Influenza Vaccine Advisory for Healthcare Providers

ACIP Recommendations for Influenza Vaccine for the 2019-20 Season

Posted September 30, 2019. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.

Routine annual influenza vaccination of all persons 6 months of age and older without contraindications continues to be recommended; however, some changes to the recommendations from the Advisory Committee on Immunization Practices (ACIP) have occurred for the 2019-20 influenza season. Influenza vaccine is now readily available in the Spokane community. 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.

Vaccine viruses included in the 2018-19 U.S. trivalent influenza vaccines will contain hemagglutinin (HA) derived from an A/Brisbane/02/2018 (H1N1)pdm09-like virus, an A/Kansas/14/2017 (H3N2)-like virus, and a B/Colorado/06/2017-like virus (Victoria lineage). Quadrivalent influenza vaccines will contain HA derived from these three viruses, and a B/Phuket/3073/2013-like virus (Yamagata lineage). This composition includes updates in the influenza A(H1N1)pdm09 and influenza A(H3N2) components of the vaccine. All pediatric vaccines will be quadrivalent vaccines.

Vaccination should be offered by the end of October; however, vaccination should continue to be offered as long as influenza viruses are circulating and unexpired vaccine is available. Children aged 6 months through 8 years who require two doses should receive their first dose as soon as possible after vaccine becomes available, and the second dose ≥4 weeks later.

Recent regulatory changes have occurred in two different influenza vaccine products.

  • In October 2018, FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥5 years, Afluria Quadrivalent (IIV4) is now licensed for persons aged ≥6 months. The dose volume is 0.25 mL per dose (containing 7.5 µg of HA per vaccine virus) for children aged 6 through 35 months and 0.5 mL per dose (containing 15 µg of HA per vaccine virus) for all persons aged ≥36 months (≥3 years).
  • In January 2019, FDA approved a change in dose volume for Fluzone Quadrivalent (IIV4). Previously, the dose volume for children aged 6 through 35 months was 0.25 mL (containing 7.5 µg of HA per vaccine virus). Children aged 6 through 35 months who receive Fluzone Quadrivalent may now receive either 0.25 mL (containing 7.5 µg of HA per vaccine virus) or 0.5 mL (containing 15 µg of HA per vaccine virus) per dose. Children aged ≥36 months (≥3 years) and adults should receive 0.5 mL per dose.

The use of LAIV4 (Live Attenuated Influenza Vaccine; FluMist®, or the “nasal spray”) is approved by ACIP as an option for those for whom it is appropriate. Following two seasons (2016-17 and 2017-18) during which ACIP recommended that LAIV4 not be used, vaccination providers now may choose to administer any licensed, age-appropriate influenza vaccine (IIV [Inactivated Influenza Vaccine], RIV4 [Recombinant Influenza Vaccine], or LAIV4). The Centers for Disease Control and Prevention (CDC), the ACIP, and the American Academy of Pediatrics (AAP) make no preferential recommendation between LAIV4 and the other injectable influenza vaccines available.

LAIV4 is contraindicated in:

  • persons with a history of severe allergic reaction to any component of the vaccine or to a previous dose of any influenza vaccine;
  • children and adolescents receiving concomitant aspirin or salicylate-containing medications;
  • children aged 2 through 4 years who have received a diagnosis of asthma or whose parents or caregivers report that a healthcare provider has told them during the preceding 12 months that their child had wheezing or asthma or whose medical record indicates a wheezing episode has occurred during the preceding 12 months;
  • persons who are immunocompromised due to any cause;
  • close contacts and caregivers of severely immunosuppressed persons who require a protected environment;
  • pregnant women; and
  • persons who have received influenza antiviral medications within the previous 48 hours.

Recommendations for influenza vaccination of persons with egg allergy remain the same as the previous recent influenza seasons (all children with egg allergy can receive an influenza vaccine).

Most influenza vaccines are manufactured using egg-based technology. Because of this, they contain a small amount of egg proteins. However, studies that have examined the use of flu vaccine in egg-allergic and non-egg-allergic patients indicate that severe allergic reactions in people with egg allergies are unlikely (1.31 per one million vaccine doses given).

People with egg allergies no longer need to be observed for an allergic reaction for 30 minutes after receiving a flu vaccine. People with a history of egg allergy of any severity should receive any licensed, recommended, and age-appropriate flu vaccine. Persons who report having had reactions to egg involving symptoms other than hives, such as angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention, may similarly receive any licensed, recommended and age-appropriate influenza vaccine that is otherwise appropriate for the recipient’s health status. The selected vaccine should be administered in an inpatient or outpatient medical setting. Vaccine administration should be supervised by a healthcare provider who is able to recognize and manage severe allergic conditions.

A previous severe allergic reaction to influenza vaccine, regardless of the component suspected of being responsible for the reaction, is a contraindication to future receipt of the vaccine. For more information, go to:

Complete recommendations and information from the ACIP for the 2019-20 season can be found here, including groups recommended for vaccination, guidance for use in specific situations, administration/storage/handling, adverse event reporting, and a complete list of products available for this season:

Complete recommendations and information from the AAP on Recommendations for Prevention and Control of Influenza in Children for the upcoming influenza season:

CDC Toolkit for Health Professionals: Prepare to Fight Flu

The CDC’s seasonal flu vaccination campaign materials are available to assist health professionals in communicating about the importance of vaccination. This digital toolkit includes details on events/activities, sample social media and newsletter content, graphics, web assets, and media prep material. This material is downloadable, shareable, and some of the material is customizable.

Below are resources included in the Healthcare Provider Fight Flu toolkit:

Upcoming Educational Opportunities

CDC Clinician Outreach and Communication Activity (COCA) Call: 2019-2020 Recommendations for Influenza Prevention and Treatment in Children: An Update for Pediatric Providers (  

Date: Thursday, September 26, 2019 at 11 am – 12 pm Pacific

Influenza remains a serious threat to children due to its potential to cause significant morbidity and mortality. More than 125 influenza-associated deaths in children were reported to the Centers for Disease Control and Prevention (CDC) during the 2018–2019 influenza season. Clinicians play a critical role in taking action to immunize children, the children’s family members and caregivers, and themselves. The early use of antivirals in children can reduce the duration of symptoms and prevent serious complications of influenza. However, immunization remains the most effective way to prevent influenza illness and its complications, including death.

During this COCA call, subject matter experts from the American Academy of Pediatrics (AAP) and CDC will discuss strategies pediatric providers can use to improve influenza prevention and control in children for the 2019–2020 influenza season.

Continuing education credits available.