Practice Guidelines

Influenza Vaccination Recommendations for 2018–2019: Updates from ACIP


Key Points for Practice

• Vaccination should be offered by the end of October, although vaccine administered in December or later is likely beneficial in most influenza seasons.

• In contrast with the past two influenza seasons, LAIV is an option this season for appropriately selected patients two to 49 years of age.

• Persons with a history of egg allergy can receive any age-appropriate licensed influenza vaccine, but those with severe egg reactions will require supervision by a health care professional to manage any adverse reactions.

From the AFP Editors

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) has released its recommendations for routine influenza vaccination in the 2018–2019 season. Updates this year include the antigenic composition of seasonal influenza vaccines available in the United States; a reversal of the recommendation for the past two seasons against the use of live attenuated influenza vaccine (LAIV); information about expanded age indications for two quadrivalent inactivated influenza (IIV4) vaccines; and recommendations for vaccination of persons with egg allergy.

Routine annual influenza vaccination is recommended for all persons six months and older who do not have contraindications (see Table 2 at No specific vaccine is preferred in persons for whom more than one formulation is appropriate. Vaccination should be offered by the end of October, although vaccine administered in December or later—even if influenza activity has already begun—is likely beneficial in most influenza seasons. Children six months to eight years of age who require two doses of vaccine this season (i.e., those who have not received two doses of trivalent or quadrivalent inactivated influenza vaccine before July 2018, or those whose influenza vaccination history is not known) should be vaccinated as soon as possible after vaccine is available so that the second dose can be administered by the end of October. Vaccination should be offered as long as influenza viruses are circulating and unexpired vaccine is available.

Inactivated influenza vaccines,

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of Practice Guidelines published in AFP is available at



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Sep 15, 2019

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