Academy Approves Updated ACIP Flu Vaccine Recommendations

What Family Physicians Should Know for 2022-2023 Season

September 1, 2022, 3:05 p.m. News Staff — Family physicians will be able to select from up to nine different influenza vaccines for the 2022-2023 season, according to a CDC report on recommendations from the Advisory Committee on Immunization Practices.

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.

Available Vaccines and Recommended Groups

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:

• Afluria Quadrivalent, Fluarix Quadrivalent, Flucelvax Quadrivalent, FluLaval Quadrivalent and Fluzone Quadrivalent for people age 6 months and older;
• FluMist Quadrivalent for people age 2 through 49 years;
• Flublok Quadrivalent for people age 18 years and older; and
• Fluad Quadrivalent and Fluzone High-Dose Quadrivalent for people age 65 years and older.

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.

Timing and Dosing

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.

Pregnant Patients

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.

Special Populations

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.

Allergic Reactions

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

COVID-19

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.

Co-administration With Other Vaccines

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.

Talking to Vaccine-hesitant Patients

Rockwell offered four tips to help family physicians increase vaccination of hesitant patients:

1. Give a strong recommendation using presumptive, not participatory, language, such as “I see it’s time for your flu vaccine” rather than “Do you want a flu vaccine?”
2. Educate your patients on their risk from influenza and other preventable diseases, listen to their concerns, and have information available to answer their questions and concerns.
3. Use every visit as an opportunity to vaccinate, and give multiple vaccines at once when it’s appropriate.
4. Use standing orders and reminders, including in your EHR system, to know when patients are due for vaccination.