September 16, 2021, 9:21 a.m. News Staff — The CDC’s Advisory Committee on Immunization Practices has released updated recommendations on the use of influenza vaccines for the 2021-2022 influenza season. The recommendations, published in the agency’s Morbidity and Mortality Weekly Report on Aug. 27, contain six primary updates that will be of interest to family physicians and other health care professionals, as well as comprehensive guidance for use of the vaccines in specific populations and situations.
The AAFP officially approved the ACIP’s recommendations earlier this month. The updates are now available at the Academy’s Seasonal Influenza Prevention & Control webpage.
“There are no changes to the recommendation that all persons 6 months of age and older should be vaccinated against influenza, and the flu vaccine may be co-administered with other vaccines, including the COVID-19 vaccines,” said Pamela Rockwell, D.O., of Ann Arbor, Mich., the Academy’s liaison to the ACIP. “Keeping safe with preventive measures such as avoiding crowds, wearing masks and frequent hand-washing will also help keep influenza and other infectious diseases from spreading.”
Overall, the ACIP continues to recommend routine annual influenza vaccination for all individuals age 6 months and older who do not have contraindications. In addition, the ACIP does not recommend any particular influenza vaccine when more than one licensed, recommended and age-appropriate vaccine is available.
The six primary updates are as follows.
1. All seasonal influenza vaccines expected to be available for the 2021-22 season are quadrivalent, and contain hemagglutinin derived from one influenza A(H1N1)pdm09 virus, one influenza A(H3N2) virus, one influenza B/Victoria lineage virus and one influenza B/Yamagata lineage virus.
2. The influenza A(H1N1)pdm09 and influenza A(H3N2) vaccine components have been updated. Specifically, for the 2021-2022 season, U.S. licensed influenza vaccines will contain hemagglutinin derived from an influenza A/Victoria/2570/2019 (H1N1) pdm09-like virus (for egg-based vaccines) or an influenza A/Wisconsin/588/2019 (H1N1) pdm09-like virus (for cell culture-based inactivated and recombinant influenza vaccines); an influenza A/Cambodia/e0826360/2020 (H3N2)-like virus; an influenza B/Washington/02/2019 (Victoria lineage)-like virus and an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus.
3. Flucelvax Quadrivalent, a cell culture-based inactivated influenza vaccine, is now approved for use in individuals age 2 years and older. Previously, the vaccine had been approved for individuals age 4 years and older.
4. Guidance on the administration of influenza vaccines with other vaccines has been expanded to include COVID-19 vaccination. According to the recommendations, current guidance indicates that COVID-19 vaccines can be co-administered with other vaccines, including vaccines for influenza. However, clinicians also are advised to periodically consult recommendations from the ACIP and interim clinical considerations from the CDC for the latest information.
5. Guidance on vaccination timing has been updated for certain populations:
6. Contraindications and precautions for Flucelvax Quadrivalent (ccIIV) and recombinant influenza vaccine (RIV) have been modified:
The ACIP’s recommendations also contain guidance for use of the influenza vaccine in specific populations and situations.
For example, the recommendations state that in situations where vaccine supply is limited, efforts should focus on administering the vaccine to those at increased risk for medical complications to severe influenza who do not have contraindications to being vaccinated. This includes
An age-appropriate quadrivalent inactivated influenza vaccine or RIV is suitable for patients in all risk groups. However, quadrivalent live attenuated influenza vaccine is not recommended for some populations.
For other populations, the ACIP’s recommendations are as follows.
Pregnant patients. Any licensed, recommended age-appropriate quadrivalent inactivated influenza vaccine or RIV may be used in patients who are pregnant or might be pregnant or postpartum during the influenza season. Quadrivalent LAIV should not be used during pregnancy, but can be used postpartum.
Older adults. For patients 65 years and older, any age-appropriate quadrivalent inactivated influenza vaccine or RIV (standard dose or high dose, adjuvanted or nonadjuvanted) is acceptable. The committee will continue to review data on the efficacy and effectiveness of influenza vaccines as more information becomes available.
Immunocompromised patients. Those with immunocompromising conditions should receive an age-appropriate quadrivalent inactivated influenza vaccine or RIV. The committee also recommends that quadrivalent LAIV should not be used in these individuals because of a biologically plausible risk for disease attributable to the vaccine.
International travelers. For travelers who want to reduce their risk for influenza, the ACIP recommends influenza vaccination at least two weeks before departure. In particular, individuals who live in the United States, are at higher risk for complications and did not receive influenza vaccine during the previous Northern Hemisphere fall or winter should consider vaccination before departure if they plan on traveling to the tropics, traveling to the Southern Hemisphere between April and September, or traveling with organized tourist groups or on cruise ships to any location.
More information on influenza vaccines and travel is available at the CDC’s Travelers’ Health Flu webpage.
The recommendations also contain additional guidance on
Rockwell provided additional guidance for FPs who are caring for patients in an office setting.
“When administering flu shots in the office please take care to see if your patient is due or overdue for any other routine vaccines,” Rockwell said. “Pediatric and adult vaccination rates have decreased dramatically since the start of the COVID-19 pandemic, and we can start to remedy that with co-administration of influenza vaccines with other vaccines.”
“Remember that a physician recommendation has the strongest impact on our patients’ receipt of vaccines,” she added.
The ACIP is currently scheduled to hold a virtual meeting on Sept. 29 followed by a two-day meeting in October. Look to AAFP.org for relevant details from these meetings as more information becomes available.