The Aug. 26 report provides the latest updates on influenza vaccination, including information on vaccine composition, storage and handling, contraindications and precautions, and links to dozens of related sources.
The AAFP endorsed the recommendations on Aug. 30 after review and approval by the Commission on Health of the Public and Science.
The Academy has also updated its Seasonal Influenza Prevention & Control webpage to reflect the latest information.
“The historically low level of influenza in the United States during the 2020-2021 season was likely due to masking, social distancing, and working remotely from home in the early months of the COVID pandemic,” said Pamela Rockwell, D.O., of Ann Arbor, Mich., the Academy’s liaison to the ACIP. “Preliminary estimates indicate that influenza levels rose during the 2021-2022 season, though still lower than most previous pre-pandemic years, and there is potential for a more severe season coming up.”
She noted that although most people recover from influenza without serious effects, many are hospitalized and some die. Those who are older, are pregnant or have a chronic disease, as well as young children, are most at risk.
Vaccination makes a difference. During the 2017-2018 influenza season, one of the most severe in recent record, vaccines prevented an estimated 6.9 million illnesses, 3.6 million medical visits, 94,000 hospitalizations and 6,000 deaths.
The ACIP continues to recommend routine annual influenza vaccination for everyone 6 months and older without contraindications.
If supplies become limited, efforts should focus on people at increased risk who do not have contraindications.
All influenza vaccines available in the United States for the 2022-2023 season are expected to be quadrivalent. The vaccines and approved age ranges are:
Fluad Quadrivalent, Flublok Quadrivalent and Fluzone High-Dose Quadrivalent are preferentially recommended for adults 65 and older, without a preferential recommendation for one over another.
Most people who need only one dose of influenza vaccine ideally should receive it in September or October.
The recommendation is different for children age 6 months through 8 years who did not receive two or more doses of trivalent or quadrivalent influenza vaccine at least four weeks apart before July 1, 2022, or whose influenza vaccination history is unknown. These children will require two doses of influenza vaccine at least four weeks apart. The first dose should be received as soon as possible so the second can be received by the end of October.
Any licensed, recommended, age-appropriate inactivated or recombinant influenza vaccine may be received at any time during pregnancy.
However, patients who are in the first or second trimester of pregnancy during July and August should consider waiting until September or October to be vaccinated. Maternal vaccination in the third trimester may reduce the risk of influenza in infants during the first months of life, when they are too young to be vaccinated.
Live attenuated influenza vaccines (such as FluMist) should not be used during pregnancy but can be administered in the postpartum period.
A live attenuated influenza vaccine should not be given to immunocompromised patients or those with some chronic medical conditions (such as anatomic or functional asplenia, cerebrospinal fluid leaks, cochlear implants or a history of severe allergic reaction to any previous influenza vaccine or vaccine component).
Influenza vaccines might harm the immune response of people who are taking certain medications, as well as those who are on chemotherapy or certain transplant regimens.
Additional guidance is available on vaccinating immunocompromised patients.
Previous severe allergic reaction to any influenza vaccine is a contraindication to all egg-based quadrivalent inactivated influenza vaccines and recombinant influenza vaccines.
Previous severe allergic reaction to any cell culture-based inactivated influenza vaccine or any component of quadrivalent cell culture-based inactivated influenza vaccine is a contraindication to use of quadrivalent cell culture-based inactivated influenza vaccine. Previous severe allergic reaction to any other influenza vaccine is a precaution to use of quadrivalent cell culture-based inactivated influenza vaccine.
Previous severe allergic reaction to recombinant influenza vaccine or any component of quadrivalent recombinant influenza vaccine is a contraindication to use of quadrivalent recombinant influenza vaccine. Previous severe allergic reaction to any other influenza vaccine is a precaution to use of quadrivalent recombinant influenza vaccine.
Each vaccine is also contraindicated for those with a history of severe allergic reaction to any component of that vaccine other than egg.
More information is in the “Persons With a History of Egg Allergy” and “Persons With Previous Allergic Reactions to Influenza Vaccines” sections of the report, as well as in contraindications and precautions sections for each egg-based influenza vaccine
In patients who are mildly ill or asymptomatic, consider deferring influenza vaccination to avoid confusing COVID-19 symptoms with postvaccination reactions.
Vaccination should be deferred for those who are moderately or severely ill.
Those who are isolated or in quarantine for known or suspected COVID-19 exposure should not be vaccinated if it will pose an exposure risk to others.
Quadrivalent inactivated influenza vaccines and recombinant influenza vaccines may be administered at the same time or in sequence with other live or inactivated vaccines.
The quadrivalent live attenuated influenza vaccine (FluMist Quadrivalent) may be administered simultaneously with other live or inactivated vaccines. However, if live vaccines are not given simultaneously, at least four weeks should elapse between administration of quadrivalent live attenuated influenza vaccine and another live vaccine.
If multiple injectable vaccines are given simultaneously, they should be administered at separate anatomic sites.
The CDC offers updated guidance on co-administration of COVID-19 vaccines with other vaccines.
Rockwell offered four tips to help family physicians increase vaccination of hesitant patients: