CDC has released recommendations for influenza vaccines for the 2018-19 influenza season. These recommendations can be found at: https://www.cdc.gov/mmwr/volumes/67/rr/rr6703a1.htm?s_cid=rr6703a1_w. Items that are addressed include the following:

• Influenza vaccination is recommended for everyone ages six months and older who do not have contraindications, using any age-appropriate vaccine.¹Encourage patients to try to complete vaccination by the end of October. Though delayed vaccination may lead to increased immunity later in the season, it could also lead to missed opportunities to vaccinate, and is not recommended.¹
  • LAIV4 (intranasal vaccine; FluMist) is an available option endorsed by the Advisory Committee on Immunization Practices (ACIP) for the 2018-19 flu season.¹ This is a change from the 2016-17 and 2017-18 recommendations and might improve vaccination rates, especially in children.¹³ Early evidence suggests this year’s intranasal vaccine should work better than previous years.¹³
  • The inactivated vaccines are recommended over the LAIV4 by the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) due to efficacy rates of the LAIV4 against the H1N1 influenza A strains in recent years. The AAP and AAFP recommend reserving the LAIV4 for age appropriate healthy patients (e.g., 2 to 49 years of age) who refuse an injection.^9,14 See ACIP recommendations for LAIV4 at https://www.cdc.gov/mmwr/volumes/67/wr/ pdfs/mm6722a5-H.pdf.
• Live-attenuated and inactivated influenza vaccines can be given at the same time as other vaccines, using separate administration sites.¹ (See Fluad row below concerning co-administration of two adjuvanted vaccines.)
• After giving a live vaccine (including LAIV4) other live vaccines should not be administered for at least four weeks.¹
• Trivalent flu vaccines protect against two influenza A-like viruses and one influenza B-like virus.¹
• Quadrivalent flu vaccines protect against two influenza A-like viruses and two influenza B-like viruses.¹

Continue to the last page of this document for information about when two doses of influenza vaccine are needed; vaccination with an acute illness; vaccinating immunocompromised, pregnant, or breastfeeding patients; and managing patients with an egg allergy. The chart below provides information about approved influenza vaccines for the 2018-19 season including FDA-approved ages for use, route of administration, dose, and cost.

Abbreviations: IIV4 = influenza inactivated vaccine, quadrivalent; IIV3 = influenza inactivated vaccine, trivalent; IM = intramuscular; LAIV4 = live attenuated influenza vaccine, quadrivalent; MDV = multidose vial; PFS = pre-filled syringe; RIV4 = recombinant inactivated vaccine, quadrivalent; SDV = single-dose vial.