What You Need to Know About the Recently Updated Immunization Recommendations


Influenza can cause serious illness, hospitalization, and death, particularly among older adults, very young children, pregnant women, and those with certain chronic medical conditions. Routine annual influenza vaccination for all persons older than 6 months who do not have contraindications has been recommended by Centers for Disease Control and Prevention (CDC) and CDC’s Advisory Committee on Immunization Practices (ACIP) since 2010.

The CDC recently updated the ACIP recommendations regarding the use of seasonal influenza vaccines and provided recommendations and guidance for vaccine providers regarding the use of influenza vaccines for the 2018–19 season.

Qsource Clinical Pharmacy Specialist Amanda Ryan, PharmD, BCGP, points out these highlights from the recommendations:

  • “No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed.” This recommendation is unchanged from last year. High dose or adjuvanted vaccines for those over 65 are not preferred over others.
  • Strains in this year’s vaccines: “Vaccine viruses included in the 2018–19 U.S. trivalent influenza vaccines will be 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 influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage).”
  • FluMist can be used again for patients 2-49 years old. “Following two seasons (2016–17 and 2017–18) during which ACIP recommended that LAIV4 not be used, ACIP voted in February 2018 to recommend that for the 2018–19 season, vaccination providers may choose to administer any licensed, age-appropriate influenza vaccine (IIV, RIV4, or LAIV4). LAIV4 is an option for those for whom it is appropriate.”
  • People with egg allergies can be vaccinated. “Persons 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. Use of LAIV4 for persons with egg allergy was approved by ACIP in February 2016. Additional recommendations concerning vaccination of egg-allergic persons are discussed.”
  • “Vaccination should be offered by the end of October. . . .Community vaccination programs should balance maximizing the likelihood of persistence of vaccine-induced protection through the season with avoiding missed opportunities to vaccinate or vaccinating after the onset of influenza circulation occurs.”

This report focuses on the recommendations for use of influenza vaccines for the prevention and control of influenza during the 2018–19 season in the United States. A summary of these recommendations and a Background Document containing additional information on influenza-associated illnesses and influenza vaccines are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html.