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).

AAFP Recommendations for the 2018-2019 Influenza Season 

The AAFP  recommends routine annual influenza vaccination for all persons six months and older without contraindications for this influenza season.

Preferential Statement
For the 2018-2019 influenza season, the AAFP recommends routine annual influenza vaccination for all persons age six months and older who do not have contraindications. The AAFP recommends Inactivated Influenza Vaccine (IIV) as preferred to Live Attenuated Influenza Vaccine (LAIV4) for nonpregnant persons 2-49 years of age. LAIV4 may still be used to vaccinate nonpregnant persons 2-49 years of age, who would not otherwise be vaccinated.

View New and Updated Information for 2018-2019 from the Centers for Disease Control and Prevention (CDC)»(www.cdc.gov)

Additional Recommendations

For Pregnant Women

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.
  • LAIV4 should not be given during pregnancy. 
  • 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.

For Health Care Personnel (HCP)

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)

For Persons with Egg Allergy

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. This includes, but is not limited to, hospitals, clinics, health departments, and physicians offices. Administration of the vaccine should be supervised by a clinician who is able to recognize and manage severe allergic reaction, per the ACIP’s recommendation for the flu vaccine and people with egg allergies(www.cdc.gov).

Primary Changes and Updates for the 2018-2019 Influenza Season

Routine annual influenza vaccination of all persons aged ≥6 months without contraindications continues to be recommended. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended, and appropriate product is available. Updated information and guidance in this report includes the following:

  • Vaccine viruses included in the 2018–19 U.S. trivalent influenza vaccines will be an A/Michigan/45/2015 (H1N1)pdm09–like virus, an A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus, and a B/Colorado/06/2017–like virus (Victoria lineage). Quadrivalent influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage).
  • Following two seasons (2016–17 and 2017–18) during which ACIP recommended that LAIV4 not be used, ACIP voted in February 2018 to recommend that for the 2018–19 season, vaccination providers may choose to administer any licensed, age-appropriate influenza vaccine (IIV, RIV4, or LAIV4). LAIV4 is an option for those for whom it is appropriate (Table 2). The AAFP has made a preferential recommendation for IIV over LAIV4.
  • Persons with a history of egg allergy of any severity may receive any licensed, recommended, and age-appropriate influenza vaccine (IIV, RIV4, or LAIV4). IIV and RIV4 have been previously recommended. Use of LAIV4 for persons with egg allergy was approved by ACIP in February 2016. Additional recommendations concerning vaccination of egg-allergic persons are discussed.
  • Two recent regulatory actions are described. In August 2017, FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for ages ≥18 years, Afluria Quadrivalent is now licensed for ages ≥5 years. In January 2018, FDA approved an expanded age indication for Fluarix Quadrivalent (IIV4). Previously licensed for persons aged ≥3 years, Fluarix Quadrivalent is now licensed for persons aged ≥6 months. Children aged 6 through 35 months may receive Fluarix 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 a third option for inactivated influenza vaccines for children aged 6 through 35 months, in addition to the previously available 0.5 mL per dose (containing 15 µg of HA per vaccine virus) presentation of FluLaval Quadrivalent (IIV4) and 0.25 mL per dose presentation (containing 7.5 µg of HA per vaccine virus) of Fluzone Quadrivalent (IIV4).