ACIP: Updated Vaccine Guidance for the 2021-2022 Influenza Season

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices has issued new guidelines for the prevention and control of seasonal influenza with vaccines for the 2021-2022 season. In general, routine annual vaccination is recommended for all patients 6 months of age and older who have no contraindications and should be completed by the end of October.

As the influenza season will coincide with the ongoing COVID-19 pandemic, influenza vaccination will help reduce the prevalence of influenza illness and can reduce symptoms that might be confused with COVID-19.  Vaccination may also help prevent outbreaks that may further strain the healthcare system.

For the 2021–2022 season, all influenza vaccines are expected to be quadrivalent.

Egg-based influenza vaccines:

• Will contain hemagglutinin derived from an influenza A/Victoria/2570/2019 (H1N1)pdm09-like virus, an influenza A/Cambodia/e0826360/2020 (H3N2)-like virus, an influenza B/Washington/02/2019 (Victoria lineage)-like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus.
• These include Afluria Quadrivalent, Fluarix Quadrivalent, FluLaval Quadrivalent, Fluzone Quadrivalent (all standard dose), Fluzone High-Dose Quadrivalent (high-dose formulation), Fluad Quadrivalent (standard dose with MF59 adjuvant), and FluMist Quadrivalent intranasal spray.

Cell culture-based inactivated and recombinant influenza vaccines:

• Will contain hemagglutinin derived from an influenza A/Wisconsin/588/2019 (H1N1)pdm09-like virus, an influenza A/Cambodia/e0826360/2020 (H3N2)-like virus, an influenza B/Washington/02/2019 (Victoria lineage)-like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus.
• These include Flucelvax Quadrivalent (standard dose cell culture-based) and Flublok Quadrivalent (recombinant).

Updates to the guidance for this upcoming influenza season include the following:

• The Food and Drug Administration approved the use of Flucelvax Quadrivalent (cell culture-based quadrivalent inactivated influenza vaccine) for children aged 2 through less than 4 years old.
• Current guidance indicates that COVID-19 vaccines can be coadministered with other vaccines including influenza vaccines. Clinical considerations regarding COVID-19 vaccination should be periodically reviewed for updated information.
• Recommendations on the timing of influenza vaccination have been updated:
  • Vaccination soon after vaccine is available should be considered for women in the third trimester of pregnancy.
  • Children who need 2 doses of influenza vaccine administered at least 4 weeks apart should receive the first dose as soon as possible to allow for the second dose to be received by the end of October.  
  • Early vaccination (July, August) should be avoided in nonpregnant adults unless there is concern that later vaccination might not be possible.
• For persons with a history of severe allergic reactions (eg, anaphylaxis) to influenza vaccine:
  • Use caution when administering cell culture-based inactivated influenza vaccine to patients with previous severe allergic reaction to egg-based influenza vaccine, live attenuated influenza vaccine, or recombinant influenza vaccine.
  • Use caution when administering recombinant influenza vaccine to patients with previous severe allergic reactions to egg-based influenza vaccine, cell culture-based inactivated influenza vaccine, or live attenuated influenza vaccine.
  • In these instances, administration should be done in an inpatient or outpatient medical setting under supervision of a provider who can recognize and manage a severe allergic reaction; allergist consult may also be beneficial.
  • For patients who have had severe allergic reactions to cell culture-based inactivated influenza vaccine or recombinant influenza vaccine or to components within the vaccine, there is a contraindication for future use.

The full report, which includes guidance for influenza vaccination of specific populations (eg, children, pregnant women, older patients, immunocompromised individuals), and situations (eg, history of Guillain-Barré Syndrome, egg allergy) can be found here.

Reference

Grohskopf LA, Alyanak E, Ferdinands JM, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021-22 influenza season. MMWR Recomm Rep. Published August 27, 2021. https://www.cdc.gov/mmwr/volumes/70/rr/rr7005a1.htm.