cell culture-based and recombinant vaccines will contain:

  • A/Hawaii/70/2019 (H1N1)pdm09-like virus (updated)

  • A/Hong Kong/45/2019 (H3N2)-like virus (updated)

  • B/Washington/02/2019 (B/Victoria lineage)-like virus (updated)

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

Available Vaccines

Any licensed influenza vaccine that is appropriate for the recipient's age and health status can be used. Trivalent and quadrivalent influenza vaccines with adjuvant and the quadrivalent high-dose vaccine are licensed for those 65 years of age or older. Approved ages are specified in the package labeling for each vaccine. No preferential recommendation is made for one influenza vaccine type over another, but efforts to assess effectiveness of different influenza vaccines for different populations continue.

For more information on the influenza vaccines available or the 2020-2021 influenza season, visit the CDC website.