INFLUENZA VACCINES DURING THE CORONAVIRUS PANDEMIC

2022–2023 Influenza Vaccine Update

All persons aged 6 months of age and older are recommended for annual flu vaccination, with rare exceptions. It is important that everyone receive a flu vaccine that is appropriate for their age and health status (CDC, 2022t).

(For a link to more detailed information on approved flu vaccines for the 2022–2023 flu season, see “Resources” at the end of this course.)

FLU VACCINE OPTIONS

In June 2022, the Advisory Committee on Immunization Practices (ACIP) approved the following recommendations, which were then approved and published by the CDC (2022u):

  • ACIP recommends that adults ages ≥65 years preferentially receive one of the following influenza vaccines: quadrivalent high-dose inactivated influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4). If none of these three vaccines is available at an opportunity for vaccine administration, then any other age-appropriate influenza vaccine should be used.
  • PCV15 (15-valent pneumococcal conjugate vaccine) may be used as an option to PCV13 (13-valent pneumococcal conjugate vaccine) for children ages <19 years according to currently recommended PCV13 dosing and schedules.
  • MMR vaccine (Priorix, GSK) according to currently recommended schedules and off-label uses as an option to prevent measles, mumps, and rubella.

WHO SHOULD AND SHOULD NOT GET A FLU SHOT

Flu shots are appropriate for most people.

  • Different flu shots are approved for people of different ages. Everyone should get a vaccine that is appropriate for their age.
  • Standard-dose inactivated flu vaccines are approved for people as young as 6 months of age.
  • Some vaccines are only approved for adults. For example, the recombinant flu vaccine is approved for people ages 18 years and older, and the adjuvanted and high-dose inactivated vaccines are approved for people ages 65 years and older.
  • Pregnant people and people with certain chronic health conditions can get a flu shot.
  • People with egg allergy can get a flu shot.

People who should not receive a flu shot include:

  • Children younger than 6 months of age
  • People with severe, life-threatening allergies to any ingredient in that particular flu vaccine (other than egg proteins), such as gelatin, antibiotics, or other ingredients
  • People who have previously had a severe allergic reaction to a dose of that particular influenza vaccine
    (CDC, 2022t)

Individuals with one of the following conditions should consult their healthcare provider to determine whether vaccination is right for them and to select the best vaccine for their situation:

  • People with an allergy to eggs or any of the ingredients in the vaccine
  • People who have ever had Guillain-Barré syndrome
  • Those who have had a severe allergic reaction to a previous dose of any flu vaccine
  • Anyone who is not currently feeling well
    (CDC, 2022t)

WHO SHOULD AND SHOULD NOT GET A NASAL SPRAY FLU VACCINE

The nasal spray vaccine is approved for people ages 2–49 years. Many people in this age group can receive the nasal spray vaccine, including people with egg allergies (CDC, 2022t).

People who should not receive the nasal spray include:

  • Children younger than 2 years
  • Adults 50 years and older
  • People with a history of severe or life-threatening allergic reaction to any ingredient of the nasal spray vaccine (other than egg proteins) or to a previous dose of any flu vaccine
  • Children and adolescents ages 2–17 years who are receiving aspirin- or salicylate-containing medications
  • Children ages 2–4 years who have asthma or a history of wheezing in the past 12 months
  • Pregnant people
  • People with weakened immune systems (immunosuppression) from any cause
  • People who care for severely immunocompromised persons who require a protected environment (or otherwise avoid contact with those persons for 7 days after getting the nasal spray vaccine)
  • People with cerebrospinal fluid (CSF) leaks (communication and leakage of fluid between the space surrounding the brain and the nose, throat, ear, or any other place in the head)
  • People with cochlear implants
  • People who have recently taken influenza antiviral drugs (depending on the specific influenza antiviral medication that was taken and how recently the last dose was taken)
    (CDC, 2022t)

People who should consult their healthcare provider about getting a nasal spray vaccine include:

  • People with asthma who are ages 5 years and older
  • People with underlying medical conditions that put them at higher risk of serious flu complications (e.g., lung disease, heart disease [except isolated hypertension], kidney or liver disorders, neurologic/neuromuscular disorders, blood disorders, or metabolic disorders [like diabetes])
  • People with moderate or severe acute illness with or without fever
  • People with Guillain-BarrĂ© syndrome after a previous dose of influenza vaccine
    (CDC, 2022t)

FLU VACCINATION TIMING

September and October are generally good times to be vaccinated, and ideally, everyone should be vaccinated before the end of October. While flu activity may be low in the community early in the flu season, it could begin increasing at any time. After vaccination, the body takes about two weeks to develop antibodies that protect against flu (CDC, 2022v).

FLU VACCINATION OF PERSONS WITH SUSPECTED OR CONFIRMED COVID-19

Persons currently infected with COVID-19 should wait to be vaccinated until after the isolation period is concluded. This also applies to people who have been vaccinated but contract COVID-19 before receiving any additional or booster doses. People may, in consultation with their healthcare provider, consider delaying their next vaccine (primary dose or booster) by three months from when symptoms started or, if symptom-free, from when a positive test was recorded (CDC, 2022w).