Prevention and Control of Seasonal Influenza With Vaccines
The AAFP recommends that physicians offer influenza vaccination as soon as it becomes available each year and continue to provide the vaccine throughout the flu season (i.e., as long as influenza viruses are circulating in the community).
The AAFP has adopted the Center for Disease Control (CDC) 2017-2018 recommendations(www.cdc.gov) for the prevention and control of influenza with vaccines, which are consistent with that of the Advisory Committee on Immunization Practices (ACIP).(www.cdc.gov)
Routine annual influenza vaccination is recommended for all persons aged 6 months and older who do not have contraindications.
The AAFP continues to recommend routine annual influenza vaccination of all persons six months and older without contraindication for this influenza season. No preferential recommendation is made for one particular influenza vaccine product over another for persons to whom more than one licensed, recommended product is available.
The AAFP recommends that the live attenuated influenza vaccine (LAIV) should not be used during the 2017-2018 influenza season for any age group this season because of concerns about effectiveness(www.cdc.gov).
The influenza vaccine is the first step to prevent the flu, and your recommendation can make a difference. Consider the following points in discussions with patients:
- Pregnant women should receive the seasonal influenza vaccine. The risk of severe illnesses related to the flu is higher in pregnant women than in women who are not pregnant.
- The influenza vaccine protects the mother and her infant from influenza-related illnesses, hospitalization, and premature labor and delivery.
- The influenza vaccine is safe for pregnant women in any trimester. The vaccine has been given to millions of pregnant women in the last decade and has not been shown to cause harm to women or their infants.
- It is safe for postpartum women to get the influenza vaccine, even if they are breastfeeding.
- Antivirus drugs are recommended for pregnant women who get the flu. Antivirus drugs can shorten the length of illness by one or two days, and can prevent flu complications, such as pneumonia.
Webinar: Benefits of the Influenza Vaccine for Adults 65 and Older
Tuesday, September 26
11 a.m. Central Time
Boost influenza immunization uptake in your practice by tuning in to this free AAFP webinar, moderated by family physician Thomas Koinis, M.D.
The AAFP supports annual mandatory influenza immunization for health care personnel (HCP), except for refusal due to a documented allergy or medical contraindication. If HCP are not vaccinated, policies to adjust practice activities during flu season are appropriate (e.g., wearing masks, refraining from direct patient care). (AAFP Board of Directors, May 2016)
The AAFP supports the removal of a prior recommendation for persons with egg allergies. It stated that patients with an egg allergy should be observed for 30 minutes following vaccination for signs and symptoms of an allergic reaction. The AAFP supports the recommendations that health care providers should observe all patients for 15 minutes after vaccination to decrease the risk for injury should they experience syncope, per the ACIP’s General Best Practice Guidelines for Immunizations(www.cdc.gov).
The AAFP supports the recommendation that persons with a history of severe allergic reaction to eggs (i.e., any symptoms other than hives) should be vaccinated in an inpatient or outpatient medical setting. These include, but are not necessarily limited to hospitals, clinics, health departments, and physician offices, and are under the supervision of a health care provider who is able to recognize and manage severe allergic conditions, per the ACIP’s recommendation for the flu vaccine and people with egg allergies(www.cdc.gov).
This protocol assists physicians and health care professionals in the management of the expected surge of patients during an influenza pandemic. Download the protocol algorithm.
- 2017-18 U.S. trivalent influenza vaccines will contain an A/Michigan/45/2015 (H1N1) pdm09-like virus; an A/Hong Kong/4801/2014 (H3N2)-like virus; and a B/Brisbane/60/2008-like virus (Victoria lineage). Quadrivalent influenza vaccines will include these three vaccines and an additional vaccine virus strain, a B/Phuket/3073/2013-like virus (Yamagata lineage). This represents a change in the influenza A(H1N1) pdm09 virus component from the previous season.
- Recent regulatory actions include two new licensures and one labeling change described below:
- Afluria Quadrivalent (IIV4) was licensed by FDA in August 2016 for persons 18 years and older. Regulatory information is available at: https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm518291.htm(www.fda.gov).
- Flublok Quadrivalent (RIV4) was licensed by FDA in October 2016 for persons 18 years and older. Regulatory information is available at: https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm524660.htm(www.fda.gov).
- FluLaval Quadrivalent (IIV4) was extended for age indication in November 2016 to include persons six months and older (it was previously indicated for persons three years and older). Regulatory information is available at: https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm366061.htm(www.fda.gov). Children six months through 35 months may receive FluLaval 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 an additional option for vaccination of children six months through 35 months, in addition to the previously available 0.25 mL per dose presentation (containing 7.5 µg of HA per vaccine virus) of Fluzone Quadrivalent (IIV4).
- Pregnant women may receive any licensed, recommended, age-appropriate influenza vaccine.
- Afluria (IIV3) is now recommended for persons aged five years and older, consistent with FDA-approved labeling.