Health Advisory: Influenza Updates for Providers

Published Aug. 27, 2020

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On Aug. 21, CDC released recommendations for immunization practices of seasonal influenza during the 2020-2021 season. Given the concurrent COVID-19 pandemic, widespread use of Influenza vaccine is more important than ever.. In addition to preventing illness, complications, and mortality from influenza, reducing overall hospitalizations, assuring widespread influenza vaccination will help maintain hospital capacity, and will help reduce school, work, and social disruption. Also, be sure that your patients are up to date or have received appropriate pneumococcal vaccination to reduce the risk of complications from influenza

Changes to the components of the 2020-2021 influenza vaccine:

  • Egg-based H1N1 vaccine component updated to an A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus.
  • Cell- or recombinant-based H1N1 vaccine component updated to an A/Hawaii/70/2019 (H1N1)pdm09-like virus.
  • Egg-based H3N2 vaccine component updated to an A/Hong Kong/2671/2019 (H3N2)-like virus.
  • Cell- or recombinant-based H3N2 vaccine component updated to an A/Hong Kong/45/2019 (H3N2)-like virus.
  • B/Victoria lineage vaccine component updated to a B/Washington/02/2019 (B/Victoria lineage)-like virus.
  • High-dose vaccine and adjuvanted vaccine will be available in quadrivalent formulations (HD-IIV4 and aIIV4) this year. High-dose vaccine will not be available in trivalent formulation.

It is best to vaccinate as soon as the vaccine is available, prior to influenza activity in the community. Give influenza vaccine throughout the season. Never miss an opportunity to vaccinate.

Groups recommended for vaccination

CDC recommends influenza vaccine for all people 6 months or older. Encourage people at higher risk for complications to get vaccinated:

  • Children under age 5 (especially those under age 2).
  • People age 50 and older.
  • Pregnant people.
  • People with diabetes, asthma, heart disease, morbid obesity or other chronic health conditions.
  • People with immunosuppression.
  • Children on long-term aspirin therapy.
  • American Indians/Alaska Natives.
  • People with extreme obesity (BMI> 40).
  • Caregivers and household contacts of those at higher risk for complications.

Guidance for specific populations

People who have experienced severe respiratory symptoms after exposure to egg may receive any licensed, recommended, age-appropriate influenza vaccine. If given a vaccine other than a culture- or recombinant-based vaccine, they should be supervised by a healthcare provider who is able to recognize and manage severe allergic reactions. Guidance for other specific populations can be found here.

Vaccinating people with COVID-19

  • To avoid exposing healthcare personnel to COVID-19, defer vaccinating people with suspected or confirmed COVID-19—regardless of whether they have symptoms—until they meet criteria to discontinue isolation.
  • If vaccination is deferred, remind patients to return for vaccination once recovered from COVID-19.

Vaccination timing

  • Administer vaccine by the end of October. Continue to offer vaccination as long as influenza viruses are circulating locally, and unexpired vaccine is available.
  • Vaccinating too early in the season (i.,e., July or August) may lead to suboptimal immunity later in the season, particularly among older adults.
  • Delaying vaccination might result in greater immunity later in the season—but might also result in missed opportunities to vaccinate and difficulties vaccinating a population within a more constrained period.

Additional resources

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