Influenza Vaccine Recommendations: Type and Timing
For adults aged ≥65 years, preferentially administer any one of the following higher dose or adjuvanted influenza vaccines: quadrivalent high-dose inactivated influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4). 1
General Recommendations
- All persons aged ≥6 months who do not have contraindications should receive routine annual influenza vaccination 1
- For each recipient, a licensed and age-appropriate vaccine should be used 1
- All seasonal influenza vaccines expected to be available in the United States are quadrivalent, containing hemagglutinin (HA) derived from one influenza A(H1N1)pdm09 virus, one influenza A(H3N2) virus, one influenza B/Victoria lineage virus, and one influenza B/Yamagata lineage virus 1
Timing of Vaccination
- For most persons who need only 1 dose of influenza vaccine for the season, vaccination should ideally be offered during September or October 1
- Vaccination should continue after October and throughout the season as long as influenza viruses are circulating and unexpired vaccine is available 1
- For adults aged ≥65 years and pregnant persons in the first or second trimester: Avoid vaccination during July and August unless there is concern that vaccination later in the season might not be possible 1
- Children aged 6 months through 8 years who require 2 doses should receive the first dose as soon as possible after vaccine is available, including during July and August 1
Vaccine Selection by Age Group
Children aged 6 months through 35 months
- Appropriate dose volumes differ by product 1:
Children aged 36 months through 17 years
- All IIV4s are administered at 0.5 mL per dose 1
- Children aged 6 months through 8 years receiving influenza vaccine for the first time or who have not received a total of ≥2 doses before July 1,2022, require 2 doses separated by at least 4 weeks 1, 2
Adults aged 18 through 64 years
- Standard-dose IIV4s, RIV4, or LAIV4 (if no contraindications) at 0.5 mL per dose 1
Adults aged ≥65 years
- Preferentially receive any one of the following 1:
- If none of these three vaccines is available, any other age-appropriate influenza vaccine should be used 1
Special Considerations
Children requiring 2 doses
- Children aged 6 months through 8 years require 2 doses of influenza vaccine (separated by at least 4 weeks) if they 1, 2:
- Have never received influenza vaccine before
- Have not received a total of ≥2 doses of influenza vaccine before July 1,2022
Post-influenza infection vaccination
- There is no required waiting period after influenza infection before administering the vaccine, only that the child has clinically recovered from the acute illness 2
- Any age-appropriate influenza vaccine formulation can be used after recent infection 2
Co-administration with other vaccines
- Co-administration of influenza vaccines with pneumococcal and/or COVID-19 vaccines is associated with lower risk of hospitalization and mortality 3
Route of Administration
- IIV4s are administered intramuscularly (IM) 1
- For adults and older children, the deltoid muscle is the preferred site 1
- Infants and younger children should be vaccinated in the anterolateral thigh 1
- LAIV4 is administered intranasally 1
Common Pitfalls to Avoid
- Delaying vaccination unnecessarily after recovery from influenza may leave individuals vulnerable during peak influenza season 2
- Using the wrong dose volume for children aged 6 through 35 months - check the specific product information 1
- Administering LAIV within 48 hours of antiviral medication use (contraindicated) 4
- Failing to recognize that children aged 6 months through 8 years may need two doses in their first vaccination season 1, 2
- Delaying the second dose of influenza vaccine beyond the recommended interval for children who require two doses 2