Recommendations for the 2018–19 influenza season from the Advisory Committee on Immunization Practices (ACIP) offer new guidance for the use of intranasal vaccine and for the vaccination of egg-allergic individuals.
This year's trivalent vaccines are based on two influenza A strains and one B strain; quadrivalent vaccines include a second B strain. Most vaccines are made from inactivated influenza viruses; one brand is made via recombinant DNA technology (Flublok Quadrivalent). The intranasal vaccine (FluMist Quadrivalent) uses live attenuated viruses.
For the past two seasons, the ACIP recommended against the use of live attenuated influenza vaccine because of questions about the effectiveness of its H1N1 component. Data on the new quadrivalent FluMist suggest that the current H1N1 component will perform better, so FluMist is now recommended for people two years through 49 years of age.
Flu vaccination is recommended for everyone six months of age and older (unless contraindicated). Two brands are available for infants, while others are approved only for children older than two, three, four, or five years of age. For older adults, the single high-dose vaccine, Fluzone High-Dose, may be more effective than standard-dose vaccines; it is approved only for people ages 65 and older.
Individuals who develop hives on exposure to eggs can nevertheless receive any influenza vaccine that is recommended for their age group, according to the ACIP. Those who have experienced angioedema, respiratory distress, or recurrent emesis after exposure to eggs can be vaccinated in a medical setting where staff is prepared to manage severe reactions.
The ACIP recommendations can be found at www.cdc.gov/mmwr/volumes/67/rr/rr6703a1.htm.—Betsy Todd, MPH, RN, AJN clinical editor